Individual & Group Health Insurance Policies

Health insurance policy is an agreement with an insurance company and an individual who pays the pre-decided premium every month and in turn the insurance company helps the individual with his huge medical bills.

There are about 1500 health maintenance organization and health care providers in America who fund all political parties heavily, which in turn keeps them much mum on health insurance reforms.

How an Individual health insurance policy is different from Group health insurance Policies?

The difference between both policies can be shown by explaining some of the characteristics of each of them

Individual Health Insurance Policies

People, who do not have employer-sponsored group health coverage, do not qualify for public coverage, or self employed go for an individual health insurance Policies such as Medicare or Medicaid. These health insurance policies are more costly than group health insurance policies. Also, these policies are granted only after your health status evaluation, which involves a series of medical questionnaire or physical examination.

It is important for the buyer, of these policies to take smart decision while selecting the plan as they do not offer same level of benefits and consumer protections provided by group health insurance policies.

Many states apply some rules under individual health insurance policies like

Guaranteed issue:Applicants can be turned off for coverage based on their health status

Guaranteed renew ability:Applicant's health insurance would not get cancelled at the time of sickness.

Limits on pre-existing conditions exclusions:Depending on which state applicant live, insurers can impose exclusion riders that completely erase coverage for pre-existing conditions for the entire life of the policy..

Portability:Again depending on the state where applicant lives, he gets no credit for prior coverage and needs to wait for the entire pre-existing exclusion period

Options Available

Fee-for-Service Insurance:Also known as indemnity insurance, it pays a part of each medical service applicant get like doctor visits. It is usually costlier than managed care plans.

Managed Care Plans:In this, organizations like health maintenance organization (HMO) or preferred provider organization (PPO) provide the policies

Open Enrollment in Managed Care Plans:By some states, an "open enrollment" period is required for the manegement of care plans, every year. This helps in attracting people to join the policies, inspite of them being having an ongoing, serious medical problem.

Association-Based Health Insurance:Under this, an individual can get health insurance through a trade or professional organizations.

High-Risk Pools:High-risk pools are taken as the last options to get health insurance for people who have not been able to get health insurance because of a serious medical condition.

Individual Health Insurance Underwriting

It is the process by which the insurance company obtains and reviews information about the insurance applicant (and family, if applicable) to make a decision whether or not to insure that person, mainly focusing his health history.

For individual health insurance, the insurance company asks many questions. For the determination of contract terms between the health insurance company and the insurer, the health history of the individual is verified by the company. This verification is done with respect to the medical questionnaire and other information such as occupation, avocation etc.

Group Health Insurance Policies

Group health insurance policies or job-coverage policies provide medical coverage for many people in a single policy. The insurance policies cover groups of international employees, missionaries, or students, regardless of age or physical condition.

Small Group Health Insurance may include any employer with between 2 and 50 employees

Types of Group Health Insurance Policy

Major Medical Coverage:The coverage is most beneficial than other plans and is suitable for missionary groups, long term expatriate assignments outside the United States, or permanent Third Country Nationals and Local Nationals.

Travel Medical Coverage:This coverage is generally used for shorter periods, when some of the major medical benefits such as maternity, or mental and nervous benefits are not offered. The coverage is most beneficial for group tours, conventions, or short-term international employee assignments from one week to six months.

Changes to Group Health insurance policies

Federal and state laws can make a number of changes in group health insurance policies. Some of them are:

  • The laws can define pre-exiting medical conditions and provide some exclusion to obtain benefits.
  • Pregnancies are not considered under pre-existing condition.
  • The laws require plans to treat all eligible individuals equally.
  • Every plan must offer special enrollment period for all new dependents due to marriage, birth, adoption or placement for adoption.


A federal law, COBRA (Consolidated Omnibus Budget Reconciliation Act of 1985), allows people had left their jobs to continue their group insurance coverage for a period of time. The applicant will be charged a higher premium than when he was working.

Underwriting:In group health insurance, insurance application is relatively brief than individual insurance. No underwriting of the individual is involved as he viewed as part of the group. The acceptation and rejection of employees depend on the acceptation and rejection of the coverage.


Group health insurance plans offer many advantages including smaller premiums, discounts, and extended coverage over individual health insurance.

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