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Group Health Insurance
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Census 2 - 50 employees or Create Profile
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With group health insurance, a single policy
covers the medical expenses of many different
people, instead of covering just one person.
Unlike individual insurance, where each person's
risk potential is evaluated to determine insurability,
all eligible people can be covered by a group
policy, regardless of age or physical condition.
The premium for group insurance is calculated
based on the characteristics of the group as
a whole, such as average age and degree of occupational
hazard.
How do you get group health insurance?
Find out whether you are eligible
Many employers offer group health insurance
as part of their employee benefits package.
Other groups that may offer insurance coverage
include churches, clubs, trade associations,
chambers of commerce, and special-interest groups.
Apply for coverage
Although your individual health is generally
not evaluated when you apply for group health
insurance, you must apply during the specified
eligibility period. For employer-sponsored health
insurance, this is often the first 30 days of
your employment, or the first 30 days following
your initial probationary period. For associational
insurance, this may be the first 30 days of
your membership in the group.
If you fail to enroll during this period, the
insurance company has the right to treat you
as though you were applying for individual insurance.
This means you will probably have to answer
extensive health questions, and go through a
physical examination. The insurance company
can then decide whether or not to insure you.
The purpose of the eligibility period is to
reduce insurance costs by preventing people
from waiting until after they discover a health
problem to sign up for coverage. Both employers
and associations may also have an open enrollment
period each year, during which you may sign
up for coverage, modify your existing coverage,
or add dependents to your coverage.
What are the benefits of group coverage?
You don't need a physical exam
Under a group health insurance arrangement,
the insurance company agrees to insure all members
of the group, regardless of current physical
condition or health history. The only condition
is that the group members must apply for insurance
within the specified eligibility period. Clearly,
this is better for those with chronic health
conditions, who might be unable to get individual
insurance.
It's cheaper than individual insurance
Because only one policy is issued for the entire
group, the initial cost of establishing group
coverage is lower than the cost of issuing a
separate policy to each person. Also, group
insurance is somewhat less risky for insurers
than individual insurance, since the risk is
spread out among a larger number of people.
Within a fairly large group, it is almost certain
that the good insurance risks will equal or
exceed the bad insurance risks. Since group
insurance costs less for the insurance companies
to establish and administer, it generally costs
less to purchase.
You might get a break on premiums
In many cases, your employer or association
will pick up some or all of the group insurance
premium. This can make group insurance even
more affordable.
What are the drawbacks to group coverage?
You can't customize your policy. In a group
insurance situation, the provisions of the policy
are negotiated between the insurer and master
policyowner (usually an employer or association).
You may not have the freedom to have provisions
included or excluded, and your deductible amount
and co-payment percentage are determined in
advance. In some situations, however, you may
be able to choose between two or more insurance
plans.
Please Note: The information contained in this
Web site is provided solely as a source of general
information and resource. It is a not a statement
of contract and coverage may not apply in all
areas or circumstances. For a complete description
of coverages, always read the insurance policy,
including all endorsements
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