Since there are fewer options for individual’s in this year’s open enrollment period (OEP), we have done some research and compiled a list of four options that are available to offer your clients compliant coverage. We are creating a series of blogs to discuss these options in detail to equip insurance agents to be prepared for a successful OEP. Catch up on the introductory blog, which provides an overview of the individual health insurance marketplace.
With that information in mind, we want to focus on our first recommendation in this post, which are Group Health Plans. This option is available to consumers who are a part of a registered business or organization with 2 to 50 employees and provides coverage to all eligible employees and their dependents. Group plans are a great opportunity to obtain compliant coverage if your clients work at an organization that offers this type of coverage.
What is the difference between Group Health Insurance and Individual Health insurance?
The main difference is fairly straightforward. Health insurance that is provided through an employer is group coverage and health insurance that consumers purchase on their own, not through an employer or other organization, is individual coverage. Below are some of the differences between group and individual plans.
Group plans are provided by employers who may offer or provide:
- A choice of health insurance plans from basic coverage to more, depending on your wants and needs
- To pay part of your monthly premiums
- To automatically deduct your share of your premium from your paycheck each pay period
- Plan documents, details, and answer any questions you have about your plan
On the other hand, individual health insurance plans require that:
- Individuals have the responsibility to shop for, choose, and purchase the right plan for them
- Consumers must pay the total monthly premium payments
- Consumers need to be familiar with the plan they choose so they can manage it well
Whether or not your clients choose to be a part of a group plan or purchase an individual plan, all plans must cover all 10 essential health benefits, as listed in our first blog, Beginner’s Guide: 2018 Open Enrollment Period.
Advantages and Disadvantages of Group Health Insurance
The advantages of group health insurance plans are many. First, group plan premiums are usually subsidized by the employer. Premiums are what consumers pay monthly for health insurance, so this means that what is deducted from their paychecks each pay period will likely be less than premiums for individual health care plans.
A current advantage of group and individual plans under the Affordable Care Act (ACA) is that plans are guaranteed issue. This means that any eligible applicant will be offered coverage regardless of their health status.
Most group plans also offer PPO networks and premiums become tax deductible. PPO plans offer a network of healthcare providers to provide comprehensive medical care. Although there are more options with PPO plans, monthly premiums and co-pays will be higher. It’s important to find the balance between the coverage you want and the premium you can afford.
If you own a small business, find out if your company is eligible for group health insurance. As an insurance agent, this is an option you can discuss with your clients during OEP. Contact Tanya Lewis Director of Group Benefits at 800-960-1371 ext. 1209 or Heather Jenkins ext. 1206 for more information on group benefits and how AgentLink can help you during open enrollment and beyond.