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GROUP HEALTH INSURANCE

GROUP HEALTH INSURANCE

1. Coverage Options
Basic Medical Coverage: Includes hospitalization, outpatient care, preventive care, and sometimes prescription drugs.
Additional Benefits: May cover dental, vision, mental health services, and wellness programs.
2. Benefits
Cost-Effective: Group plans often have lower premiums than individual plans because risk is spread across a larger pool of members.
Employer Contributions: Employers may subsidize part of the premium costs, making it more affordable for employees.
Simplified Enrollment: Generally easier to enroll, with fewer medical underwriting requirements compared to individual plans.
3. Types of Group Health Insurance
Fully Insured Plans: The employer pays a premium to an insurance company, which assumes the risk of providing healthcare.
Self-Insured Plans: The employer takes on the risk and pays for employee health claims directly, often with a third-party administrator handling the claims.
4. Eligibility
Typically available to employees, their dependents, and sometimes members of associated organizations.
Eligibility criteria can vary by employer or organization.
5. Claim Process
Claims are generally handled directly by the healthcare provider, who bills the insurance company, reducing the administrative burden on employees.
Employees may need to submit claims for out-of-network services or specific expenses not covered directly.
6. Exclusions
Common exclusions may include pre-existing conditions (for a limited time), cosmetic procedures, and certain high-risk activities.
7. Renewal Process
Group health insurance plans are typically renewed annually, with premiums and benefits reviewed by the employer.