Group Health Insurance Plans
Group Health Insurance plans can be beneficial to the business owner for many reasons.
- The employer gets a legitimate tax deductible expenses for the portion of premium that they contribute towards the employees plan.
- The employee understands the benefit of having such coverage option made available to them and thus creates an employee benefit retention system. In today’s market those employees who are left out on their own to purchase their own health coverage will find the market options are not good and will seek out employers who do offer benefits like never before.
Buying insurance for your small business (group coverage) has different rules than buying just for yourself or your family (individual coverage). The good news is that coverage for small businesses can be provided to business owners as small as 2-50 employees. In a world where smaller network based plans such as HMO (Health Maintenance Organizations) are becoming more prevalent due to price, PPO plans (Preferred Provider Organizations) are still available in the employer market. Having a PPO option can make all the difference for an employee who needs access to more doctors and hospitals than a traditional HMO plan. Of Americans who have health coverage, nearly 60 percent secure that coverage through an employer-sponsored plan. Millions take advantage of the coverage for reasons as obvious as the employer takes responsibility for a significant portion of the health care premium.
Who Is Eligible for Group Coverage?
The general rule is that if an employer offers group health coverage to any full-time employees, the employer must offer coverage to all full-time employees.
The employer has the option to offer coverage to part-time employees (defined as those working fewer than 30 hours per week). If the employer offers coverage to any part-time employees, all of them must be offered coverage.
These rules apply regardless of the medical condition of the employees. In other words, any eligible employee can’t be denied coverage based on previous medical problems, known as preexisting conditions.
In addition, any dependents of eligible employees are generally eligible for coverage under a group plan. Dependents include spouses, children, and in some cases, unmarried domestic partners. Dependents cannot enroll for coverage unless the employee has enrolled.
Under the Affordable Care Act, group insurance plans are required to extend coverage to adult dependents through age 26. This only applies in cases where the adult dependent’s employer does not offer coverage. The provision applies to all people under 26, whether or not their employer offers coverage.