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Commercial Health Insurance

What is Group Insurance?

Group Insurance is a plan where individual employees are included under one ‘master policy’ that is owned by their employers. The policy usually provides coverage for more services at a much lower cost per participant. Labor unions, churches and other non- profit organizations may also obtain group insurance for members and possibly their dependents.

Group Insurance 

Individual members of a group insurance plan receive insurance cards that demonstrate their eligibility for benefits. If the master policy held by the employer requires participation in an HMO, then individuals are also registered as members. Some major medical policies may not restrict an individual’s choice of primary physician and specialists. HMO policies often require a patient to use a specified physician, but you may visit the link on HMO’s provided for more information.

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Financing for a group insurance policy is more often than not, a flexible payroll deduction, although some companies will pay the entire cost for the employee as a perk for working there. The cost of premiums sometimes will go up significantly without warning. If a few participants receive expensive treatments for serious medical conditions, the rest of the group may have to absorb the higher premium costs over time. Some participants may benefit from treatments for pre-existing conditions because group insurers don’t always require physical exams before issuing a master policy.

Group insurance benefits can change from company to company. Most policies cover emergency and routine medical procedures such as regular doctor’s appointments and hospital care for accidents. Many cover extended care in hospitals or rehabilitation centers. You will need to check to see if your group insurance covers the spouse or dependants. Some offer vision care or dental, but coverage may be limited to specific procedures. Mental health may also be covered under group insurance. Prescription drugs are often covered, but most likely with co-pay. Under a co-pay plan, the covered individual must pay an established price out-of-pocket for name brand and generic medications.

Group insurance is more affordable than a similar number of individual policies, but with a few drawbacks. With an HMO insurance plan, some members find their choices of physicians and treatments very limited Restricting the list of approved physicians happen even under major medical plans can often called the PMD (preferred medical doctor) policy. Employers who fear large increases in premiums may take an unusual interest in their employees’ private health issues and suddenly implement non-smoking policies or other measures that will ensure physical well being of their employees.

As a rule, Most group health policies contain a COB (Co-ordination of Benefits) provision. COB is for those employees that are covered by more than one health insurance plan. You may use both insurance policies for the same medical claim but one plan, usually the plan that places you as the primary card holder, will be your personal primary insurance. The secondary insurance will pick up the cost that your primary insurance company did not cover, in most instances.

• Injuries or loss of limbs
• Diseases like emphysema or carpal tunnel syndrome
• Injury inflicted at work
• Medical treatment
• Rehabilitation needed so workers can return to work
• Lost wages
• Death
• Liability insurance for the company for lawsuits filed by injured employees