- Posted by Canopy KC
- On July 25, 2017
- 0 Comments
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Group health insurance is a policy offered to a select group of people or eligible employees from their employer. Typically, these plans are tiered in their coverage amounts, premiums, deductibles, and copays, but in general are uniform for all employees. Monthly premiums are shared with the employers, with the employee’s share of the monthly premium being deducted from their paycheck.
What are the requirements?
Eligibility requirements will be dependent on the size of employer that is offering coverage. The general rule of thumb is that an employer will offer coverage to any full-time employee or to any part-time employee. Monthly premiums, annual deductibles and percentage coverage for services will fluctuate based upon your employment status.
Can I be denied?
No, an eligible employee or dependent cannot be denied health insurance coverage based on pre-existing conditions. This is federally mandated by the Affordable Care Act (ACA) as well as the Health Insurance Portability and Accountability Act (HIPAA).
Can my family be on my group health insurance policy?
Yes, an eligible employee’s dependents can be offered health insurance through group health insurance coverage. Dependents include an employee’s legal spouse and dependent children 26 years of age and younger. This answer may be different if you are an employee of a small business (50 employees or fewer). Small businesses are not required by law to offer group health insurance coverage to employees or their dependents.
Do I have to enroll in my employers group health insurance?
No, you can opt out of your employers group health insurance plan or policy. However, it is important to note that every person is required by law to have health insurance or face a standardized tax penalty of 2.5% of your annual income per adult or $695 and $347.50 (whichever is higher) per child (healthcare.gov) as of 2016. If you are over the age or 26, regardless of school or employment status, you can no longer be on your parent’s health insurance plan.
How is group health insurance different from individual insurance?
While group health insurance and individual insurance cover the same essential health benefits, group health insurance tends to be more cost effective. Why? Because the risk associated with coverage is spread across a group of people vs one individual or family. Essential health benefits include: Outpatient and Emergency Services, Preventative and Wellness Services, Hospitalization, Mental & Behavioral Health, Maternity & Newborn Care, Prescription Drugs, Laboratory Services, and Rehabilitative Services.
- If you are a small business and you are looking to provide group health insurance, Canopy will be your guide. We offer a comprehensive and strategic evaluation of any existing plan or situation and develop a group health insurance coverage plan that maximizes benefits while balancing costs. We also offer support in navigating current Healthcare Reform 101 as well as Human Resource Consulting with an “HR Support Plus” program. Our proactive approach is day to day, month to month and year round. It’s all part of our client’s-come-first mentality.
- If you are an employee and your employer is offering group health insurance coverage, look in to it. Research all aspects of what each policy has to offer prior to making your decision. If it still does not make sense, the representatives at Canopy, are here to help (even if you’re not a part of one of our plans).