Group health insurance refers to a medical policy issued to a group (typically a business with W2 employees, although there are other kinds of groups that can get coverage) that covers all eligible employees and sometimes their dependents.

Who is eligible for small group health insurance?

Small groups are definitely eligible for group insurance if -

*If you are looking for a small business health plan for you and your spouse only, you may still be eligible if you live in the following states: Washington, California, Texas

You can start group insurance as long as you meet eligibility even if not all your employees need insurance.

What is the advantage of group health insurance over an individual insurance plan?

Group insurance is pre-tax, which means you can offer this employee benefit and have it exempt from employer and employee taxes. This usually means a 30-40% tax benefit on the cost of insurance. Thera and SimplyInsured will ensure you file all the proper forms to have group insurance premiums be tax-deductible. Individual insurance, by contrast, provides no tax benefits and must be paid for with post-tax money.

Is there a difference in cost to insure employees versus dependents under a group plan?

Pricing for medical insurance is only based on age and is not based on whether the person is an employee/dependent/spouse.

Does an employer have to offer insurance to all employees?

You do not have to offer insurance to all employees, but if you do decide to offer insurance, you must treat all employees of the same type the same way.

What happens when an employee leaves the company?

If an employee leaves your company or wishes to leave the insurance for whatever reason, they can be removed at any time during the year, and you will no longer be charged for their insurance.

Health Maintenance Organization: HMOs tend to have the lowest monthly premium, but they require referrals to see specialists from a primary care physician (PCP). There is no out-of-network coverage on this type of network.

Preferred Provider Organization: With a PPO network, you can choose any doctor on their preferred list of providers, no referrals are needed. You can also use an out-of-network provider (ie., not on the preferred list), but you will have to pay more out of pocket. PPO networks are the broadest and most flexible, but will increase your monthly premium.

Exclusive Provider Organization: With an EPO, you must pick from the providers on the list, or the insurance company will not pay. An EPO is like a PPO, but without out-of-network benefits. You do not need to choose a PCP or get referrals.

Point of Service plan: A POS plan is like a HMO, but in some cases you can get out-of-network coverage like with a PPO. Typically you are required to get referrals, with some exceptions (eg., Humana).