Virginia Group Health Insurance

Group health insurance is an employer sponsored plan and can be established for the self-employed, associations, sole proprietorships, partnerships or corporations.  Group health, life, disability, dental and other supplemental plans can be established for companies with as few as only two employees to large corporations with hundreds or thousands of employees.  For employers in Virginia and most states, there are many advantages to employers and employees of having a group insurance plan as part of a benefit package.

Why should I as an employer or employee purchase group health insurance?

• Group health insurance helps to attract and retain quality employees. 
• Group benefits can be offered on a voluntary or involuntary basis. 
• Premiums paid by the employer are generally tax deductible as a business expense. 
• Premiums paid by the employee can generally be paid on a pre-tax basis unlike personal plans or family plans. 
• New employees joining a group insurance plan usually do not have to pass through medical underwriting.  Your acceptance is usually guaranteed without regard to pre-existing medical conditions or illnesses you may have.  You can't be turned down. 
• Benefits such as maternity, disability insurance, dental insurance, life insurance, long-term care insurance and other supplement plans can usually be packaged with your group health insurance plan.  The costs and premiums for many of these options can be more affordable and conveniently deducted from each paycheck. 
• Group health insurance can generally be continued under COBRA for a period of time should an employee be laid off or decide to change careers.
•  Dependents such as a spouse or children can be added to group insurance plans taking advantage of group pricing and the family deductibles and out-of-pocket expense limits. 
• Group insurance generally offers excellent preventive care for routine physicals, mammograms, immunizations, well baby and well child visits, etc.  There are also wellness programs with emphasis on diet and exercise to lose weight, smoking cessation, medication maintenance and employee assistance programs for advice and counseling.  These ancillary plans are generally free of charge to employees. 
• Pre-existing condition waiting periods are generally waived if you have had other insurance prior to joining a group insurance plan.

What is COBRA?

COBRA stands for Consolidated Omnibus Budget Reconciliation Act which passed in 1986. This federal legislation provides employees that leave their employer an option to stay on the group insurance plan for a period of time, which is generally 18 months.  The employer discontinues contributing to the premium, therefore, the former employee bears the full cost of the plan.  The option to exercise COBRA is a 60 day period after the group insurance coverage has ended.  This allows individuals that are changing jobs or careers to transition smoothly from one group insurance plan to another without fear of being uninsured.  This is especially important if there are pre-existing medical conditions to be concerned about.

What is HIPPA?

HIPPA stands for the Health Insurance Portability and Accountability Act.  While this legislation has many parts, most people are familiar with a couple of the major provisions.  One aspect deals with protection of your personal and private information.  There is a great deal of sensitivity today among employers, insurance companies, and other organizations.  The other aspect of HIPPA, as it relates to insurance, is an important one.  You may find yourself in a situation, especially in today's economy, whereby your options to continue health insurance have run dry.  This could include your COBRA extension time elapsing, your employer may have closed its doors or your insurance company may have discontinued offering coverage in Virginia.  Being HIPPA qualified or eligible allows you to move to a personal plan without underwriting or waiting periods for pre-existing medical conditions.  Prior to 1996, this important consumer protection did not exist.

Is group health insurance less expensive than a personal plan?

It can be, but not always.  There are some important factors to consider.  Group health insurance generally provides more benefits than individual personal plans.  An example would be maternity benefits.  There are many other mandated coverages in group insurance which means that it may not necessarily be less expensive.  You may not need these mandated benefits and would rather tailor a plan to you specifications rather than the cookie cutter group plan.  Here are some questions you should consider:

ý      Is the employer contributing a portion of the premium thereby making the net cost less expensive for me?  Tip!  Employers in Virginia are required by law to contribute a minimum of 50% of the employee only premium cost.

ý      Does the employer contribute anything towards the cost for my dependents?  If not, would I be better to shop for a personal plan for my dependents?

ý      Do my dependents or I have health conditions that would make it difficult to purchase a personal plan?

ý      Does the group insurance plan require that I pay a portion of my premium based on age or do employees of all ages pay the same amount?