Employee Group Health Benefits

Are you looking for Health Insurance for your group or business? Ankley Insurance Services can help you understand your options and find a plan that is right for your needs and your budget. Give us a call today!

What is Group Health Insurance?

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.

  • Copay is a set dollar amount the insured pays for a particular service, like a doctor office visit.
  • Coinsurance is a percentage of medical expenses.

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%.

Group Health Insurance

What to Know About Group Health Insurance

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.

  • Employer Waiting Period – This is the most common type of waiting period and refers to the time that a new employee must wait, usually 90 days, before he or she is eligible to begin utilizing health care services under the group plan. Employers implement this waiting period as a defense against individuals taking a job simply to use the health care benefits for a one-time incident and then leaving the company.
  • Pre-Existing Condition Exclusion Period – This waiting period is for those participants who have a pre-existing condition, and applies to the time period of six months immediately prior to applying for coverage. The waiting period varies at the discretion of the insurance company and can last anywhere from one to eighteen months. Coverage can be limited or excluded altogether for any pre-existing condition, again at the discretion of the insurance provider.

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.

Give Ankley Insurance Services a call today to find a health insurance solution that is best for your business!