Coventry Health Insurance of Georgia (GA) | Group Health Insurance | What Defines a Group in a Group Health Insurance Plan?

Group Health Insurance

What Defines a Group in a Group Health Insurance Plan?

Many people think an individual health insurance plans means you have to be just one person in order to purchase a policy. However, individual plans include plans for individuals, and their family members. It is differentiated from a group health insurance plan, which is what a business or company uses for all of its employees.

For example, a large company will negotiate and contract with a large group health insurance plan provider, such as Blue Cross Blue Shield or Coventry, to provide group health insurance Georgia policies for all of their employees. Then, each employee will individually enroll in the group health insurance plan. The employer may subsidize the monthly premium costs, as part of the compensation package. Sometimes, the employer will pay for the monthly premium for their full-time employees, and possibly the employee will be responsible for the additional premium costs related to their family members' enrollment in the group health insurance plan. Sometimes, however, the employer may subsidize the entire premium costs.

Although it is a huge benefit and perk of an employees' compensation and salary package to have the ability to enroll in a group health insurance plan, group health insurance plans are higher priced than an individual health insurance plan. So, if you have to pay for your premiums, or those of your family members, out of pocket, then you may not be getting a good deal. In fact, you may be better off doing some comparison shopping in order to find a better value, or lower priced health insurance plan. It is rare that an employer would require that you join the group health insurance plan that is offered through your work. Therefore, you have the freedom to shop around and choose your own plan. If your employer does pay for your portion, but not the premium for your family members, then you can enrolled in the group health insurance plan for yourself, and find a different lower cost individual health insurance plan for your family. This would be a wise use of money.

The reason group health insurance plans are higher priced is a legitimate one. Insurance companies determine the risks involved in its particular pool of members and then estimate what the cost to them will be based on the health and medical conditions of its enrolled members. For individual health insurance policies, insurance carriers will deny enrollment to those considered high risk. Therefore, they can keep premiums for individual health insurance policies low, because they are not accepting high risk members. However, for group health insurance plans, insurance carriers are not legally allowed to deny coverage to any qualified member, which is to say, any employee of the company they have contracted with. Therefore, because they will have higher risk enrolled members in the group health insurance plan, the premiums for everybody will be higher. If you are one of those individuals who may be denied for an individual health insurance policy, because of a chronic health condition, or other high risk factors, such as being overweight, smoking, or advanced age, then this condition of group health insurance plans works in your favor.

A group health insurance plan may be a good option for you, but do not forget to compare with individual health insurance policies.

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