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Frequently Asked Questions about Group Health Insurance

1) What is the difference between "Group" and "Individual" coverage?

Group policies may comprises of two families or more and need an employer to pay a minimum of 50% or the single person premium to qualify, whereas an individual policy can cover only one family or individual.

2) How does the insurance company decide on our group's premium?

Insurance company uses two methods to calculate your group health insurance premium: medical underwriting or community rating. These methods used depending on the rules and regulations on your state. Medical underwriting means each employee is considered separately, so that the overall health of each one in the group determines the final premium. For small employers, premiums could even go up if you have one employee with a history of chronic illness or any catastrophic illness.

3) What is a provider?

A provider is a hospital, healthcare facility, physician and other medical expert that provides healthcare services.

4) What are the insurance issues that need to be concerned with during divorce proceedings?

There are actually several issues. First of all, you required to decide who would be the owner of your various insurance policies. Secondly, if both your spouses and child(ren's) are covered under your group health plan, how would both be covered after divorce? Thirdly, consider what would happen to the income from the support order or alimony if the group health provider should die.

5) Why is ownership of the insurance policies vital?

The owner is a person who controls the policy and has the right to name further beneficiaries. For instance, your spouse might be the current owner of a health insurance policy that has you named them as the beneficiary. This means that your spouse can change the beneficiary at any time, differing to what is desired or needed.

6) If my child is in spouse's group health plan, what are my options after divorce?

Divorce is eligible event for benefits under COBRA, so named after the act of Congress, which created it. But, this is simply a temporary measure. Ask your attorney whether the divorce settlement could include a provision for health insurance as well, particularly if either spouse could offer it at a rational cost through group health coverage. Finally, you might require to buy additional health coverage to protect yourself and your child(ren).

7) Is there a federal law, which requires employers to offer health benefits?

No. Although state and federal laws control health plans, there is no federal law and no law in any state, which requires employers to provide health insurance benefits to employees. However, it's a familiar practice for employers to offer health benefits. In today's tight labor market, it's a prime way to draw and retain employees.

8) I'm self-employed. How can I find a health plan?

You should investigate several group health insurance options before you buy an individual plan. Some states also allow the self-employed to buy health insurance at group rates, as just a "group of one." One-person group premiums are notably lower than premiums on individual health insurance policies.

9) How could my company decide which diseases, treatments, and conditions to cover with our health plan?

Your state's laws direct which diseases and conditions should be covered by your health plan. Coverage for other diseases and conditions is elective, and whether you select to purchase it would depend on how much you're ready to spend and what coverage your employees require.

10) What is the typical waiting period before employees become qualified for a new employer's health plan?

According to a study by the Kaiser Family Foundation, "Employee Health Benefits 2000," the standard wait for health insurance coverage at small firms (between 3 and 199 workers) is 2.1 months. That's somewhat longer than the standard wait of 1.5 months across firms of all sizes.

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