Health Insurance Articles

Group Health Insurance And What It May Not Cover

2010-07-09

One of the most common ways for Americans to obtain health insurance coverage is by way of their employers in the form of group health insurance. This kind of coverage will often provide for not only the primary insured - the employee - but also for their spouse and children. These plans are typically less expensive for companies to underwrite than individual health care plans, owing to the larger consumer base, and as a result the premiums paid by the employee are often much lower than they would pay if they were to obtain their own insurance. But while group health can be an excellent way to cover basic health care expenses such as doctor's visits and basic prescription drug requirements, there are a number of services which are not covered by most group health insurance plans - here are a few of the most common.

First, although group coverage will still apply for those employees with pre-existing health care conditions, it will often come with a waiting period before the benefits fully kick in, and this can be anywhere from six months to a year. While these employees ultimately do receive the same coverage as their peers, it is important to know that they will have to go through a period of very limited coverage before the plan will fully assist them.

Secondly, cosmetic procedures of any kind are rarely covered. In cases where cosmetic surgery may be necessary due to chronic pain or an injury suffered at work, group insurance may be used to pay for the necessary repairs. Cases such as a cleft palate or breast reduction surgery for a female employee who is suffering back problems may be covered, but any purely cosmetic procedure will not be paid for by insurance. Thirdly, alternative medicine is often left out of group insurance plans. This is typically defined as a medicine which is used in place of conventional medicine, instead of alongside it. A treatment which involves a non-hospital setting with a practitioner that is not licensed by a medical board would fall under this category. Plans will often cover complementary medicine such as acupuncture or massage, as it works alongside traditional medicine, but anything which falls too far outside the scope of "normal" will not be covered by a group health plan.

Even with the exclusions noted above, a group health insurance plan can be an excellent way for employees and their families to find reasonable rates on coverage. In many cases, it is advisable for families to find specifically tailored plans in addition to the group health model, but at the very least it provides coverage for the most essential of services.