What you need to know about the Group Health Insurance Today?
Updated 01 February 2019
Health problems are quite difficult to avoid even with a healthy lifestyle and in today’s world where there is no scarcity of factors that can give you stress or some medical problem; health insurance provides a great tool to be prepared for the high medical expenses. Ironically, the never decreasing trend of Medical expenses sometimes becomes the reason for stress and depression for some. Even the regular checkups for a family can cross a few thousand bucks, so, you can easily estimate for the expenses one has to pay for in case of hospitalization. And above all medical expenses are not something for which you really have a choice, even if the money is not readily available it is arranged anyhow when it comes to the medical expenses. So, a health insurance or a mediclaim proves to be of great help in these cases.
There are various types of health insurance plans available in market and the choice of plans if each type is broad enough that there is a perfect plan for everyone. The choice amongst different plans can be made based upon various factors like the amount of premium to be paid, the maximum sum assured provided, type of coverage or even the critical illnesses covered. There are various benefits of a Health insurance plan like for the elderly people, it makes them financially independent and they don’t become a liability on their family. There are basically two types of Health insurance based upon the number of persons covered under the plan; Individual plan and the Group Health Insurance policy. The names are kinda self-explanatory and they are not very different from each other too. Today, further in the discussion, we will discuss in detail about the Group Health Insurance taking into account all the related aspects of it. So, let us get started.
What is Group Health Insurance?
Group Health Insurance is a kind of Heath Insurance where the coverage provided under the policy is for a group of people and not a single individual. The coverage is provided for the people included in the group and their dependents which include their spouse and the children.
Usually, a group health insurance is provided by the organizations for their employees where the premiums are paid by the organization only. It is beneficial for the companies as the premiums paid for the individual plan for each employee would be way more expensive than the premiums paid for a group health insurance. But the coverage provided under a group health insurance is not enough and therefore, they do not completely eliminate the need for an individual health insurance plan or a family health insurance policy which provides better coverage than its counterpart. More detailed comparison of an Individual plan with a group health insurance I given below in the latter half of the article, so, hold your doubts till then and let us move on to the next section where we are going to list the types of group health insurance.
Types of Group Health Insurance
Below we have mentioned about the different types of Group health insurance plans.
- HMO Plans: The key characteristic of a Health Maintenance organization (HMO) plan is that the services provided under it are limited to a certain geographical area with certain exceptions for out-of-Network service coverage. The coverage to be provided by the policy is decided mutually by the group members. The member participants must use the coverage services within the mentioned geographical network in order to be covered by the health plan. Another thing about an HMO group health insurance is that the group participants are also required to decide on a group Doctor who is afterwards responsible for taking all the health related decisions of the group.
- PPO Plan: Preferred Provider Organization (PPO) provides better coverage services in comparison to the HMO plans. A PPO usually has contacts with a group of hospitals and medical service providers which deals with the employers and insurers to provide group health insurance to the employees at reasonable rates of premium. Under a PPO, there are no restrictions with respect to the geographical location of the insured in order to use the services provided by the plan.
- POS Plan: Point of Service (POS) plans are a trade-off between the HMO plans and the PPO plans. Here, even though the restrictions of a geographical region are not actually there but neither has it provided complete independence in that context. One has to choose between the in-network or out-of-Network for seeking the services
- Minimum Premium Plan: Minimum Premium plans are somewhat beneficial for the employers as they allow them to pay only a part of the premium monthly and the rest is needed to be paid only when the insurance company has to pay off the claims. The benefits for the employers under this plan are least effect from bigger claims, better cash flow and immediate benefits from the lesser premium amount.
- Self-Funded Plan: As the name suggests, these plans are funded from within the organization itself without the involvement of any third party insurer and is an outcome of the constant thriving of the employers to find out the ways to minimize the cost of providing the group health insurance to the employees.
Benefits for the Employees
- Organizational Support During Reimbursement: Since, the insurance is provided to all the people who are members of the group, therefore, it is helpful for those who wants to buy a health insurance but cannot afford to pay for the expensive premiums.
- Automatic Insurance Coverage: To be insured under a group health insurance, one just has to be the part of the group to be insured which means when you join the company, you are bound to get a default insurance coverage included with your package.it is great for the people who not insured otherwise.
- Maternity Coverage Right from the Start: Under an Individual health insurance plan, there are certain waiting periods which are not there in the group health insurance and one of them is getting the maternity expenses covered from Day 1 i.e. after joining the company, you are entitled to get the maternity coverage right from the start.
- Zero Waiting period: Similar to the zero waiting on maternity coverage, there is no waiting period for the coverage provided for the pre-existing conditions which is there in the individual plans. Irrespective of your pre-existing health condition, you get coverage for all the health problems from the day you join the company or the organization.
- No need for a Medical Checkup: When you buy an Individual health plan, you have to go for a health checkup to let the insurer know of all the pre-existing condition beforehand while in group health insurance no such Medical check-up is required.
Benefits for the Employers
- Lower Cost on Premiums: One of the immediate benefits to the organization is that they have to pay a lot less on premiums in case of group health insurance. Moreover, just like any other commodity, discounts on a bulk order can also be enjoyed here.
- Tax Benefits: Group Health Insurance Offers Tax deductions under various sections of Income Tax department of India.
- Helps in Attaining Loyalty and Increasing Retention of Employees: Constantly changing workforce is not a good sign for the better performance for any organization and thus, the companies are becoming more and more employee centric. Group health insurance is used as a tool ensures the loyalty of the employees towards the company. It helps in retention of old employees into the company which is a good sign for the company itself.
- Motivates Employees: Just like we mention initially that ever increasing medical expenses sometime themselves become the cause of medical problems causing stress. And no employee can work fruitfully being under stress, therefore, being insured by the company tends to take away the stress from the minds of employees in context to the medical expenses.
- Choice of Premium Payment Alternatives: The companies get a choice for the payment option of the Insurance premiums which can be paid either monthly, quarterly or annually.
Individual Plan vs. Group Health Insurance
In the last two sections, we have made comparison between Individual health plans and the group health insurance plans. Let us put it together under the single heading.
First and foremost, the coverage provided by a group health plan is not as complete as an Individual plan and thus, it is not a substitute for your personal health insurance but the positive side here is that it suffices the insurance needs of the people who want to buy a health plan but cannot afford to pay the monthly premiums.
Next up, the premium paid for a group health plan by an organization are a lot less than what they would have to pay if they go for a personal health insurance for each of their employee.
As discussed earlier, there is zero waiting period for the coverage for Maternity and the pre-existing conditions while there is a pre-specified waiting period associated for both these services in an individual health plan. While we are this topic, you should also know that you have to go through a complete medical checkup before you buy a personal health insurance for yourself while there is absolutely no need to get done one for a group health insurance.
Your group health insurance provided from your employer is only valid until the time you are part of the company and as soon as you leave the company, you are also not covered under the insurance plan of the company while the coverage under the personal health plan is provided for the complete coverage period.
Myths Related to Group Health Insurance
There are multiple myths that people carry in their minds regarding health insurance that really need to busted. Not all the myths that are mentioned below are related particularly to the group health insurance but they are mentioned in general for the health insurance.
- Employer Provided Group Health Insurance is Enough: This has been discussed multiple times in this article itself and yet it is mentioned again because we do not want anyone to rely wholly on the employer provided insurance as the coverage is not broad enough as well as the insurance is provided for as long as you are part of the organization and as soon as you are out of the company, you are not covered under the group health plan too.
- Health Insurance is Meant for the Elderly People Only: Well, a lot of young people believe that health insurance is a stuff elderly people and they don’t need it in their young age. How come it is certain that no medical problem is going to occur in the young age and is going to wait for the old age to arrive? It never too early to get a health insurance done for you and your family because who knows it might prove to be helpful in case of some unforeseen circumstances.
- Reimbursement Process is a Hassle: You don’t have to refrain yourself from buying a health plan just because you think that reimbursement process is going to be a hassle to deal with. In reality, it is not that complex to claim your medical expenses. There are two ways by which one can claim the expenses; cashless and cash reimbursement. Either way you choose, you just have to show all the relevant medical reports and the bills and complete some bare minimum formalities and done, you can get your claim.
So, we have reached the end after talking about group health insurance in a great detail from its types to its advantages to both the employer and the employee to comparing it to its counterpart Individual health insurance plans and ending it with busting some of the common myths that people believe in about any health insurance plan in general. We hope that this discussion really helped in getting some knowledge about group health insurance. We feel good that you read it till this part, thank you.
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