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Group Health Information

What is group health insurance?

Group health insurance is a single policy issued to a group of people, offering uniform healthcare benefits to all members. In most cases, these policies are purchased by employers and offered to eligible employees and their families as part of an employee benefits package. Enrolling in group health insurance generally costs participants less than what they would pay for an individual healthcare policy for two main reasons:

  1. The risk is spread over the whole group, as opposed to just one individual.
  2. Many employers pay a portion of employees’ premiums.

What are the benefits of group health insurance?

For employees, the benefits of group health insurance include the reduced price of healthcare and the ease of enrolling through their employer. For employers, the benefits range from attracting quality workers to the tax credits they can receive.

Is your business required to purchase group health insurance?

Large businesses with 50 or more employees are now required to offer group health insurance under the Affordable Care Act. Small businesses with fewer than 50 employees are not required to offer coverage, but they can qualify for tax credits to help offset the cost if they choose to offer healthcare and pay for at least half of each employee’s premium.

What kinds of health insurance are there?
All plans cover an array of medical, surgical and hospital expenses. Most cover prescription drugs and some also offer dental coverage.  All plans are compliant with the Affordable Care Act.

Managed Care:  
Nearly all Americans have some kind of managed-care plan1. Various plans work differently and can include: health maintenance organizations (HM0s), preferred provider organizations (PPOs), exclusive provider organizations (EPOs), and point-of-service (POS) plans. These plans provide comprehensive health services to their members and offer financial incentives to patients who use the providers in the plan.

-    HMO's (Health Maintenance Organizations): HMOs cover medical care provided by doctors and hospitals inside the HMO’s network only.  HMOs 
             may require members to get a referral from their primary care physician in order to see a specialist.2

-    PPO's (Preferred Provider Organizations):  PPOs cover medical care provided both inside and outside the plan’s provider network. These plans give 
             patients the freedom of choosing their personally preferred choice of doctors and hospitals. PPO Networks tend to be quite large, affording many 
             options within their networks, When choosing out-of-network care, members typically pay a higher percentage of the cost.2

-     EPO's (Exclusive Provider Organizations):  EPO's are a lot like HMOs: They generally don’t cover care outside the plan’s provider network.  Members,
             however, may not need a referral to see a specialist.
2

-    POS's (Point of Service): POS plans vary but they’re often a sort of hybrid HMO/PPO. Members may need a referral to see a specialist, but they may also             have coverage for out-of-network care, though with higher cost sharing.2


Core Plan Documents ( Section 125 Premium Only Plan)

Contact us today for more information about group health insurance.

1 - Source: 
MANAGED CARE AND THE STATES

2 - Source: http://www.webmd.com/health-insurance/20140815/hmo-ppo-epo-hows-a-consumer-to-know-what-health-plan-is-best

   
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