Individual & Family Health Plans

Individual health insurance is, quite simply, coverage that an individual purchases for himself and/or his family. These insurance policies and provisions are regulated by the state where the policy is purchased. Individual insurance is very different than group health insurance, which is the type of insurance offered through an employer.

Obtaining Individual Health insurance no longer requires medical underwriting and no longer has pre-existing exclusions. Generally, individuals and families will need to shop for and/or change their health plan annually during the “Open Enrollment Period”.

Open Enrollment for 2016 Health Plans is scheduled for November 1st through January 31st.

If an individual or family experiences a “Life Changing Event”, they may be eligible to enroll in a plan outside of the Open Enrollment time period. Some examples of a Life Changing event would be loss of employer group coverage, expiration of COBRA benefits, Marriage, Divorce, Birth or Adoption of a child and change of residence state.

There are more details to look at when shopping for and individual health plan other than just the monthly premium. Researching the Insurance Carrier’s network, formulary, customer service and OUT of Network penalties is very important when making a decision on the right plan for you and your family.

Group Health Insurance

What is employer group health insurance coverage?

Group health insurance coverage is a policy that is purchased by an employer and is offered to eligible employees of the company (and often to the employees’ family members) as a benefit of working for that company. A group health insurance plan is a key component of many employee benefits packages that employers provide for employees. The majority of Americans have group health insurance coverage through their employer or the employer of a family member. One of the advantages for employees in a group health plan is the contribution most employers make toward the cost of the health coverage premium – in many cases, employers pay one-half or more of the monthly premium for an employee. Another advantage is that most employers have established Premium Only Plans (often called POP plans) that allow employees to pay any employee-required contributions to premiums on a pre-tax basis. Between the employer contributions, which aren’t taxable for employees, and the POP plan, employer-provided health insurance is significantly subsidized due to these tax breaks.

10 Essential Benefits

The Affordable Care Act requires that all plans cover essential health benefits for individual and family plans and small group plans.

All of our plans offer these required essential health benefits:

  • Outpatient services
  • Emergency services
  • Hospitalization
  • Maternity and newborn care
  • Mental health and substance use disorder, including behavioral health treatment
  • Prescription drugs
  • Rehabilitative and habilitative services and devices
  • Laboratory services
  • Preventive and wellness services and chronic disease management
  • Pediatric vision

Some of these benefits, like preventive services, will be paid at 100 percent with no copay. You pay for the other benefits after you meet the applicable copay, deductible or coinsurance, based up on the plan design.

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