Group health insurance is coverage offered through an employer. The employer chooses the available plans and usually pays part of the premium. Employees pay their share and any costs required when they use care.
For employers: start with the full cost
Compare the company’s contribution, what employees will pay, local provider networks, and the work required to administer the plan. A lower monthly premium does not always mean lower total costs.
- Fully insured: an insurer takes on covered claims in exchange for premiums.
- Self-funded: the employer funds covered claims. Administration and protection against large claims need careful review.
- Level-funded: payments are structured monthly, but the contract still has funding risks and conditions to understand.
For employees: know what you are choosing
Ask for the Summary of Benefits and Coverage, or SBC. This document helps you compare deductibles, copays, coinsurance, and coverage examples. Check the full plan documents for exclusions and details.
- Confirm your doctors, hospitals, and prescriptions for the exact plan.
- Compare the payroll cost for yourself and any dependents.
- Ask when coverage starts and when enrollment must be completed.
Enrollment has deadlines
New-hire enrollment, annual enrollment, and qualifying changes follow different rules. Contact your benefits administrator promptly after a change. Do not assume an enrollment window stays open until your next renewal.
Where to begin
Business owners can compare group benefit options. Employees with an existing plan can find help with coverage or a claim.
Helpful reference: HealthCare.gov: Summary of Benefits and Coverage.