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Group Health Insurance

Benefits that Keep your Employees Happy

Group Health Insurance is coverage underwritten on members of a group such as employees of a particular business, union, association, or employer.  Each employee in the group is entitled to benefits covered under the plan such as hospital room and board, surgeon and physican fees.  There are deductibles and a coinsurance requirement that each employee must pay.  Following are some of the various featurers of group health insurance:

  • A True Group Plan is one in which all employess must be afforded coverage regardless of physical condition; therefore coverage cannot be denied becuase of a pre-existing condition.  This plan usually requires the employee to pay the first premium within the first 30 days of employment or forfeit the right to automatic coverage.
  • A Schedule of Benefits is provided to each employee and outlines what the insured and his or her covered dependent(s) are entitled to in the event of disease, illness, or injury.  Once the deductible on the plan is satisfied the insurance company pays a given percentage (usually 80%) until a total sum is reached for the calendar year, the total sum is usually $5,000.  After that total sum is reached the insurance company pays 100% of the covered expenses until the end of the calendar year subject to a maximum lifetime amount.
  • Eligible expenses under this plan include hospital bills, surgery, doctor's services, private nursing, medicines, and x-rays.  Payment allowed for these and other expeses are spelled out in the policy.
  • Many Exclusions occur in group health plans, including benefits under Workers' Compensation; certain mouth conditions; convalescent or rest cures; expeses incurred by a member of a Health Maintenance Organziation (HMO) or other prepaird medial plans; expenses associated with intentional self-inflicted injuries or attempt at sucide.
  • Coordination of Benefits occurs when two or more group health isnurance plans covering the "insured", one plan becomes the "Primary Plan" and the other plan(s) become the "Secondary Plan(s)".  When a claim is made the "Primary Plan" pays without regard to the benefits provided under any other plan, the 'Secondary Plan(s)" then pay the difference between the total claim amount and the amount that the primary plan has paid, up to the total allowable expense.

 

United Benefit Solutions is dediciated to not only educating our clients and their employees on the plans available but also providing a professional caring staff who will work with you on all phases of your health insurance needs.  We are proud of our continued relationships with our clients and work hard to provide you with the best pricing, coverage and services in today's health insurance industry.