What Your Employees Need to Know About Their Group Health Insurance:

Trying to figure out the complexities of group health insurance is never easy. Even if you have a grasp of the situation, your employees may feel left in the dark. Although insurance companies include a description of benefits for new policyholders, this may not be enough to answer an employee's questions about their health care. Here are some frequently asked questions employees may have about their group health insurance plan.

1. How much do they have to pay? As the employer in a group health insurance policy, it is your responsibility to provide at least some payment for monthly premiums for the policy. It is important that your employees know exactly how much you will provide and what they will have to pay on the policy. Ideally, this should be answered before an employee signs up for your group health plan to avoid any confusion.

2. How high is their deductible? In addition to their monthly premium amounts, your employees should have a clear idea of what their annual deductible will be. This will help them decide on which plan will best suit their needs, and will be necessary if they plan on using a health savings account to help pay for their premiums.

3. Is the insurance plan HSA eligible? With the popularity of health savings accounts growing, your employees will need to know if your group health policy is HSA eligible. This means that the annual deductible must be greater than $1000 and the insurance company may not charge a co-pay for the policy.

4. Are there any exclusions in the policy? Group health insurance is just like any other type of insurance. There will be specific exclusions in your group health plan that your employees will need to know about. For example, dental care may be excluded from coverage, or preventative screenings may be excluded. It is important to get a list of exclusions for your policy from your health insurance provider.

5. Are there any available benefit riders? Benefit riders can be used to circumvent certain health insurance policy exclusions. Returning to our previous example, if dental care is excluded in a policy, there may be an available dental benefit rider that your employees can add on to their policy.

6. Can the policy be cancelled? Group health insurance policies commonly have a cancellation clause that allows the issuing insurance company to cancel the policy, sometimes without a good reason. It is important to know ahead of time if this is the case in your particular group health plan.

7. How will the policy be renewed? Many insurance companies require specific steps for a policy to be renewed, while others feature automatic renewal. Your employees will need to know what is expected of them if they wish to renew their policy.

8. Do they need to take a medical exam to be eligible for coverage? Health insurance companies will normally require an initial physical before an employee is accepted into a group health plan. Your employees may need to pay the cost of this exam out of their own pocket, or process the claim through their current insurance policy. The doctor will normally be selected by the issuing insurance company, which can complicate the issue. You may need to grant time off for these physicals if your employees cannot schedule an appointment during non-office hours.

9. Is the plan a flexible health insurance plan? To avoid cookie-cutter health insurance problems, many businesses are now offering flexible health or cafeteria style health insurance plans. This will allow your employees greater flexibility if they prefer an HMO or a PPO style plan. This is very useful is only a few of your employees want an HSA eligible insurance plan and the rest prefer an HMO.

10. Will they have coverage for a pre-existing condition? If your employees have pre-existing conditions, this can affect their group health coverage. They will need to discuss this with your insurance company representative to make sure that they will have the kind of coverage that they need.

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