Group vs. Individual Insurance

Before you make any changes into your existing health care coverage, it is vital you understand each plan and how it affects you. Every plan is unique and offers different benefits as well as drawbacks that must be weighed in terms of your business situation, budget, and needs. 

Take the time to study the differences and similarities between group and individual insurance policies so you can make an informed decision.

Group Insurance

Typically, group insurance is purchased through a company for its employees. It can be purchased by the company on the open market or it can be a self-insured plan. Group insurance rates are historically lower than individual policies and each employee is offered a menu of covered benefits. Except in a few circumstances, small employers cannot be turned down for medical coverage. A small employer is defined as having at least 2 employees and not more than 50 employees.

With large group health plans covering 51 or more eligible employees, health insurance companies can turn down medical coverage. Also, insurers can require a minimum number of participants to continue coverage and can cancel insurance due to nonpayment of premiums and instances of fraud.

Self-employed persons with no other employees do not qualify to purchase group health plans. However, if you are purchasing coverage for yourself and an additional family member, you qualify for a group health plan under the New Mexico Health Insurance Alliance. Another feature of group insurance is the way they treat pre-existing health conditions.

A group health plan cannot exclude pregnancy, newborn babies, or newly adopted children from coverage. There is also a limitation to so-called ‘look back’ provisions. This is where an insurer can look back and see if you received care, a diagnosis, or medical advice for a medical condition. Under a group health plan, your look back period is limited to the first six months from the time you joined the plan during their regular enrollment period.

Individual Insurance

Individual health insurance is purchased by a person for themselves or their entire immediate family members. An added bonus of individual insurance plans is the flexibility to customize your policy to your lifestyle. You can exclude maternity benefits from your policy to reduce your premiums and adjust co-pays and yearly deductibles to work within your budget.  Receiving health rates quotes for individual plans is easy. Simply complete the required information and possible terms of coverage to receive a comprehensive rate quote.

What Works Best for You and Your Family

There is no easy answer to the question of which plan is superior. Each plan has its pros and cons and only you know your unique situation. This is where Linton & Associates comes in. Our staff is on-hand to discuss your insurance needs, and our team of highly-trained professionals can assist you in determining the best plan for your lifestyle. 

Leave your question here or contact us to schedule an appointment to discuss your insurance options for your individual or business needs.