California Group Health Insurance
What’s Group Health Insurance?
- Group health insurance is provided to a group of people by an employer or through an organization, such as a university, professional or trade union, AARP, VA, and so on.
- Group health insurance may be selected for only the group member, or subscriber, or for the member and his or her spouse and dependent children.
Who Pays for Medical Costs?
Generally, the employer pays part of the cost of insurance, allowing employees to have lower insurance premiums for substantial insurance coverages. The remaining cost of the health insurance is spread out among employees. For organizations, the members of the group share the cost of insurance.
Your financial responsibility for health care visits and prescriptions depends on the plan. And you need to consider if the savings you gain from having a group plan rather than an individual plan are worth the coverage choices you cannot make with a group plan.
Who Selects the Plan?
The company or organization buying group insurance for its members generally decides upon one or more plans from which members can select, and various options that may increase or decrease the members’ costs. The group may also provide the option for members to select dental insurance and/or vision insurance.
If you are eligible for group health insurance through your employer, your employer will provide information describing the coverages and choices you may select. Carefully consider the options to make sure that you are choosing the best coverage allowed for your particular circumstances.
What Rules Govern Group Plans?
To keep insurance affordable, most group plans are managed care plans in which you receive medical treatment from a network of health care providers at doctors’ offices, hospitals, and/or clinics within the plan. The premium for these plans is usually lower and you pay less for copayments and coinsurance. A group plan may require you to utilize only certain physicians and facilities, select a primary care physician, seek a second opinion on referrals, provide notification for out-of-state services, and so on. The exact rules and regulations depend on the type of plan.
The most common managed care plans are HMO’s, PPO’s, and POS plans.
When You Add Children
If you have children when you enroll in the plan, you can elect to have them covered as soon as your plan beings. If you do not make that choice, you may have to wait for an “open enrollment” period at the company in order to enroll your children; this could risk their being uninsured for a certain time.
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