If your employer provides Group Health insurance, bear in mind that these plans vary widely in cost and in what they cover.
Chances are you aren't aware of these facts about Group Health plans
- Your plan doesn't necessarily cover you. Employers are not required to provide health coverage to all workers. They can tailor benefits to specific groups of employees as long as they make clear distinctions between the groups — for example, covering full-time employees but not part-timers.
- Your health habits could affect your premiums. Many employers offer financial incentives for healthy lifestyles, such as discounts on an employee's share of premiums. At the same time, a growing number of employers apply premium surcharges for behaviors or conditions like smoking or obesity.
- Your family might not have coverage. Although many companies offer dependent coverage, they are not legally required to do so. Employers that do cover dependents may reduce subsidies, add surcharges if a spouse has other coverage, or exclude spouses from plans altogether.
- Pregnancy might not be covered. Federal rules generally require employers with 15 or more employees that offer group health plans to treat pregnancy-related expenses the same as other medical conditions; smaller employers may not be covered and state rules can vary.
- You're paying a growing percentage of the premium. Health care costs have continued to rise, and employees are typically paying a larger share of those costs than in the past. Many workers do not see the full cost of coverage until they leave a job and must secure individual coverage on their own.
Learn more about employer-sponsored plans in Understanding Group Health and Life Insurance.
For information on dependent and supplemental options, see Understanding Health and Dental Insurance Options.
If you have any questions about health insurance for you and your family, talk to an agent.
Frequently Asked Questions
Am I automatically eligible for my employer's group health plan?
Not always; eligibility rules vary by employer and may depend on hours worked or employee class, so check your plan documents or ask HR.
Can my employer charge higher premiums if I smoke or have high cholesterol?
Some employers apply premium surcharges for certain health risks or behaviors, subject to applicable nondiscrimination rules and state regulations.
Does a group plan have to cover my spouse and children?
Employers are not required to cover dependents, and contribution levels for dependent coverage can vary or change over time.
Will pregnancy always be covered under a group plan?
Large employers that offer group plans must generally treat pregnancy like other medical conditions, but coverage for small employers and plan specifics can differ by state and plan.