The FAQ’s About Group Health Coverage

Health care continues to be a hot topic in print media and online, and rightly so. After all, it’s not a question of whether or not we need health care; the question is a matter of when we’ll need health care. Ominously, health care costs continue to rise, so having health coverage is more important than ever. Call it a hedge against the inevitable.

By far, the best way to handle your health insurance needs if you’re employed is by means of group health insurance. According to the Healthplans Group Health Insurance FAQ, “Group health insurance is a health program provided by an employer or trade group or organization, purchased from a health insurance provider by the business owner or group.” Here’s a list of some of the more prevalent questions that employees have about their group health insurance.

The FAQ's About Group Health Coverage

Group health insurance is your best bet for coverage that won’t break your budget.

How much do Employers kick in for Health Insurance?

Employers typically contribute somewhere between one fourth and half of an employee’s monthly premium for a qualifying group health insurance plan. The exact amount depends on the state, policy, and insurance carrier.

Can an Employer change Insurance carriers and levels of benefits whenever they want?

Yes, they can make health plan changes at any time. Most of the time, you’ll be notified about changes during open enrollment, but really, your employer can make changes anytime.

What’s a Group Health Insurance Open Enrollment?

This is a period of time, typically ranging from 30-60 days prior to the health insurance benefits renewal or the effective date of coverage, set aside for the purpose of educating employees on what group benefits are available and what changes have come about. This is the time to sign up for coverage or even change existing coverage.

What happens to My Group Health Insurance if I leave My Company?

You might be eligible for continued insurance protection under the Consolidated Omnibus Budget Reconciliation Act (COBRA) law, which could give you a minimum of 18 months of continued coverage.

What about if I’m still with the company, but the Group Coverage Ends? Am I Stuck?

No, you’re not. If your group coverage ended somehow, you are still able to apply for individual health coverage because of the Health Insurance Portability and Accountability Act (HIPAA). If you meet the qualifications, you are issued a policy on a guaranteed basis. Be careful though; there is no limit on the maximum premium that the insurance company can charge you.

What about Pre-existing Conditions? Can an Insurance Company turn Me Down?

Thanks to what’s popularly referred to as ObamaCare, as of January 1, 2014, most individual and group health plans must provide coverage to all applicants regardless of preexisting conditions. Furthermore, companies can’t charge women higher premiums than men.

I don’t like ObamaCare; I’d rather be insured under the Affordable Care Act.

They’re one and the same.

What’s the Deal with HMOs?

A Health Maintenance Organization plan is a group plan that offers a full range of medical services to members, who are assigned or can select a physician from a group of approved general practitioners. These physicians then refer their patients to specialists as the situations warrant. One commonly voiced drawback with an HMO is the limits on your choices of doctor.

I’m Self-employed. Can I still get a Group Health Insurance Plan?

There are a number of states that have “Group of One” policies that freelancers and sole proprietors can purchase. You may also get group insurance via your local chamber of commerce, or by checking with online insurance carriers.

To wrap it all up, just remember this: health care coverage is a crucial part of a good quality life while helping to budget for unexpected events. Make sure you do your research, particularly when your company holds open enrollment. Learn what your options are, know your rights, and you’ll be doing your part in keeping your health and that of your family safe.