Group health insurance

After many years of experiment and development of health care and coverage, the health care system of the United States has not been able to solve a very basic but essential challenge: providing quality health care to every American in the US at a price that they can be afforded. Most people do not recognize that health insurance is provided differently for different types of employers. And because health care insurance is regulated by the state, the laws greatly vary from one state to another. Reports state that over 60% of the population in the United States has health insurance that has been provided through an employer-sponsored health insurance group plan. Within this percent, often times a spouse or children are also included on the policy, whether the company pays for their coverage or not.

Millions of people in America work for smaller employers. For health insurance purposes, this means a company with 50 or less employees. There are millions of other people who receive their health care coverage through large companies; these are companies that have more than 50 employees working for them. The laws pertaining to the coverage that can be provided by large groups is different than what can be provided by smaller groups. The determination of premium rates is also different between for the two groups.

Group health insurance is a policy that an employer purchases and offers it to eligible employees of that company as one of their benefits included in the job position. Many times the employee’s family members are offered the coverage as well. Most of Americans today have group health insurance coverage with their employer or with the employer of a member in their family.

There is no federal or even state law that requires private employers to provide health benefits to their employees. Many times employers will offer coverage as a particular way to draw in or keep employees working with the company. When a group health plan is offered by a company, it may be subjected to many state orders regarding the benefits that are included, unless the employer happens to be self-insured. Being self-insured simply means that the company pays the costs of claims itself and not the insurance company.

Some states will vary, but by state law, health benefits are somewhat different for group plans than individual plans. Most individual plans will not include maternity coverage, but most group plans do. Mental health is typically not covered very well on in individual plan, but with most group plans, these benefits are treated just like any other type of illness. Most group plans cover pre-existing conditions as soon as someone is added on to a plan and without a waiting period. By law, an employer is required to pay at least half of an employee’s monthly premium, and not required to pay for a spouse or children.

We’d like to thank Mr Mark Paton on this great article.