Health Insurance can be purchased on an individual basis or as a group as long as it is attached to a business that meets certain criteria. For Medicare information you may visit our Senior Insurance page. We’ve outlined the differences between the two options below:
Healthcare Reform changed the way we purchase individual health insurance. In the past individual health insurance was fully underwritten based on a persons health and subject to declination. Now it is guaranteed issue meaning guaranteed approval. There is however a caveat, an open enrollment period has been implemented. This period is subject to change however it is generally open for 4-5 months a year. If outside of this enrollment period an individual may only apply if there has been what is called a “qualifying life event” such as marriage, childbirth, or loss of existing coverage.
- All applicants are now guaranteed issue no matter the health condition(s)
- Must enroll during annual open enrollment period. Subject to change
- Applicant may enroll outside open enrollment period if they have a qualifying life event such as marriage, newborn child, or loss of coverage
Group Health Insurance is purchased on behalf of a company and offered to its employees. This is broken into two categories. Small group and Large group. Small group is considered 2-49 eligible employees and Large group is 50+. Small group health insurance is guaranteed issue which means coverage is guaranteed without medical underwriting. This is thanks to the law AB1672 which was passed in 1993. This dramatically changes the way small group health insurance is purchased. Large group on the other hand is underwritten and subject to declination by the underwriting insurer.
- Small groups (2-49 employees) are guaranteed issue as long as they meet the 75% participation threshold
- Large groups (50+ employees) are subject to underwriting. Generally as long as a group meets certain criteria they will be able to obtain the coverage they need
- More requirements are being placed on larger groups due to healthcare reform