Group or small business health insurance policies provide options to cover the health of business owners and their families. Owners of small businesses, usually employing less than 10 people, can enter into a pool, or group, of people and that group becomes the purchaser of health care policies. These groups are available through industry networks, Chambers of Commerce, or through insurance brokers. When considering group or small business health insurance policies, iHealthCoalition.org recommends obtaining at least 3 quotes before making the final decision.
Most large group insurers will offer some type of indemnity plan to small groups, ranging from the basic major medical plans that cover medical risk, to managed care and preferred provider plans that have enrolled medical providers. This is where homework is very important, because some insurance plans will offer menu-style options that allow for customization of coverage and can reduce premium costs, such as excluding pregnancy coverage if not of childbearing age.
Group or small business insurance policies have monthly premiums. The premiums are determined by age, sex, number of individuals covered, and region of the country. But these are not the only out-of-pocket costs that can be incurred.
Many insurance plans have deductibles, the amount that has to be paid out-of-pocket by the insured before the insurance payments start. Deductibles increase the insured’s financial risk exposure,
therefore the higher the deductible, the lower the premium rate.
Co-payment is the amount that is paid by the insured each time a provider is seen. There are also co-payments for hospital emergency room, medical facility visits, and prescription drugs.
Co-insurance is similar to a co-payment. Insurance plans that have a major medical component which covers hospitals and/or catastrophic care will also have a deductible that must be met, then a co-insurance amount the insured must pay. These are called 80/20 or 70/30 plans, where the insurer will pay the 80 or 70 percent of cost, and the insured is responsible for the remaining 20 or 30 percent. Percentages vary depending on the type of insurance plan selected.
When selecting group or small business health insurance ask questions and look out for issues such as the reliability and stability of the insurer. Check ratings with the Better Business Bureau and the local Insurance Commissioner.
Ask questions about any pre-existing conditions that might not be covered, and any waiting periods. Check to determine if any illnesses are excluded from the insurance plan. Find out if there are maximum allowable payments. Ask to see a full list of exclusions and review them carefully.
Review your past medical history as well as family medical history. Use this information to determine what could occur in the future, and select a group or small business health insurance plan that will limit your financial liability. Also, if selecting a plan that has participating providers, check to determine the doctors, specialists, and hospitals that are considered in-network.