Group Health Insurance

Evaluating Group Health Plans

Health plans vary tremendously, but the basic comparison factors are relatively simple – you should analyze benefits, price, and providers of any plan.

Benefits

You should research the benefits of various plans to find what each covers. Assessing the following benefits will provide practical help evaluating policies:

  • You should find out what co-payments are required for outpatient care and inpatient treatment.
  • Find out what kind of co-payments are required for generic or name brand prescriptions.
  • You should understand what your deductible options are and how they will affect the insurance premium.

Price

Compare plans with similar benefits to determine which plan offers the best value for your money. Your employer might offer several options from which you could choose:

  • Some companies offer a choice between two insurance plans.
  • California employers can also provide a basic insurance plan, but they allow employees to purchase more comprehensive insurance as a personal option.
  • Some larger companies offer multiple insurance plans.

Providers

This is an important area you should investigate. Traditional insurance plans allow you to choose your own doctor, but managed care plans include preferred provider organizations (PPOs), health maintenance organizations (HMOs), and point of service (POS) plans. These plans often restrict your choices of medical services providers to an approved list. The list could prove crucial in deciding whether to enroll in a given plan.

California Group Health Regulations

California regulations require small group health plans to enroll a minimum of 75% of eligible employees. Employers must pay a minimum of 50% of the basic coverage plan. State regulations also include the following restrictions:

Guaranteed issue

Every eligible person must be accepted, regardless of any pre-existing conditions.

Guaranteed renewal

Insurance companies cannot cancel policies because policyholders make medical claims.

Ratings Protection

Insurance companies face limits on the rates they can charge, so they cannot make group insurance premiums too high for groups with greater levels of medical risk.

Portability

You must have the option of continuing your coverage if you change jobs.

Top California Group Medical Insurance Providers

Some of the top California group health providers include Kaiser Permanente, Anthem Blue Cross, United Health, Aetna, Health Net, Blue Shield of California, and United Healthcare. These providers offer a variety of health plans, including; HMO, PPO, EPO, POS, HRA, HSA, and Indemnity plans.

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