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Group Health Insurance

Group Health insurance is similar in form to individual health insurance.

The primary differences are the conditions under which a person may apply and the requirements for acceptance. Before applying through a group, a person must satisfy the waiting periods and employment requirements of the group. However, once an application can be made, the conditions for acceptance are usually less strict than with an individual health insurance policy. Also, certain protections under the law are available for members of group policies that are not available to owners of individual plans.

Before selecting a group health insurance policy, it is important that you do consider and evaluate the needs of the potential members of the group. Some things to keep in mind, to discuss with your broker are:

Some health plans have networks of doctors, make certain that yours is in it.

Not all health plans will let you go outside the network, if this is important to you make sure that your plan has an "out-of-network" benefit.

Check for coverage of routine medical care. Not all plans cover "routine checkups" or cover them only in small amounts.

Check the drug benefits. Forty percent of the cost of medical care is for drugs. Some health plans use a formulary system to determine which drugs they will pay for. Make certain that this formulary is extensive and that your doctor is willing to prescribe off of the formulary if necessary.

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