Group Policies

Health insurance is a problem for nearly everyone. Many people don’t have it, and many of those that do still have trouble affording it. There hasn’t been a definitive resolution to this problem by the federal government, medical practitioners, or the health insurance industry, so you may decide to purchase an Individual Health Policy or participate in a Group Policy.

Of the two options, a Group Policy sometimes offers better coverage, because the carrier can’t refuse to write the group or waiver coverage, and has a pricing range for the group. Some employers don’t offer Group insurance, yet with today’s programs from some carriers, a “group” can be as few as two people.

An employer that doesn’t offer a Group Policy may still arrange for each individual to have their own Individual Health Policy, which the employee would own. The policy is medically written by the carrier for that individual employee, and the carrier has the option of excluding any pre-existing medical conditions.

Individual Health Policy: This policy can be written for full-coverage or catastrophic coverage only. Both policies are medically written by the insurance carrier, and the carrier has the option to exclude coverage for any pre-existing condition you may have.

Full-Coverage Policy: This policy covers full medical benefits such as hospitalization, doctors visits, prescription benefits, and other medical expenses once the deductible has been met.

Catastrophic coverage: This policy only covers medical expenses during hospitalization once the deductible has been met.

With an Individual Health Policy, the employee may not receive the exact coverage they need, which is why a Group Policy is the best option.

Group Policy: This is a policy provided by the employer. In most cases the employer will pay part (sometimes all) of the premium for the individual employee, and the individual is responsible for dependent premiums. This policy will ask medical questions of each employee, but there won’t be any coverage exclusions for pre-existing conditions if the individual has prior insurance coverage. The carrier has to write coverage for the whole group or no one at all.

There are three different types of Group Policies:

  • Full-Coverage Policy through a Health Maintenance Organization (HMO) or Preferred Provider Organization (PPO)
  • Catastrophic Plan
  • Health Savings Account (HSA)

Health Savings Account (HSA): This allows the employee to set aside a portion of his/her income – tax-free – in an interest-earning savings account. The monies will help pay expenses up to his/her deductible; then the carrier pays 100%. This gives the individual some control over their health expenses. Unlike a Flexible Savings Account offered under a Cafeteria Plan (use it or lose it), the monies in the HSA will roll over year to year.

Cafeteria Plan: This is a plan that allows the employer to provide a variety of miscellaneous coverages under one package, which may or may not include Flexible Spending Accounts, Short-Term Disability, Long-Term Disability, etc. It may or may not be offered with a Group Policy.

Other Available Policies:

  • Short-Term Disability
  • Long-Term Disability
  • Dental
  • Vision
  • Cancer
  • Travel

Please contact us for more information.