What Are Group Health Insurance Plans And Who Needs

What Are Group Health Insurance Plans And Who Needs

Are you looking for a comprehensive guide on Group Health Insurance plans? We have got you covered. Medical coverage is provided by group health plans to individuals who are part of an organization or who work for a corporation. Dental, vision, and pharmacy insurance are some of the extra health services Group Health Insurance may offer. With a larger pool of people to cover potential losses, insurance companies can keep premiums cheap. In addition, members have access to affordable insurance that shields them from unforeseen medical expenses.

Offering Group Health Insurance is a must-have factor if you want to attract and retain top talent, and it will help you retain your present staff as well.  According to human resources experts, health insurance is the most valuable benefit offered by employers, followed by retirement and dental coverage. The message is loud and clear: if you want to be a competitive company, you need to offer health benefits. Insurigo Inc. is an industry-leading company offering exceptional insurance solutions customized to your business-specific needs. In this tutorial, we will help you understand the coverage, benefits, working strategy, and validity of Group Health Insurance in a detailed guide.

What is Group Health Insurance?

Health insurance plans provided by employers to their employees are known as Group Health Insurance or employer-based coverage. Because the insurer bears less risk when covering a larger number of people through a group health insurance plan, premiums for individual members tend to be more affordable.

Companies with 50 or more FTEs are required by the ACA to either pay a tax or offer health insurance to their employees and their dependents who are under 26 years old. Companies with as few as two workers must also provide group coverage, according to insurers. Self-employed individuals may be able to enroll in Group Health Insurance plans in certain states.

What is Covered by Group Health Insurance Plan?

Depending on the plan, most Group Health Insurance will pay for some or all of the following medical expenses: doctor’s visits, hospital stays, certain in- and out-patient procedures, preventative care, prescriptions, therapy (from specialists like physical and occupational therapists), and any necessary emergency care, like trips to the emergency department or urgent care center. 

Members should contact their health insurance provider to learn more about their coverage, deductible, and other financial obligations for both required and elective procedures. The coverage of mental health and alternative treatments has been broadened by several providers of Group Health Insurance plans. 

Health savings accounts (HSAs) and other forms of health reimbursement can also be offered by employers to their employees as supplementary insurance.

What is a Group Health Insurance Plan?

The health insurance coverage for your employees is provided by a Group Health Insurance plan. As an employer, you have the option to provide your workers and their qualifying dependents with health insurance through a variety of schemes. 

Because it is a group plan, the insured people share in the financial burden. Group Health Insurance is often referred to by employees as job-based health insurance, and you are free to use that terminology when explaining it to them.

Types of Group Health Insurance Plans

Group Health Insurance plans can be further analyzed based on plan type and metal type. Both give employees a range of financial options and geographical flexibility. 

Plan Types


One perk of a health maintenance organization (HMO) plan is that it usually lets workers pick their primary care physician (PCP). If the worker or their dependents have a specific health concern, their primary care physician will refer them to other specialists as needed. 

One major drawback of HMO plans is that patients are not allowed to see doctors or hospitals that are not part of their insurance network. Only in the most dire of circumstances might an exception be made. 


Patients with a PPO (Preferred Provider Organization) plan of Group Health Insurance have more freedom than those with an HMO plan to see any doctor, even if they aren’t part of the company’s network. 


Plans that combine HMO and PPO features are called EPO plans. The plan can also be used in conjunction with a Health Savings Account by eligible employees. 

Metal Types

Platinum Plan

Employees often receive the biggest advantages from platinum plans of Group Health Insurance. Up to 90% of medical costs are covered by it, with the employee picking up the slack. In contrast, the monthly premiums are often more expensive. 

Gold Plan

Policies in the gold category cover as much as 80% of medical costs, making them comparable to platinum policies. 

Silver Plan

Up to 70% of medical costs might be covered by silver plans. 

Bronze Plan

Bronze plans cover 60% of medical costs, which is the lowest amount. The most reasonable rates of Group Health Insurance for workers are offered by them, nonetheless. In general, it’s a good approach for people who don’t need to visit the doctor very often. 

How Does Group Health Insurance Work?

Typically, organizations and businesses buy Group Health Insurance plans and then offer them to their employees and members. Individuals are unable to acquire coverage through these plans because they are exclusively available to groups. For most plans to be considered valid, at least 70% of the target population must participate. No two plans are ever identical due to the wide variety of insurers, plan kinds, prices, and terms and conditions.

Group members are offered the choice to accept or deny coverage once the organization chooses a plan. Plans may be multi-tiered in some regions, giving policyholders the choice between basic and advanced coverage with optional extras. Members and the organization each pay a portion of the premiums according to the plan. For an additional fee, Group Health Insurance can also be extended to members of the group’s immediate family and other dependents.

Since a larger number of people are covered by a Group Health Insurance policy, the overall cost is typically far less than that of an individual plan. Because more people invest in the plan, the premiums are lower and the overall cost is lower than with individual plans.

Benefits of Group Health Insurance

Opting for a Group Health Insurance policy has many benefits over purchasing individual coverage. Supplemental health insurance is offered by many businesses. These plans typically include dental, vision, and pharmacy coverage, either individually or in a bundle.

If a family has only one doctor or their alternative or individual health insurance is prohibitively expensive, they may be able to save money by adding their dependents and other family members to their group plan.

There are several tax advantages for businesses and employees alike when it comes to Group Health Insurance coverage. Employers can claim the cost of premiums paid each month as an expense, and workers might potentially lower their taxable income by paying premiums pre-tax.

The small company healthcare tax credit is another option for some smaller companies. If your company has less than 25 full-time employees, pays an average of less than $50,000 per year, provides health insurance through the SHOP Marketplace, and covers half of each employee’s health care costs (excluding family and dependents), you may be eligible for a small business health care tax credit.

How does group insurance differ from individual insurance?

Group Health Insurance is typically more affordable because it is offered through employment or an organization to which you belong. Purchasing an individual policy through an insurance provider or your state’s health insurance exchange can be a daunting and costly process.

Individual health insurance policies provide greater flexibility and choice, while Group Health Insurance plans are often less expensive. Quite often, employers will only offer a handful of plan options to their employees. Certain businesses just provide one plan type.

It is common practice to hold off on purchasing individual health insurance until the subsequent open enrollment season starts. Once a year, there is an open enrollment period. Regardless of the date, you can enroll in a group health plan when you begin a new employment.

A Guide to Purchasing Group Health Insurance

Choosing and maintaining an appropriate Group Health Insurance plan entails several labor-intensive and intricate steps:

  • Find local carriers by doing some research.
  • Please choose a plan.
  • Get quotations.
  • Locate affordable coverage that meets your requirements by comparing the results.
  • Oversee all aspects of employee enrollment, including paperwork submission to the insurance, enrollment of employees, and payroll deduction setup.
  • Maintaining tabs on enrollment changes, removing terminated employees from coverage, and tracking the eligibility of new hiring requires constant coordination between employees and your carrier.
  • Keep employees informed of the Group Health Insurance plan at various points during the plan year, such as when open enrollment is happening and when they may get help enrolling.
  • Punctuate premium payments, adhere to IRS rules, and establish and manage a state continuation program or COBRA for employees without health insurance.

Why Do Employers Need Group Health Insurance?

One strategy to recruit and keep top personnel is to provide Group Health Insurance. The majority of Americans recognize the benefits of employer-sponsored insurance due to their familiarity with group plans. By covering the costs of medical care for your employees, a group plan can boost morale and productivity.

Employers and employees alike might reap tax benefits. Employers can claim premium contributions as a tax deduction, while employees can typically collect their contributions pre-tax. Your workers will have less tax to pay because of this.

Additionally, you might be compelled by law to provide Group Health Insurance to your employees, depending on the magnitude of your company.

Is Group Health Insurance Mandatory in Texas?

Businesses in Texas are not required to offer Group Health Insurance. Employers in Texas are not required by law to offer health insurance to their employees. However, the Affordable Care Act (ACA) mandates that large employers with 50 or more full-time equivalent employees offer affordable health insurance that meets certain requirements or face fines.


When compared to other options, Group Health Insurance is among the most budget-friendly. Premiums are far lower than with conventional individual health insurance policies because risk is shared among the covered. The reason this is feasible is that the insurer takes on less risk when more individuals join the plan. This perk is especially appealing to workers who might not otherwise be able to afford private health insurance. Insurigo Inc. is a prominent company providing unmatched Group Health Insurance plans simplifying your insurance problems. You can trust us to acquire top-quality insurance solutions. Call us now or get a quote for a free consultation.


Is it still possible for people who aren’t employed to get group health insurance?

Employers are the most common source for group health insurance. On the other hand, group plans are available to members of certain associations and professional groups. The advantages of group coverage can also be accessible to people when small enterprises join group plans through professional employer associations.

Who is eligible for group health insurance plans?

By combining their risks and finding more economical healthcare choices, businesses can offer group coverage to their employees if they reach a specific employee threshold.

Are there any legal requirements for providing group health insurance?

The Affordable Care Act (ACA) places certain obligations on big businesses, but no federal law requires them to offer health insurance. If they don’t provide affordable health coverage that satisfies particular standards, employers with 50 or more full-time employees may be subject to penalties.

Can small businesses benefit from group health insurance plans?

Yes, group health insurance has a lot to offer small businesses. Providing competitive health benefits enables them to draw in and keep top talent while enhancing employee well-being overall.

 Is group health insurance required for companies to have?

Offering group health insurance can be a great way for companies to recruit and keep bright workers, even if it’s not required in many regions. Certain industries or firm sizes may be subject to special laws in some countries.