Nature of Group Insurance
MR. WATSON: All right, guys, group health. Group health is usually provided by the employer for the employee. The insurance company must take the entire group or not take the group at all. They can not pick and choose which individuals they will cover.
MR. WATSON: With group insurance, do the employees receive a policy or a certificate?
ALL: Certificate.
MR. WATSON: Who gets the master policy on these group health policies, guys?
ALL: The business and the business owner.
MR. WATSON: Who is the contract between? The employer and the insurance company. The employees are not even named. Do you agree?
ALL: Yes.
“Characteristics of group health insurance”
MR. WATSON: The group must be a “natural group.” Folks, tell me what a natural group is.
WOMAN: A group who comes together for reason other than getting group insurance.
MR. WATSON: So a natural group comes together for legitimate business reasons and not expressly for the purpose of getting insurance. An unnatural would be?
ALL: Any other reason.
MR. WATSON: An unnatural group is a group that came together for the primary purpose of buying health insurance. You can’t do that.
MR. WATSON: Some states have minimum size requirements for the group, but in many states the group can be as small “one”. Like a sole proprietor, he could get group insurance. Some states may have a minimum of 15.
Individual eligibility:
MR. WATSON: Individual eligibility:
- Maybe you have to be with that employer a minimum of one to three months, although some employers offer group coverage once you've been with the company for a month. Could even be immediately - it's up to the employer.
- Maybe only full-time employees, maybe part-timers are allowed to get it. Again, it's up to the employer.