GROUP & MAJOR MEDICAL
Group Health plans provide medical insurance coverage through an employer or social organization that purchases the policy and extends the benefits to its members. No two group policies are alike because the insurance carrier, number of covered lives, ages of insured, plan type, and network are tailored to meet the organization’s unique needs.
Premiums are split between the organization and its members, and coverage may be extended to members’ family and/or other dependents for an extra cost. Costs are often lower than in an individual plan because the insurer’s risk is spread across more policyholders. Insurers can better manage risk when they have a clearer idea of who they are covering, the information they gain by conducting a census before offering a price quote. Using HMO vs. PPO provider networks allows insurance companies even greater cost controls.
Not everyone is covered by or eligible to purchase a group health insurance plan. Those who are self-employed, work part-time, are out of the workforce and are not eligible for Medicare or Medicaid often need to purchase an individual plan to protect themselves from financial loss in case of an accident or disease. The Affordable Care Act provides insurance exchanges, with fixed election periods, that allow most Americans to purchase coverage, often at a discount. There are a number of high-quality short-term health plans (lasting up to 364 days, but often with the option to renew) for affordable rates. These plans typically require health underwriting, while group and ACA plans do not.
Group, Major Medical, Medicare, and Short Term Health plans all have one thing in common- they seek to reduce the insured’s healthcare costs for a designated benefit period. Premiums, deductibles, copays, coinsurance, out of pocket maximums, networks, drug formularies- these components make up the insurance policies that help families mitigate the costs of preventative, emergency, or ongoing health treatments. United Agent Resources understands all of the markets well and can help you properly place most clients.
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