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Getting Into a Group Plan

The advantages of group health insurance over individual health insurance are quite discernible. There are protections that guarantee you a lot more security in coverage than individual plans. Still, there are a lot of fine lines between the protections under a group plan. Remember that a group plan can be any plan through an employer, association or large organization with a fair amount of members, or a labor union. Your protections vary on different factors, mainly whether your plan is fully insured or self-insured. Your plan is fully insured if there is a health insurance company representing your group plan that pays the coverage for healthcare. If your plan is directly covering your healthcare costs, you are under a self-insured group plan.

Even though you cannot be singled out or evaluated under a group plan on individual factors such as your health status, age or gender, you do have to be eligible for the plan. Your employer may not offer health insurance to all employees. If health insurance covers all employees, then you cannot be rejected. If the plan is exclusive and requirements must be met, you must meet these requirements in order to receive coverage by the plan. You may also be denied coverage by an HMO if you live outside the area.

Remember that you cannot be turned away, denied coverage or charged more because of your health status. This includes your medical history, genetic background and/or disabilities you may have. Again, this is called nondiscrimination. This applies to you if you are guaranteed coverage under a group plan.

One company that is well known in Nevada offers different health plans for different employees. For full time employees, it offers coverage for prescription drugs. For part time employees it does not. This is not illegal. However, this company also conserves its spending by giving a high option plan to to full time employees that are determined healthy after a full physical examination. Those that cannot pass the examination are given a different health package with less coverage. This is not allowed by law.

Even if you do not qualify for a group health plan initially, you must be given another enrollment period after certain events in your life. For example, if circumstances change for your family whom are dependents, you may be offered special enrollment.

These events may include the birth of a child, a new marriage or divorce, or death in the family. In these cases you must be offered a special 30 day enrollment period even if it is not the first time you have applied for the health insurance from that provider or group plan. If you are accepted under this special enrollment, it is not considered late enrollment and there are no consequences.