Ohio Group Health Insurance: To Take Or Not to Take

When it comes to looking for health insurance options for yourself or your family, it can be more cost effective to take advantage of a group policy offered through your employer. However, there are several things to note in regards to a group policy. The important question to ask is how much of the premium will you be responsible for each month. In the state of Ohio, as in other states, there is a state run agency, the Department of Insurance (herein referred to as DOI), that regulates the rates and requirements of health insurance. The DOI has certain regulations that the health insurance carriers are obliged to abide by should they wish to sell health insurance in Ohio.

There are laws governing the various types of coverage that must be provided in a group policy that vary quite drastically from that of an individual policy. For example, all Ohio group health insurance plans are required to offer maternity coverage for all female employees, spouses and children as well as short and long term disability for the employee. These are important to note, because unlike individual coverage in which these are optional riders, they greatly increase the premiums. Another incredibly important aspect of the group plan is that there are no declinable conditions under a group plan. For example, a person who has cancer could not be declined coverage through their group policy, whereas if they were trying to apply for an individual policy they would be automatically declined.

When discerning whether or not to sign on for your employer's group plan or to take out an individual policy it is most helpful to seek out the assistance of an honest agent. Be forewarned: there are many agents who will not assist you in this case...they will simply try to sell you an individual plan that may not be in your best interest. It is important to look at all of the facts. The first question that I would ask a consumer who came to me with this dilemma would be if they have any health conditions. If they have something such as Diabetes, Cancer, Rheumatoid Arthritis, etc I would immediately advise them to take the group policy because, as I explained above, it would be impossible for them to get an individual policy.

Almost as important as the first, the second question I would ask is how much it would cost them to have the group policy. Often times, especially in the downturn of our economy recently, the employer will offset some of the health coverage costs to their employees. It is not uncommon for us to see the employee's eating about 50% of the monthly premiums. If this is the case, because group policies are so much more expensive than an individual policy in most scenarios, it would be in the consumer's best interest to take out their own policy. This could potentially save them hundreds, if not thousands, of dollars a year.

It is important, however for a person and their family to weigh these options heavily as the group policy will always be a richer policy because of the extras it is required to offer. Often times a group policy will also offer dental, vision, and life insurance so there are definitely pros and cons to the group option.

I would encourage anyone in this situation, as I said before, to seek out an honest and helpful agent or if you happen to have someone within your extended family or friends who work in the Ohio health insurance world to get their opinions. It can never hurt to get all the details and weigh the positive and negative aspects of any situation!