Group Health Insurance

Health care is expensive wherever you are in the world, and if you do not have health insurance you are often excluded from proper health care. Times are tough in the United States, and the number of people without health care insurance is rising dramatically because they can no longer afford it. They either have lost their jobs and therefore their health insurance, or they had a private policy, which became simply too expensive due to the rising costs of medical treatment.

With so many people having lost their jobs, people who (still) have a job are reluctant to change jobs; afraid of losing the insurance they have right now. Health care insurance can nowadays been seen as an employee benefit, and many employers indicate this in their job advertisements, offering it as a perk to get more people interested in the job.

How does it work?
Group health insurance is offered to businesses, unions and associations only. By purchasing such a policy, the employer will be able to offer a medical scheme for their employees and their relatives and/or partners. This is available for both small businesses and large corporations. Often both employer and employee pay a part of the premiums, since medical aid is quite expensive, particularly with the rising cost for health care and medication. If you are a new employee that is offered medical aid via the employer, then you might want to check the policy and reputation of both employer and the scheme first, to see that the cover fits your needs. The employer, for instance, might have chosen a limited cover whereby the employee will be required to pay certain medical services themselves, like dental and eye care.

Various packages available
An employer can choose from various health care packages. He either opts for the very basic plan, such as indemnity plans. On this plan, you are allowed to find your own doctor and you will pay the medical bills yourself. The insurance company will then refund you for either the full amount, a part of it, or just a percentage. There are limits to the amount and number of days that will be restituted. The other option is managed care. Managed care knows three options: health maintenance organization, preferred provider organization and point of service plans.

Health Maintenance Organization (HMO) means that you can choose a doctor from an approved list. This doctor will be your general practitioner and will refer you to specialists and surgeons that are linked to the medical scheme.

The Preferred Provider Organization (PPO) ensures you still have your main physician who still could refer you to specialists linked to the scheme. However, if you need treatment of specialists that are not on the list, you might still be covered, partly or in total.

The last option, Point Of Service plans (POS), gives you the most freedom, but then is also more expensive. With POS, you can still choose your general practitioner, but you can go to almost any specialist and surgeon who are not linked to the scheme and still get full cover.

In general, a group insurance policy is cheaper than an individual policy as a group insurance pays for the masses but the funds get used by a few.

Is there a waiting period?
Yes there is, particularly when you have been out of medical cover for quite some time. You will have to stay medical free for a certain length of time. After this period, will you be able to claim medical costs if you have them. If you changed jobs or you used to have a private health policy, then the waiting period may be considerably shorter, but you will still have some time that you are uncovered.

Will you still be insured when you lose your job?
In most instances you will unfortunately lose the medical cover the moment you leave a company or when you lose your job. On certain occasions, however, you will be able to remain insured if you are able to pay the premiums. This very much depends on which health care insurance option the employer has chosen.

Worrying trend
A worrying trend is that, particularly the smaller companies, are struggling to be able to pay the costs for the group health insurance they have for their employees, and many of them are unfortunately forced to stop offering the insurance schemes, leaving their employees without an affordable medical cover. The costs for medical treatment and medicines have risen exorbitantly and health care insurers will have to cover those costs by regular increases of the premiums.

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