Do Your Homework When Buying Group Health Insurance

By Insurance.com Posted : 09/16/2004

With any group health insurance plan that you choose, there are always going to be limits to that plan, and before you purchase a particular group health insurance plan for your company, you will want to do your homework. For instance, you will want to find out what is offered and covered under the proposed group health insurance policy and if the health insurance company is financially sound. If they are in the midst of a merger for example, or not as financially stable as you would like, their delivery of service may not be as good as is promised.

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It is also important to understand what kind of features and benefits will be provided in the health plan that you are buying. In some cases, a group health insurance plan will be presented with a summary of benefits, but this is just a summary. For complete details as to what the plan consists of, or to get information on the exact ins and outs of the plan, you will need to request the information from your health insurance representative.

To help you narrow down your decision between health insurance plans, we have listed some questions and helpful tips below. These questions and tips will help keep you on track with what kind of plan you initially set out to purchase for your organization.

 

  • What happens with claims and appeals?
    Traditional health insurance plans and PPOs may require employees to file claims for reimbursement. HMOs typically require less paperwork. How fast can claims and appeals be taken care of?
  • Emergency room services.
    Is prior approval needed for an emergency room visit? Or does the plan follow the "any prudent layperson" standard-that means that if any person reasonably believes he or she is suffering from a medical emergency, the HMO cannot deny payment?
  • What is considered an out-of-pocket expense?
    Are there expenses for different kinds of health care? What are the co-pays and deductibles? What is the maximum annual and lifetime payout?
  • What is the grievance and appeals process?
    Is the appeals process internal or external? Is there a third-party arbitration for difficult issues? How much time does it take to settle a problem? What is the process for members to appeal claim denials or file other grievances?
  • What are the limitations or exclusions?
    Be sure to read the fine print. Know what services are covered under the particular group health insurance plan you are looking to purchase. Make sure you ask your healthcare provider if there are limitations or exclusions on things like experimental procedures, transplants, infertility treatments, laser eye surgery, bariatric surgery, preventative scans, mental health coverage, rehabilitation, drug therapies, and durable medical equipment.

 

Check with the Better Business Bureau (BBB) or the state insurance department, or ask for the latest member-satisfaction survey and see if there are any complaints against the health insurance company you are considering working with. In addition to calling the BBB, request the names and phone numbers of other companies and organizations who have the group health insurance plan you are considering. Call and find out why these companies have this group health insurance plan, why they like it, if they've encountered any problems, and if so, how the health insurance company handled it.

If you are interested in receiving a group health insurance policy quote for your company, log on to Insurance.com. Here you will be able to evaluate multiple rates from best-in-class health insurance providers-helping find the best group health insurance coverage for your employees and yourself.

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