Group health insurance plans are generally offered to employees by their employer. They might also be offered by organizations to their memberships. The plans may include various health benefits such as doctor's visits, medications, and x-rays, as well as a selection of extended benefits comprised of vision and dental. Group health insurance may also include coverage for the employee's spouse and family members.
Health insurance is regulated by each individual state in the US, thus, programs and benefits will be varied. In addition, policies are treated different for smaller businesses, generally less than fifty employees, and large corporations in excess of fifty staff members. Each individual company may offer different programs based on the employee's years of service and weekly hours worked. Therefore, full-time employees may enjoy better coverage than part-time staff. Further there are federal mandates which make group health insurance plans accessible to all. For example, because a small employer has one or more employees with existing medical conditions, an insurance company may not refuse to do business with the company. This is known as "guaranteed issue".
In terms of the premiums, how they are paid will depend on the employer. Some employers pay the full premium as part of labor negotiations, while others choose to pay a percentage with the employee paying the balance. For companies that cannot afford longer reaching programs, the deductibles for the employees will be higher than companies offering "better" benefits. In the past, companies with larger profits offered plans with little costs to their employees.
Group health insurance plans can be consumer-driven or managed plans:
- Consumer-driven plans include HSAs where employees have more control over their medical decisions and the associated costs. Another type is the "cafeteria plan" where employees choose from a basket of services. Since one family may prefer dental while another needs vision benefits, each employee can personalize a package for his/her needs.
- Managed plans usually include PPOs (Preferred Provider Organizations) where employees can save money by choosing health careprofessionals from an approved network but at the same time, have the right to go outside the network, HMOs (Health Maintenance Organizations) where employees must choose from a predetermined list of providers, and Point of Service which is a combination of PPO and HMO.
Even though health care benefits tend to be available from companies that are larger and richer than others, it is actually in any company's best interest to keep its work force healthy. By providing options for preventative care, it is cheaper in the long run due to decreased costs per employee and decreased sick days. And companies that offer good group health insurance plans are more able to attract quality staff and in turn, keep their existing staff. This reduces costs by decreasing the need for continual new-employee training.
From the employee's standpoint, having a group health insurance is a serious benefit. For families who may need medical for their children as well regular dental and eye checkups, the heath care plan will be invaluable. Further, should the bread-earner become incapacitated, rendering him/her incapable of working or should he/she die, the plan may include accident and life insurance upon which the other members will depend.
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