health insurance coverage HMO, PPO
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Group insurance coverage MD DC VA
Health Insurance
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Health Insurance- Coverage Types

Group Health Insurance

  1. Group health insurance is the best plan for most insured. In general no proof of insurability is required to participate, where many insured may not be covered otherwise. Under group plans the cost of services is negotiated to be the lowest and the coverage is considered good
  2. Plans may or may not offer coverage for family members of the insured. It is up to the group administrator or the employer benefit department to set the coverage policy
  3. Most group health plans cover medical services and prescription drugs. Dental and Vision coverage may be offered as an additional benefit.
  4. Employers/group administrators may pay part of the premium cost as a benefit to the group members, where the insured pay their share of the cost.
  5. When insured terminates the relationship with the group, a special law allows keeping the group plan with same coverage for a certain time. The insured has to provide with the full premium cost.

Individual Health Insurance

Individual health insurance is the alternative to the group health insurance. It is offered to individuals and their families under certain conditions.

Typical characters of individual health insurance are:

  1. The cost of individual plans may be significantly higher compared to group insurance plans, for the same coverage
  2. Prescription drugs may be offered with additional cost
  3. The proposed insured has to be medically qualified for the individual plan. Pre-existing conditions (smoking, chronic diseases, medications taken, over weight, pregnancy and many other conditions) may result in higher premiums or rejection
  4. If insured, pre-existing conditions are typically not covered for certain time or may not be covered at all.
  5. Higher deductible fees are likely.
  6. If there is a gap in health insurance coverage, it may result in rejection.
  7. Health insurance may terminate coverage or raise premiums under the local state regulations to insured with recently diagnosed medical conditions

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