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Understanding Group Health Insurance Plan

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 Understanding Group Health Insurance Plan
Understanding Group Health Insurance Plan

Understanding Group Health Insurance

These days cost of living rises almost every day and it makes sense to review your health coverage periodically. If in a family, both spouses are working for employers that are providing group health insurance cover, then it's even more necessary to compare both plans.

Usually, health insurance plans offered by employers have an open enrollment period and dependents can be added or dropped. Also, if you want best coverage for your family then you should make an accurate comparison of benefits offered by your plans. Keep a copy of your current policy in hand, and do side-by-side comparison when the next open enrollment period starts. You may find that when it comes to selecting the best family health insurance plan, one policy doesn't fit all.

Check the Basics

What are the rates of premiums, annual deductibles, benefits and yearly maximum benefits offered by each plan? What's the difference between the different service co-pays for each plan?

Cover for Mental health

If mental health cover is offered by your plan then know about what services are covered? Is your plan makes it mandatory to get referral from physician for therapy/counseling? How much you'll have to shell out in co-pay for a visit to a mental health professional's office? Are number of appointments to doctors office are limited in a single fiscal year.

Check your familys requirements

Does your family need certain recurring annual medical check-us like routine check-ups, eye exams and eye glasses, physical therapy and chiropractic services? What's the difference between policies for this coverage, including co-pays?


What provisions are your policies provisions for prescription drugs? Does your plan offer you choice between filling prescriptions with generic, formulary or non-formulary drugs and what's the difference in costs? Compare prescription co-pays.

Womens Health

What is the cost and provided cover for annual women's wellness exams like mammograms and pap smears? Also, what are the coverage details for infertility treatments, hysterectomy, birth control, and other gynecological concerns?

Older Children

Most family health insurance plans cover a full-time student, below age of 22, or until college graduation. However, certain plans don't cover children once they reach their 18th or 21st birthday, even if they are still pursuing their studies. If your child is not considered your dependent, s/he may be eligible to purchase Consolidated Omnibus Budget Reconciliation Act (COBRA) insurance coverage for a period of 18 to 36 months.

Addition to the Family

You should be aware of healthcare conditions covered under your plan. Also, services during pregnancy and childbirth could differ from policy to policy. Under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) health care plans cannot consider pregnancy as pre-existing condition during the open enrollment period. Changes in your family, such as the birth or adoption of a child, may prompt a new enrollment period in which you could add your new family member to your plan.

Understanding Group Health Insurance Plan

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