Pros and Cons
As consumers well know health insurance will drastically change in 2014, so what’s discussed today may not be the same when these changes kick in, in 2014. Group health insurance is generally associated with an employer-based plan. Individuals can also get group coverage by joining with an organization such as AARP, National Association For the Self-Employed, or other qualified groups.
Advantages of Small Business Group Health Insurance Florida
Since the cost of health care in these group plans is spread among all members, the premiums are generally much lower compared to individual plans. There is generally no health exam required to join a group plan, but some plans do require disclosure of any pre-existing conditions. One of the provisions incorporated in the Affordable Healthcare Act, which will be implemented in 2014, is the exclusion of these pre-existing conditions. What this means is – insurance companies cannot deny someone coverage if they have a pre-existing health condition.
Choosing a PPO or HMO Group Plan
Most employers, offering group health insurance in Florida, usually provide employees with several options. The two most common are Preferred Provider Organization (PPO) and Health Maintenance Organization (HMO). The differences are significant.
- PPO: This plan offers the customer a wider range of options when it comes to the network of doctors. They have what is called “in-network physicians and out-of-network physicians.” The patient choosing an in-network doctor will pay much lower co-pays and most services will be covered. This is due to the fact that these doctors have a contractual agreement with the group it is servicing. Now, a patient can choose to see an out-of-network doctor without a primary doctor’s referral. They will probably incur higher out-of-pocket expenses because these practitioners are not liable to the group contract.
- HMO: This plan generally has lower monthly premiums because the employee is limited to a group of doctors, specialists, and hospital facilities. The concept of this plan is to control costs, and this is done by utilizing a primary doctor as the hub for patient care. Contrary to the PPO plan, a patient must get a referral from their primary doctor for specialty care. Of course, emergencies are a different matter. If a patient goes outside the normal procedures, then the HMO can deny paying any claims.
Pros and Cons: Group Health Insurance Florida
- Pros: In Florida, most employers subsidize a portion of the employee’s monthly premium. Group plans generally have the same premium for families – no matter how large or small. Unlike many individual plans, most group plans do cover maternity care. This is a big benefit for couples just starting out.
- Cons: Termination from employment or membership. The federal government enacted a provision called COBRA – this gives a terminated employee the right to continue their group coverage after leaving the company. The problem is the premiums go sky high and it’s compounded by the employee is unemployed.
The type of group health insurance offered in Florida is dictated by the terms and conditions negotiated between employer and insurance provider. The information above will help each individual determine which plan is suitable for their situation.
Jesse Smedley is the Principal Broker for iHealthBrokers and the founder, president, and CEO of Smedley Insurance Group, Inc. and iHealthBrokers.com. Since the inception of SIG in 2007, Jesse has been dedicated to helping people save money on their health insurance by providing them with resources to educate themselves on all their health insurance options, both under age 65 and Medicare beneficiaries. He is featured in many publications as well as writes regularly for expert columns regarding health insurance and Medicare.