Monday, September 27, 2021

Did you know, all of the following statements regarding group health insurance is true except?


Health insurance is one of the most important investments for an individual. It will protect you and your family during any trouble. Individual health insurance is common for a wise man to do. So, let's introduce a new term, Group health insurance. Do you know what is it? Let's start exploring. 

What is group health insurance?

Group means a bunch of people, therefore group health insurance means a bunch of people who have been covered with health insurance plans for being members/employees of the same organization or company. The group health insurance for business will help the employees stay safe if they meet with a sudden accident. 

These group health insurance plans are commonly known as corporate health insurance. So, why do companies buy group health policies? The reason is, some insurance companies also provide extended group medical insurance for the family of the employee too. 

Group health insurance can be bought by any large firms(more than 1000 members). Any established startups. Companies that are small scale and have just launched in the market with at least 15 employees, can apply for a group health policy. Also, any medium-sized startup company can buy group insurance to help their employees secure them and their family. 

How does a group health insurance policy help employees and employees? 

Let's start with, 

How a group health policy helps employers? 


  • When you buy a group health policy, you pay lesser prices for group policies than individual policies. 
  • All your profits are going into tax payments? Buy group health insurance and pay no more extra taxes. According to the US government,  companies that provide insurance to their employees will have to pay fewer taxes. 
  • Does your company have health premiums? The most asked question for any employee, when they say yes, people will try to know more about the company and their benefits. It will create goodwill for your organization and add help you grow.

What about the employees? 

There are a few things to know about what health policies that benefit your employees. 

  • Employees feel motivated. If your employees are not satisfied, you will reach your company goals. Motive and make your employees happy. 
  • If your employee is hospitalized for any reason, a group health insurance policy can help him largely. This facility from the company he works for will create a genuine love and respect which in turn will be a benefit for the company.
  • A sense of care can be shown to the employee if the company provides a health policy. 

How Does a Group Health Insurance Work?

The main aim of bringing up a Group medical insurance plan is to provide health insurance coverage to each and every individual member of the group. So, that no discrimination is faced by any individual members. There are various group health insurance coverage plans. Group health insurance plans for small businesses, where a minimum of one to 50 members are needed. With just two employees including you can have a group health policy in the US. When you are issuing a group health insurance for employees, you need to keep in mind that you should have one or more full-time eligible employees. 

The group health insurance coverage will always take into consideration the inclusive and exclusive terms and conditions applied for group insurance.  It will include every member of the group, but these inclusive and exclusive rules, carry form one insurance company with another. Nearly every insurance company provides a group health insurance plan, although every company has their own rules and they follow them strictly.  The group health insurance for individuals will work exactly the same as other individuals included in the group. The group health insurance costs very little in the US. There are insurance companies who actually start the insurance premium of just rupees $40! Varied companies have varied plans, choose that plan that suits your needs. 

Key takeaways

  • Insurance coverage is extended even to the employee's family members. 
  • You have to be a participant for the plan to work out. 
  • Policy premium is split between the organization and the members/ employees. 
  • You don't have to pay separately for the insurance, it will be automatically deducted from your monthly salary. 
  • Each employee or member will be treated similarly for the health policy. 

What are things that are not covered under Group Health Insurance? 

You see, all of the following statements regarding group health insurance is true except, groups should have one or more employees to avail of the group insurance policy. Every insurance company has its policies so does the states, hence every policy and benefits dependent on the state you live in. Generally, there are few cases when the insurance coverage will not pay for you. Let's check if all of the following statements regarding group health insurance is true except, it doesn't cover any cosmetic or body enhancement surgeries. 

Case 1: Fertility treatments/therapies/medications

The group health insurance policy does not cover any treatments done for infertility. This health condition differs from country to country, therefore it cannot be said correctly. The other aspects like pregnancy and abortion also not covered under health policy. Even if the pregnancy is complicated and needs a life-threatening operation, health insurance doesn't consider this. This goes for C-section too.  There is the various insurer who provides insurance for abortion cases when the situation becomes critical for a mother. Well, let's make the point clear, voluntary abortion will not be included in the insurance, it has been money. 

Case 2: Diagnostic expenditures

There will be no insurance claim for diagnostic expenses. The diagnostics include blood tests, scans, MRI, virology tests, etc that are conducted at a nursing home or hospital.  

Case 3: Cosmetic Surgeries

If the surgery is not life-threatening and done for the mere enhancement of bodily features will not be included in the insurance. The surgeries include botox, liposuction, lip job, nose job, etc. 

Case 4: Pre-existing diseases

If you have any pre-existing diseases like blood pressure, sugar, or any autoimmune disease, insurance companies do not pay you for that. Well, here's the twist, some insurance companies do cover your pre-existing health issues and some don't. Hence choose wisely. 

Case 5: Off-label prescription drugs 

Sometimes, various drugs are not listed on the label and that can be an issue for the insurance providing company. If the drug is lot labeled, insurance companies will not pay for the expenses. There are special situations where they do, but that is a complicated process. 

Case 6: Health Supplements

If you are directed to consume health supplements and it is mentioned in your prescription, only then an insurance company will cover your expenses. 

Case 7: Alternative therapies 

Insurance companies will not cover your expenses for any alternative therapies like acupressure, Ayurveda, aromatherapy, acupuncture, etc. 

Case 8: Some medical conditions 

If you have a disease like a hernia, cataract, gallbladder removal, sinus, joint replacement, etc. The insurance companies might not cover the expenses, again, there might be some companies who do. The rules modify/vary from company to company. 

Case 9: Hospitalisations

If the employee gets admitted to a hospital and the treatment doesn't match the doctor's recommended treatment and disease, the insurance company will not cover you. 


The hospital admission fees, service charges, etc will not be covered by an insurance company.  Hence, these are the services that are not covered under group health insurance. 


Hey there, I'm Shuvam, a full time blogger who has the passion of sharing knowledge related to tech, design, finance, health, fashion and many more.
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