With health insurance, one of the most important questions to answer is who is covered.
Some people are fortunate enough to have health insurance supplied by their employer, while others have to go on to the health marketplace or elsewhere to purchase insurance.
In either case, the coverage available can vary greatly depending upon the cost of the insurance. As a general rule, the more expensive a plan is, the greater coverage it provides.
Coverage is not the only deciding factor about health insurance, but it is certainly crucial to examine the coverage a health care plan offers when making a decision.
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Individual Health Insurance
Individual health insurance is insurance that a person purchases to cover themselves and their family.
This coverage is the most common form of insurance and used to pay for medical expenses relating to those individuals covered under the plan.
Individual health insurance is not offered by your employer but is generally provided by a health insurance company.
This variety of insurance is often more expensive than group health insurance. The costs are not shared and thus the financial responsibility falls entirely on a few people or one person. This financial responsibility is the reason for the higher cost.
Group Health Insurance
Group health insurance, as contrasted by individual health insurance, is insurance that is purchased to cover a group of people. Often, this is an incentive offered by an employee to attract potential employees.
Group health insurance, generally speaking, is more affordable than individual health insurance due to the uniformity and the sharing of the costs.
Regardless of the size of the business, many plans exist for employers to offer to their employees. More expensive plans might be out of the picture, but many plans are available for even smaller companies to use.
Coverage and Individual Health Insurance
As stated previously, individual health insurance is only designed to cover a few people or a small group of people. It is not designed to cover a large number of people, like all the employees belonging to a certain employer or company.
Individual health insurance is also easier to change, as the plans are not created by a third party but by the individual and the insurance company.
Coverage from individual health insurance generally applies only to an individual and their immediate family.
Coverage and Group Health Insurance
Group health insurance is designed for a larger group of people. The benefits, terms, and coverage are more standardized since it is made for such a purpose.
Typically, only whoever is offering the group health insurance can change it which Group Health Insurance discusses in detail.
The people who are covered under the group health insurance are unlikely to have the freedom to negotiate the terms of the insurance. They did not construct the plan and therefore, it remains the same for everyone.
Group health insurance is less specific in that it may cover the family members of the insured, but sometimes it may not.
Differences in Group Health Insurance
It is most common for group health insurance to be offered by an employer to entice employees to remain with the company or to draw in new employees. In other words, it is an additional benefit of working for the employer.
Health insurance laws may vary considerably depending on the state, as discussed in Employer Sponsored Group Health Insurance.
Additionally, different employers can choose to offer different group health care plans to their employees. There is plenty of variety between such plans.
Premiums and Group Health Insurance Plans
Premiums are one of the central components of any health insurance plans, including group health insurance plans.
There are two sets of rules for premiums in such plans:
- those for smaller employers
- those for larger employers
Smaller employers must determine premium rates based on factors about the employee:
- whether or not the employee is a smoker
Larger employers base their premium rates on employee participation and any previous claims experience if such experience exists. No eligible employee can be denied coverage in such plans.
Regulation of Group Health Insurance Plans
Health insurance companies are typically the entities that fully insure employer-sponsored group health insurance plans.
The insurance company assumes all risk associated with claims in this instance and states also regulate fully insured group health insurance plans, as described by States and Group Health Insurance Plans.
The federal government regulates some provisions such as waiting periods for employees and preventative services offered by plans.
Group health insurance plans offered by larger employers are sometimes insured by the employers themselves. This self-funding, as it is called, allows an employer to alter the group health insurance plan as they like.
Group Health Insurance Plans and Sole Proprietors
Typically, group health insurance plans are offered by larger employers that can more easily afford the cost of such benefits for their employees.
However, sole proprietors may purchase such plans for their employees as well. They are required to have at least two employees in order to be eligible for group health insurance plans.
States in addition to insurance companies often enforce strict regulations on very small employers to make sure that the business is legitimate and their number of eligible employees is correct.
Some states do not allow sole proprietors to purchase group health insurance plans at all.
Stepchildren as Dependents
Typically, the insured can extend coverage to others by claiming them as dependents.
Stepchildren must be a spouse’s natural or adopted child. Additionally, the stepchild must have a stepparent included in the current marriage of the person claiming them as a dependent on their health insurance.
Otherwise, they are not eligible for coverage.
Stepchildren and Coverage
Now we return to the main question. In the event that stepchildren meet the requirements to be considered dependents, they can often receive coverage under another person’s health insurance plan.
This is the case even if the stepchild does not go to school or live with their stepparents. A married stepchild or one working a full-time job is still eligible for coverage if they are considered dependents.
Stepchildren and Health Insurance
The issue of stepchildren and health insurance is a complicated one. Health insurance is currently constructed for more traditional families and as such, it can be difficult to figure out the status of stepchildren in a health insurance plan.
However, if they can be claimed as dependents, it is likely that the stepchild can receive coverage.
If the stepchild cannot be claimed as a dependent, then it is less likely they will be able to receive coverage under their stepparent’s health insurance policy. In such a situation, they would have to seek out their own insurance.
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