Group insurance refers to a special kind of health care insurance plan in which individual employees or a group of employee is covered under one ‘master policy’. The employer purchases such kind of group insurance for his employees. The best part of the group insurance plan is that, it has so many contributors and as a result, it offers coverage for more than one service at a much lower cost of premium. Apart from the “from-profit” organizations, non-profit organization, labor unions, churches and other service groups can also get group insurance policy in order to make their employees covered from any sort of unforeseen health hazards, which may incur heavy expenses.
Each member under the group insurance scheme receives insurance certificates, which demonstrate their eligibility for receiving benefits. In this case, often the employer, who has to be a part of an HMO (health maintenance organization), holds the master policy. Similarly, the individuals (his employees) are also registered as members of the organization. There are many group insurance policies, which are associated with major medical groups such as Blue Cross or Blue Shield. According to the terms and conditions, laid by a medical policy, it may or may not restrict an individual’s choice of primary physician and specialists. However, HMO policies are a bit different, which often require a patient to use a specified physician, who is entitled to approve any visits to any eligible specialists, if required.
When it comes to financing for a group insurance policy, it is a flexible payroll deduction. However, there are some companies, which will bear the total cost of the policy as a benefit for employees. But, the problem crops up with many insurance policies, when their cost of premiums rise up significantly without any prior notification or warning. The problem is that, if a few participants of the group receive expensive treatments for serious medical conditions, the rest members of the group, has to bear the higher premium costs over time, although they are not having such treatments. To enjoy the benefits of group insurance policy, the insurance providers will ask for the physical exams before issuing a master policy. The most beneficial part of such physical tests is that, participants, having serious illness can be covered from treatments for pre-existing conditions.
Group insurance benefits can vary widely from company to company. Typically, most of the policies cover basic emergency and routine medical procedures such as regular doctor’s appointments and hospital treatment for accidents. The difference between the coverage is made when any plan offers extended care in hospitals or rehabilitation centers.
Group insurance may or may not cover the employee’s spouse or dependents, while some policy plans offer assistance for vision care or dental work; but in this case, the policy coverage will be limited to specific procedures. Some policies also cover mental health needs under group insurance. Prescription drug expenses fall under group insurance benefits, but it will come with a co-pay provision. Under a co-pay plan, the individual enjoying the policy should be entitled to pay an established price for name brand and generic medications.