Group Health Insurance
Group health fundamentals
Group health insurance covers a group under one master contract, with employees receiving certificates. Underwriting focuses on the group's characteristics-size, industry, age and gender mix, claims experience-rather than individual medical underwriting. Eligibility rules define who may enroll: active full-time employees, dependents, and sometimes retirees. A contributory plan requires employees to pay part of the premium; a noncontributory plan is employer-paid. Late enrollees may face waiting periods. Open enrollment allows eligible members to add or change coverage.
Continuation and traps
COBRA generally applies to employers with 20 or more employees and allows qualified beneficiaries to continue coverage for limited periods, commonly 18 months for termination or reduced hours and longer for disability or certain family events. State continuation rules may add rights. HIPAA special enrollment allows midyear enrollment after events such as marriage, birth, or loss of other coverage. Conversion privileges may allow an individual policy when group coverage ends, but conversion is not the same as COBRA. Group rates are experience-rated and can change for the group; an individual cannot be singled out for a rate increase because of a claim.
Worked rule
When an employee leaves, first ask whether the employer is subject to COBRA and whether the employee is a qualified beneficiary. If yes, send the election notice; do not assume the group plan ends immediately.