In an atmosphere of ever-growing health care and health insurance costs, group health insurance coverage is becoming critical for many employees. In fact, surveys consistently show that employees value health insurance benefits above all others.
Studies have shown that a solid majority (over 60%) of Americans receive health insurance benefits via group health insurance coverage through their employer (or their spouse’s employer). Of course, from the employee’s point of view, this is the least expensive option for securing health insurance. Nevertheless, whether you are a business owner or employee, what follows is a discussion of some interesting aspects of the group health insurance market.
There are two main reasons that employers offer group insurance coverage. The first is to attract talented employees. The second reason is related to the first: To reduce employee turnover. It’s not uncommon for employees to become “dependent” on their health insurance. For example, an employee who may otherwise leave their job to become self-employed may not do so because of health reasons. That is, he or she may not be eligible under an individual policy due to a preexisting condition. Preexisting conditions are typically not covered under individual health insurance plans.
The primary difference between individual and group health insurance is that group plans are “guaranteed issue”, while individual plans are not. “Guaranteed issue” means that an insurance company cannot deny coverage due to any preexisting medical conditions.
Some individual health insurance plans are issued to individuals with preexisting conditions, but usually only with what is called an “exclusionary rider.” This “exclusionary rider” will exclude coverage for treatment related to the preexisting condition. It’s interesting to note that in California, insurance companies are not allowed to practice this policy. As you might expect, the result is a much higher rate of decline applications for individuals, since insurance companies choose simply not to issue coverage for individuals with preexisting medical conditions.
For group health insurance coverage, premium cost sharing between employer and employee has pretty much become a common feature in today’s labor market. In the vast majority of cases, insurance companies require employees to pay a minimum of 50% of the premiums, although many choose to pay a higher percentage. In general, the larger the company, the greater the percentage paid by the company. Not all insurance companies require coverage for dependents, although again many businesses elect to offer this coverage as well.
There are tax incentives available to both employer and employee for qualifying group health insurance plans. Employers can typically deduct 100% of the premium costs, while employees can pay their portion of the monthly premiums with pretax dollars. Both practices can result in significant savings over the course of a year.
Lastly, group health insurance coverage is available as either an indemnity (fee-for-service) plan or managed care plan (HMO, PPO, or POS). Indemnities plans are the oldest, as well as the most expensive, type of health insurance. As a result of their high costs, indemnity plans have all but disappeared from the landscape, and been replaced by managed health care plans.
Managed group health insurance plans come in various forms: Health Maintenance Organization (HMO), Preferred Provider Organization (PPO), or Point of Service (POS) plans. The HMO was the first alternative to traditional insurance (indemnity) and became popular for its ability to reduce costs for both employer and employee by creating networks of doctors and hospitals and thereby being able to apply cost saving measures.
The PPO plans have in recent years become the most popular type of group health insurance. PPO’s (as well as POS plans) combine many of the freedoms enjoyed with indemnity plans while still being able to implement many of the cost saving features of an HMO.
The struggle to offer employees affordable group health insurance coverage is an ongoing process for most employers in today’s health insurance market. Part of the process is education, from the standpoint of both the employee and employer. It’s important to understand that retaining affordable and quality group health insurance is vital to both sides of the labor market – employer and employee. Indeed, when done properly, this can be a win-win situation for all concerned.