Group And Individual Health Insurance Essay

1009 words - 5 pages

Group and Individual Health Insurance Policies

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Group and Individual Health Insurance Policies

Health insurance is the type of insurance coverage that relates to the cost of an individual’s medical care and surgical expenses. It is extremely important to have insurance coverage as, while no one plans to get injured, or become sick, most people, inevitably, need medical care at some point in their lives. Regardless of age, all persons should always be prepared for the worst. This includes financial preparedness in the form of obtaining health insurance, which protects the insured from unexpected high medical costs that can be incurred.
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This refers to a stipulated annual amount that individuals have to pay from their own funds, before the health plan starts to pay for any covered health care expenses.

The benefits covered under the group health plan, typically, include general medical expenses, major medical expenses, dental care expenses and optical care expenses. Pan American Life Insurance of Trinidad and Tobago (2015) highlights several benefits, under their group health insurance policy, for a company located in Trinidad and Tobago. Benefits under this group plan cover the cost of general medical expenses, up to a fixed maximum amount, while their supplementary major medical insurance covers expenses, associated with very serious or prolonged sickness and accidents, incurred in or out of the hospital. Coverage is also provided for the employees’ dental care and treatment, once the service is provided by a legally qualified dentist or orthodontist, in excess of the deductible amount. Their group policy, also, provides reimbursement of optical expenses for examinations and supplies, up to a specified amount. An employee’s claim is handled through the reimbursement of expenses, upon submission of properly documented claims.

While group health plans are used by a select group, there are other options available to persons who are not part of a select group. Individual health insurance plans cater to individuals and are customized, according to their needs and requirements. Factors such as age, health, family medical history and so forth are considered, when determining the premium amount. This type of policy is, normally, paid for by the individual and is, usually, more expensive than the group health insurance plan. It is, normally, used by persons who do not have coverage, such as the unemployed or self-employed, or those who do not have enough coverage through their employers. The policy is controlled by the individual and is, therefore, not dependent on such factors as employment, or association. The premium rate is, usually, fixed, at the time of buying the insurance and only changes depending on the individual’s needs. The individual plan, therefore, provides more freedom to cover, exactly,...

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