Group Health Coverage
Health Insurance for All
Group health insurance plans are designed to be more cost-effective for businesses. Employee premiums are typically less expensive than those for an individual health plan. Premiums are paid with pretax dollars, which help employees pay less in annual taxes. Employers pay lower payroll taxes and can deduct their annual contributions. The money an employer pays for employees to have health insurance and other benefits. when calculating income taxes.
How group health insurance works
Group health insurance helps businesses pay for health care expenses for their employees. When you pay a premiumThe amount that must be paid for your health insurance or plan., insurance companies pay a portion of your medical costs, including for regular doctor checkups or injuries and treatments for accidents and long-term illnesses. The amount and services that are covered vary by plan.
For example, an employee may have a $20 copay for each doctor visit. Or, their plan may not cover any expenses until they have paid their deductible. Generally, the higher an employee's monthly premium, the lower their deductible will be.
Although the vast majority of group health insurance plans are employer-sponsored benefit plans. It is possible, however, to purchase group coverage through an association or other organizations. Examples of such plans include those offered by the American Association of Retired Persons, the Freelancers Union and wholesale membership clubs.
Joining a group health plan
If you work full-time for an employer that offers group health insurance options, then you should be able to join a group health insurance plan through that employer. Some exceptions to this:
If you’ve already been working there for some time, and it is not Open Enrollment Period.
Usually when you get hired somewhere, you should have your health benefits explained to you, and given a certain amount of time to opt into your plan. If you chose not to join that group health insurance plan within the amount of time set by your employer, then you’ll have to wait until the annual Open Enrollment period to opt in. If you’re confused about your options, talk to your HR department to understand more about how group health insurance benefits work at your company.
If you are a contracted employee.
Sometimes it’s hard to understand exactly how employment works. If you don’t work enough hours to be a full-time employee, or were hired as a contracted employee, there’s a chance you won’t have the opportunity to be covered under health benefits offered by your employer. This is a huge issue since many of these workers are not considered “employees” even if they work more hours than they would need to be considered a full-time employee.
You work for a small business that isn’t required to offer group health insurance.
If you are employed by a small business owner, they might not be required to offer health insurance by law. Usually, if a small business has less than 50 full-time employees, they are not legally required to offer group health insurance to employees. Don’t expect this to be the case with all small business owners–your employer still has the option to offer group health insurance, even if they have only one employee.
What to do if you can't join a group health plan
Although there are many perks to joining a group health insurance plan, it’s not an option for everyone. If you’re unable to join an existing group health insurance plan, there are still plenty of health insurance options out there that you can choose from:
Individual health insurance.
You can choose from an Obamacare (ACA) plan, which will be the same as what you’ll find on the government health insurance Marketplace. If you’re not expecting to qualify for a government subsidy, you might also want to look into a health plan that is not associated with the Affordable Care Act.
Short term health insurance.
If you’re looking for an affordable way to get some coverage, short term health insurance is a good option. You won’t be getting as many benefits or as much extensive coverage as you would with more traditional individual plans, but you’ll be protected against outrageous medical bills in the case of a serious illness or injury.
Critical Illness and Accident insurance.
This is another option for coverage that will offer less benefits, but save you money. A critical illness insurance plan pays a cash amount to you directly, in the event you’re diagnosed with a critical illness that’s covered by the plan. If you’re also concerned about getting in a serious accident and want to protect yourself from those medical bills, you can purchase an Accident insurance plan.
Join an association health plan.
If you are apart of a professional organization, industry group, trade organization, or state or local chamber of commerce, you may have the opportunity to join an Association Health Plan (AHP). Make sure to read up on these associations, because there is some potential risk involved with joining an AHP that might not be legitimate.