What To Expect

Group medical insurance is a must for any business. If you have more than 50 employees, you’ll be legally required to provide them with insurance, while those with fewer employees can still benefit from offering insurance by getting better employee morale and retention. But what should you expect when you start shopping for a group medical insurance policy?

It is much more complicated than just buying the first policy you see, and taking the time to choose the right policy is something that you need to do. Luckily, a few basic things can make it easier to find the right policy. Knowing what to expect can prepare you and help you give your business and your employees the coverage that they deserve.

How Does Medical Insurance Work?

Group insurance is just what it sounds like. Instead of a policy that only covers a single person, it’s a type of insurance that covers multiple people. businesses will purchase a group health plan and then offer coverage to their employees.

In a traditional, single insurance plan, you’ll purchase a plan and pay the monthly premiums based on the plan’s structure. That structure is directly impacted by things that influence your overall level of risk – things like your age, weight, whether or not you’re a smoker, your medical history , and so on. Those who are of a higher risk will have higher premiums and deductibles because they pose a larger risk to the insurance company.

Once you buy the policy, you’ll then provide information about it to all eligible employees. You may have a policy that allows them to pay out of their own pockets and increase coverage. They could add things like dental or vision coverage, increased protection on their health plan, or even pay to include their spouse and children on the policy.

Each policy has its own unique coverages. As such, businesses will have to spend time looking at their needs and their budget, then find a policy that helps them achieve those specific goals. It’s important to think about each aspect of coverage and not just spend money on something that only makes your business compliant – if you are paying for the insurance, you’ll need to make sure your employees can actually use it. Things worth considering include:

  • Monthly premiums
  • Level of benefit amounts
  • Deductibles
  • What is and what isn't covered under a policy
  • Additional coverage options
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You Two Main Options

You have two primary options when you choose your group health insurance policy – self-insured and fully insured. Knowing the differences is a must for getting the right kind of policy for your budget and your employees.

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Fully Insured

This is the traditional insurance that most think of when they think of health insurance. The employer pays the premium costs and offers insurance to their team. The insurance company carries the costs and the risks of medical coverage.

Self-Insured

In a self-insured policy, the employer assumes the risks associated with medical coverage. You pay money monthly into a fund that is set up to cover all medical expenses. When an employee files a claim, the money is pulled from that fund.

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Once that you begin shopping for your group medical insurance policy, you’ll need to provide several bits of information. Each of these will have a direct impact on the policy, and will be used to determine the overall level of risk that your business carries with it.

Once that risk has been assessed, insurance providers use a metric to determine the overall costs of your policy. The higher the level of risk, the more the policy will cost. But again, since risks are spread throughout the group instead of on an individual basis, you end up with a fair rate. Some of the information you’ll have to provide the insurance company which includes:

  • Number of employees
  • Type of work done on the job
  • Age of employees
  • Genders

The goal here is to calculate risk fairly and accurately, giving employers less to worry about and also giving employees the kind of coverage that they need to stay healthy. Once you provide the info, you’ll be given a quote.

Take a look at the specifics of the policies you’re reviewing here – do they have copays? Prescription coverage? Dental and vision options? Sometimes paying a small amount more increases coverage dramatically and it might be worth investing slightly more into a policy to give your team better protection.

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