(source: The New Complete Medical and Health Encyclopedia vol. III)
In general, private health insurance coverage is one of two kinds: group and individual. Employers, unions, and other kinds of organization typically provide group insurance as an employee or membership benefit. An individual can buy individual insurance whether or not he or she is covered under a group policy. But a good group policy usually covers all the major health problems or contingencies that a person could face under normal circumstances.
Group insurance has a number of specific advantages over individual coverage, among them are the following:
In general, private health insurance coverage is one of two kinds: group and individual. Employers, unions, and other kinds of organization typically provide group insurance as an employee or membership benefit. An individual can buy individual insurance whether or not he or she is covered under a group policy. But a good group policy usually covers all the major health problems or contingencies that a person could face under normal circumstances.
Group insurance has a number of specific advantages over individual coverage, among them are the following:
- Because a number of people can be included under a single contract, with consequent savings to the insurer in sales, administrative, and claims costs, the insurer can charge less per individual covered.
- In most cases the company, union or organization holding the group contract pays part or all of the individual premiums.
- With group insurance the health of the individual insured person is usually not a major factor in determining eligibility. The insurance company is more interested in the average age and overall health status of the group. The health of individuals may become a selection factor, however, where small groups, 10 or fewer persons, are involved.
- Unless an individual leaves a job or gives up a membership, his or her group coverage cannot be canceled. Termination of the group plan itself would, of course, terminate coverage.
Despite such advantages, individual and family policies fulfill at least two fundamental needs. First, they provide coverage for persons who are not members of the insured group. Such policies may also cover those who cannot, for whatever reason, obtain group coverage. Second, the individual or family policy can provide supplementary coverage where a group plan does not meet all basic health insurance needs
Group and individual plans differ in basic ways. Where a group policy establishes the level of benefits for all group members, the individual policy can more easily be tailored to specific requirements. With the individual policy, too, each person or family is enrolled separately. The cost of individual insurance is usually substantially higher because the insurer considers the age, health status of the insured, and other factors when setting premium rates.
Group and individual plans differ in basic ways. Where a group policy establishes the level of benefits for all group members, the individual policy can more easily be tailored to specific requirements. With the individual policy, too, each person or family is enrolled separately. The cost of individual insurance is usually substantially higher because the insurer considers the age, health status of the insured, and other factors when setting premium rates.
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