| Group
health insurance makes individual coverages available on a group basis.
A primary advantage is the purchasing power of the group that achieves reduced
acquisition costs for the insurance company. The insurance company
is then able to reduce the rate it charges to provide insurance for each
individual member of the group. The Group is in a better position to bargain with
the insurance company for additional benefits for its members. There are
a variety of types of group health insurance plans, the major distinctions
being the mechanism used for purchasing the insurance. Common varieties
of group health insurance plans include: 1.
Fully Insured Employer Group - The employer contracts directly with the insurance
company to provide certificates to covered employees. Typical arrangement
is either for major medical or health maintenance organization (HMO) coverages. 2.
Small Employer Group - Insurance companies group certain industries together
and then gather small employers together to form a larger group. These groupings
enable the insurance company to better predict the cost of providing the
insurance. The small employers can then get coverages otherwise not available
unless charged a much higher rate. All the small employers get the same policy
without deviation. 3.
Large Employer Group - same as a fully insured employer group with direct contract
between the insurance company and the employer to provide individual
certificates to covered employees. 4.
Health Maintenance Organization (HMO) - a group program under which the
organization provides a full range of medical services to participants.
Participants are either assigned or select from a group of general practitioners,
who then refer their patients to specialists when the need arises. Good generalized
system of providing medical care which is marked by curtailment in selection
by the individual participant of the health care provider who render services.
Individual participants insured by an HMO are called “enrollees”. 5.
Self-Funded ERISA - available to large groups. The group contracts with an insurance
company or third-party administrator to handle the paperwork. The group pays
for all costs associated with the operation of the insurance plan
itself, along with the added cost for administration. 6.
Association Group - similar to a fully insured employer group, the distinction
being that instead of an employer, it is a different type of group, such as a
credit card company offering insurance as a benefit to its cardholders
or a church group offering insurance to its parishioners. 7.
Group Managed Care - a long-term health insurance plan offered through
the group or association. 8.
Preferred Provider Organization – another kind of health care network (doctors,
hospitals, and other health care providers) that contracts with health insurance
companies. |