Will an insurance company deny coverage to a single employee in a group health insurance plan?
As a rule this will not happen, since the principle of group healthcare coverage implies that all employees are automatically covered under the plan. Employees do have to be active members of the company and meet certain employment criteria.
Are mandate benefits federally required?
Mandate benefits, which are benefits required by law to be included in any insurance plan, are very common at the state level, but there is no federal law. For example, in most states things like care for newborns and substance abuse must be covered.
How does a comprehensive plan work?
Comprehensive plans provide a broad range of coverage, usually requiring you to pay deductibles (a set amount of money out of pocket before the insurer will pay) or co-payments (a fixed amount you must pay during a medical procedure). After these payments are met, the insurer will pay all or the majority of your medical costs up to a fixed dollar amount that either regenerates annually or represents a maximum for your entire life.
What is the difference between an HMO and a PPO?
Health Maintenance Organizations (HMOs) require that you select a general care practitioner from whom you must get approval to see specialists. You typically do not pay a deductible with an HMO, and instead will only pay a co-payment. Preferred Provider Organizations (PPOs) allow you the flexibility of choosing any practitioner or specialist. PPOs typically require a deductible and possibly also a co-payment.
How does a “base-plus” plan work?
Base-Plus plans are two-part coverages divided into two categories of medical services. The first covers doctor visits, lab work, testing, and examinations like x-rays with no co-pays or deductibles; the insurer pays for all expenses. There is, however, a deductible and/or co-payments required for medical services falling into the latter category. The lack of a deductible with some services makes a base-plus plan potentially very attractive, because more routine medical exams cost no money out of pocket.
What are the advantages to a group insurance plan?
Group insurance plans, typically through an employer, allow anyone to be covered, regardless of your pre-existing health conditions. There may be certain restrictions, but you will almost certainly receive automatic coverage as soon as you are eligible.
What kinds of insurance coverage can I expect from my employer?
Group insurance through employers typically covers these four insurance types: life, accidental death & dismemberment (AD&D), disability, and health/medical insurance. Some employers also include dental plans and vision care.
Can labor unions offer group insurance plans?
Yes. Unions can act as policyholders just like a company and offer benefits to their members. This is especially useful with certain industries where a worker will be contracted to work for many companies throughout the year. More often, though, unions help their members obtain cheap health insurance through collective bargaining with an employer.