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Group Health Insurance is an insurance plan that provides coverage to a specific group of people, typically employees working for the same employer. There is usually no variation in the details of the plan(s) offered to the group, as they are usually the same for each participant. With group health insurance plans, the employer often chooses the specific plan(s) that the participants will use and in most cases also pays a percentage of the premium. Every plan includes a schedule of benefits, which describes the details of what is financially covered for medical expenses should the participant or any of his or her dependents need to utilize the plan. There is often a Deductible, which is the fixed amount that the participant is required to pay for before the insurance company pays for most covered benefits. Once the deductible has been paid the insurance company and insured share in costs in terms of copays and coinsurance.
The most common coinsurance is 80/20; the carrier pays for 80% of the medical costs and the insured pays the 20%. Coinsurance has a specified maximum amount that the insured is responsible for; for example the coinsurance may be $3500. Once the member’s 20% payment toward covered medical expenses reaches $3500, then, the insurance would cover all further covered expenses at 100%.
One important element of group health insurance in America is the Health Insurance Portability and Accountability Act. HIPPA is a regulatory policy that protects employees by requiring that all employees are offered coverage by their employer’s health insurance plan without a health examination mandate and regardless of the status of their health. HIPAA also regulates the waiting periods associated with certain health care plans. The waiting period is a specified period of time that is required to pass before the coverage of a health care plan can commence. But there are different kinds of waiting periods for different kinds of insurance plans. The two most common types of waiting periods are employer, affiliation, and pre-existing condition exclusion waiting periods.
Employers are not legally obligated to provide health insurance to their employees, but very few people will work for an employer who does not offer this very valuable and often necessary benefit, which is why employers tend to make it a staple of their compensation packages.
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