GHP (Group Health Plan) Health Insurance (2022)

If your goal is to have cheaper, more affordable health insurance, then enrolling in a GHP (group health plan) may be the best route to take. Group health insurance plans are health insurance coverage options that are offered by employees. To partake, you must be a full-time, or full-time equivalent employee. You can choose from three different networks - Health Maintenance Organization, Preferred Provider Organization, or Point-of-Service Plan. Each network has similarities and differences so it is important to explore and find out what is the best for you and your loved ones.

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Chris Tepedino is a feature writer that has written extensively about home, life, and car insurance for numerous websites. He has a college degree in communication from the University of Tennessee and has experience reporting, researching investigative pieces, and crafting detailed, data-driven features. His works have been featured on CB Blog Nation, Flow Words, Healing Law, WIBW Kansas, and C...

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Laura Walker graduated college with a BS in Criminal Justice with a minor in Political Science. She married her husband and began working in the family insurance business in 2005. She became a licensed agent and wrote P&C business focusing on personal lines insurance for 10 years. Laura serviced existing business and wrote new business. She now uses her insurance background to help educate...

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Reviewed by Laura Walker
Former Licensed Agent Laura Walker

UPDATED: Feb 14, 2022

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The Rundown

  • A group health plan is a health plan offered by an employer or an employee organization that provides health coverage to employees and their families
  • A GHP often requires a 70% participation rate
  • Businesses need at least one full-time or full-time equivalent employee to offer group health plan insurance

United HealthCare is one of many insurance companies that offer group health plan insurance to small and larger businesses. A GHP (group health plan) is a cheaper health insurance route to take – it covers a group instead of an individual.

There are rules to follow when involve with a group health plan. There are also different plans to choose from depending on what is best for you and your family.

Find a GHP family provider. Enter your ZIP code and get a free quote today.

What is GHP Health Insurance?

A health plan that is offered by an employer or employee organization that provides health coverage to employees and their families is known as a group health plan. Only groups, and not individuals, can enroll in group medical insurance plans.

Although all group health insurance plans are different due to variations in costs, health insurance companies, group plan types, and plan specifications, they typically share the following characteristics:

  • Often require a 70% participation rate
  • Group members have the choice of enrolling in or declining health coverage
  • Group health premiums are shared between the company and its employer
  • Family members and dependents can be added to group plans at an additional cost

Businesses need at least one full-time or full-time equivalent employee to offer group plan health insurance.

According to the Affordable Care Act (ACA), small businesses with less than 50 full-time or full-time equivalent employees are not required to offer health insurance, while larger employers with more than 50 full-time employees are required to provide group medical insurance to their workforce.

Due to the advantage of larger risk pools, group health insurance plans are often more affordable than individual health plans. For employees, premiums are paid with pre-tax dollars, reducing their taxable income. These advantages are on the employee side.

As for the employer, there is a potential for tax benefits. The money paid toward monthly employee premiums is usually tax-deductible. Eligible small businesses may be able to qualify for the small business health care tax credit.

The following are some basic facts on group health products:

  • Employers transfer all risk of loss to their insurance carrier
  • Employers pay a premium to their carrier and the rates are based on the number of employees enrolled in the plan each month
  • The Monthly premium will only change within the current year if the enrolled membership changes
  • The Insurance carrier will collect the premiums and pay the healthcare claims based on the coverage benefits outlined in the policy
  • Each person covered is responsible for paying any deductible, co-payments, and coinsurance for services covered under the policy

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What are the different types of group health plan insurance?

If you enroll in group plan health insurance, you can choose which medal plan you can be a part of. Platinum, Gold, Silver, and Bronze plans are what is available.

A platinum plan provides employees with the most benefits. It pays as much as 90% of health-related expenses and the worker covers the rest – but it tends to have higher monthly premiums.

A gold plan pays up to 80% of health-related expenses. Health-related expenses are covered up to 70% with silver plans.

Bronze plans pay the least at 60%. They offer the most affordable premiums for workers. It is a great plan for those who are healthy overall and don’t require many trips to see a physician.

Health Maintenance Organization (HMO)

Common examples of group health plans include Health Maintenance Organization (HMO) plans and Preferred Provider Organization (PPO) plans.

HMO is a plan that has its own network of doctors, hospitals, and other healthcare providers who have agreed to accept payment at a certain level for any services they provide. HMO’s two biggest characteristics include its cost and choice.

HMO usually offers lower monthly premiums than other insurance plans. They also tend to have lower copays and coinsurance, which helps make them more affordable. Although their costs are generally lower, they do not cover any out-of-network care, except in a true emergency.

If you have an HMO plan, you must choose a primary care physician from a network of local healthcare providers when you join. This provider will be the best overall picture of your health and will be the one to coordinate any additional care you might need. If you need additional care, your primary care physician would provide a referral to a specialist within the HMO’s network.

Preferred Provider Organization (PPO) 

A PPO plan offers a network of healthcare providers you can use for your medical care. These providers have agreed to provide care to the plan members at a certain rate.

Unlike an HMO, a PPO offers you the freedom to receive care from any provider – in or out of your network. You are also not required to choose a primary care physician and do not require referrals. Also, if you find yourself in need of medical care when you are away from home, you can see any healthcare provider you choose.

PPO has higher out-of-pocket costs associated with it, but it also provides more choices when it comes to your healthcare. There is also an annual deductible that must be met. If you have a PPO plan but still want to save money, remember that using in-network providers, doctors, and other healthcare professionals will help.

Being a part of this network is generally a good option for you if you want more control over your choices and don’t mind paying more for that ability. It would be helpful if you travel a lot since you would not need to see a primary care physician.

Point-of-Service Plan (POS) 

This is a type of managed care plan that is hybrid – HMO and PPO. Participants designate an in-network physician to be their primary care provider. Patients may also go outside of their provider network for health care services. You are required to get a referral from your primary care doctor, in order to see a specialist.

POS plans require the policyholder to make co-payments, but in-network co-payments are often $25 and under per appointment. This plan also does not have deductibles for in-network services, which is a significant advantage over PPOs.

Though POS plans can be up to 50% cheaper than PPO plans, rates can cost as much as 50% more than HMO rates.

Enroll in a group health plan that works best for you. Enter your ZIP code and get a free quote today.

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