To compare and calculate group health insurance plans involves getting your hands on the appropriate information from your employer and the companies issuing the plans. There are also government resources that might provide such information. There is a catch, however. Group health insurance plans begin with a shell of basic coverage which is then modified according to the needs and desires of the group offering it.
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Group plans are modified to the needs of the individual group. Therefore, any information you receive from a health insurance provider or a government source only gives you a general overview of what the plan usually provides. If you need specific details you’ll have to get them directly from the group offering the plan.
For most of us, the group offering the plan will be our employers. A trade organization is an option for group health insurance for self employed people. You might be able to get the information from a health insurance company, but that could be like pulling teeth if you can’t convince them you’re a member of the group.
How does group health differ from individual insurance?
The National Association of Health Underwriters defines group health insurance in terms of employer groups. Under this classification they explain that such health insurance is purchased by an employer for the benefit of all qualifying employees. Sometimes employer groups are large enough that they form their own unique group within the insurance company’s organization. Smaller businesses that don’t have enough employees to create their own group are often lumped together with others to make one large group.
While employer groups make up the largest percentage of group health plan users, there are other groups comprised of trade organizations, chamber of commerce members, college alumni associations, nonprofit groups, and so on. Any group of likeminded people with enough numbers and financial resources can procure a group health plan within reason. The benefit of doing so is the fact that group health insurance tends to be significantly less costly than individual insurance.
Individual health policies for insurance are simply what one person buys for himself and/or his family. Individual health insurance is very similar to buying a car- you simply go to a few dealers, ask some questions and maybe go for a test drive. Then choose the car you want. Individual health insurance works exactly the same way.
If my employer offers more than one choice, how do I compare the different plans?
It’s not uncommon for employers to offer multiple HMOs to choose from. Sometimes an employer will offer a choice between an HMO, PPO, and major medical insurance. To compare the different health plan options you have requires that you look at them in detail. Some of things you should look at include:
- types of health insurance coverage provided
- monthly health insurance premium
- health insurance deductible
- annual and lifetime health insurance coverage limits
It is often difficult for consumers to compare group health plans because there is so much paperwork and so many options. To make things easier the Minnesota Department of Health Checklist offers a free comparison checklist to help you wrap your head around your options. By going through each item and perusing the policy documents to see whether or not it’s covered, you can get fairly good idea of what you’re getting from each plan.
What if my employer only has one health care option?
The economics of business and insurance dictate that some small companies have only a single option for health insurance. In such a case you are certainly still free to compare different group policies by contacting individual insurance companies for information. However, you’re only going to get from your employer what the company offers. If you do find a better policy through a trade organization or a business group, you may have the opportunity to sign up with them if you have some sort of official involvement with the group.
Another thing to consider is that some companies offering only one option are actually self insured. This may be true even if an outside health insurance company is administering the plan. Companies who self insure often have plans that are entirely different from those offered by the company hired to administer them.
A company who self insures typically offers coverage for the things most common to its entire pool of workers. By not including extra coverage that wouldn’t normally be used, the insurance tends to be cheaper in the long run. However, it may not be as comprehensive in terms of major medical coverage.
Regardless of your options, it’s ultimately your responsibility to know what you’re getting in terms of health insurance. Take all the time you need to read documentation, ask questions, and compare multiple group plans with one another.
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