What’s the Difference Between Individual, Family, Group and Health Insurance?

By: Kurt Stammberger


In general, group health insurance plans offer many advantages over individual health insurance. These include smaller premiums, better tax concessions, and extended coverage. Virtually all business owners can qualify for group health insurance.

Furthermore, because you represent a bigger chunk of business to the insurance carrier, you can usually negotiate terms and conditions quite a bit as a business owner. Hence it’s advisable to do your homework before you start negotiations. Some of the online insurance websites are quite good; they provide plenty of information for free. There are also a variety of free online calculators you can use that let you play around with various scenarios and see how it impacts your bottom line. You can also request free insurance quotes by filling out a simple form on a number of websites.

Insurance providers calculate group health insurance premiums based on many factors. Some important considerations are:
* Average age of employees
* Nature of work and occupational hazards
* History of illness amongst employees
* Coverage amount

Group health insurance plans cover normal as well as emergency medical treatment. The insuring company pays medical expenses, in part or in full. The actual amount paid to a healthcare provider depends on the type of policy you buy, but in general, more coverage will be more expensive.

Employees can often opt for additional coverage in an employer-provided group health insurance plan. Typically if an employee wants to extend the coverage to spouse, he can do so by agreeing to pay the additional payment.

In today’s group health insurance plans, the employer usually pays from 25% to 50% of the premium and the employee pays the rest, but there are some companies that pay 100% of the premium. Plans like fee for service, HMO, PPO, POS are all available to groups, though each employer will most likely pick a subset of these to offer to their employees.

AFFORDABLE HEALTH INSURANCE: INDIVIDUAL AND FAMILY

The popular adage - 'Health is wealth' is proving to be increasingly true as medical and hospitalization costs continue their seemingly relentless rise. If you can manage to stay healthy, you can save tens of thousands of dollars in lower insurance premiums and medical cost-avoidance. But that’s not always under our control. Thus, making the health insurance purchase decision is a critical one. With so many options, and so many stakeholders involved, choosing the right health insurance can be an extremely frustrating task.

While the fee-for-service type of managed care plan has been around for a while now, managed care plans are also very popular. Fee-for-service insurance requires you to pay a certain part of your medical expenses in advance and then submit the remainder of your medical bill to the insurer for reimbursement. While fee-for-service insurance gives you the freedom to visit health service provider or hospitals of your choice, the downside is that you may have to file claims, track payments and end up paying higher out-of-pocket costs.

Managed care plans necessitate an agreement between the insurer and a network of selected healthcare providers who must meet certain quality standards. Managed care plan policyholders are offered financial incentives to use the services of (only) the healthcare providers in the network. Health Maintenance Organizations (HMO) and Preferred Provider Organizations (PPO) are the two types of managed care plans. A HMO is a prepaid health plan wherein you pay a monthly premium. While costs may be low, the HMO decides which healthcare provider you’re allowed to visit at each stage in your treatment. By contrast, a PPO allows you to choose your healthcare provider… but if you choose one outside of the PPO network, your out-of-pocket costs will be higher.

It’s important to remember that you always have full control of the insurance policy you buy. While it’s difficult to negotiate (as an individual) on specific plan points with carriers, there are an incredible diversity of plans available out there, and you should never be afraid to “vote with your feet” if you find a better deal.

SMALL GROUP HEALTH INSURANCE

Employers attract employees by offering them attractive incentives and benefits, and one of the most valued benefits is a comprehensive health insurance plan that fulfils most medical expenses of the employee (and his or her immediate family) at a low cost.

Most plans stipulate that any employer with between 2 and 50 employees is eligible for Small Group Health Insurance. When you contact a broker or insurance provider, you’ll be asked to provide birth, age, and medical details of each employee, including any pre-existing medical conditions amongst them. While it’s illegal in most states for insurers to deny to insure groups because of pre-existing conditions, such medical problems might make your rate-quote higher than it otherwise would be.

Depending on the size of your company and your financial constraints, you might choose to pay between 75 to 80 % (also called co-payment) of the premium… or the entire amount. It’s really up to you, as an employer, to decide what’s fair for your existing staff and attractive to prospective employees. If the employee chooses to include a dependent under the group coverage it is not compulsory for you to pay premium for the dependant. When you avail yourself of a Small Group Health Insurance, you are automatically entitled for yearly renewals. Employees pay a standard deductible before receiving insurance benefits paid by the employer. The deductibles usually range between $200 and $2,000. As a rule, the higher the deductible, the lower the monthly premium.

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Kurt Stammberger is VP, Marketing at Healthia Inc. Healthia provides integrated comparison-shopping information on health insurance products and services, doctors and health insurance plans to empower the drive towards Consumer-Driven Health Care.

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