What is Usually Covered With Group Health Insurance?

Group health insurance plans are purchased by companies and organizations and then offered to its members or employees. Plans can only be purchased by groups, which means individuals cannot purchase coverage through these plans. Plans usually require at least 70% participation in the plan to be valid. Because of the many differences—insurers, plan types, costs, and terms and conditions—between plans, no two are ever the same.

Once the organization chooses a plan, group members are given the option to accept or decline coverage. In certain areas, plans may come in tiers, where insured parties have the option of taking basic coverage or advanced insurance with add-ons. The premiums are split between the organization and its members based on the plan. Health insurance coverage may also be extended to the immediate family and/or other dependents of group members for an extra cost.

The cost of group health insurance is usually much lower than individual plans because the risk is spread across a higher number of people. Simply put, this type of insurance is cheaper and more affordable than individual plans available on the market because there are more people who buy into the plan.

A set of 10 categories of services health insurance plans must cover under the Affordable Care Act.

These include:

• Doctors’ services
• Inpatient and outpatient hospital care
• Prescription drug coverage,
• Pregnancy and childbirth,
• Mental health services, and more.
• Some plans cover more services.