Broker Check

3 Common Misconceptions About Group Medical Insurance

| October 10, 2022

       Are you unaware of the changes that came with the Affordable Care Act, that may benefit you? Most employers are. One of the biggest problems I see is people are hesitant to use their health insurance. Not just because of cost, but because they don’t understand how the insurance works. There’s a big misconception regarding pre-existing conditions.  

      Having a pre-existing condition used to mean that the insurance companies would let you enroll into a plan, but they could decline your claim or even deny you coverage for an ailment or condition that you had before enrolling with the health insurance company. I witnessed this firsthand. I was in a horrific car accident back in 2007, where there wasn’t too much of my body, that wasn’t considered a pre-existing condition. This meant that the insurance company would not cover any of the ailments I had as a result of the car accident. Now because of the Affordable Care Act, pre-existing conditions must be covered. This major beneficial change can help so many employers and employees, but the problem is they don’t know. 

        Many believe that you can only join your company’s group medical insurance plan only once throughout the year, at a time called Open Enrollment. While this is partially correct, there are also times where life changes may qualify you for a Special Enrollment Period. A Special Enrollment Period allows for a non-participant to join the group medical insurance plan outside of the Open Enrollment period given certain conditions. These conditions include certain life changing events like losing health coverage, relocating, marriage, having a baby (baby must be born, pregnancy does not qualify), adopting a child, or if your income is below a certain amount. 

        Another misconception is believing that picking the least expensive plan means you picked the cheapest option for yourself. While this could sometimes be true, your insurance plan should fit your lifestyle. With insurance, it’s not about finding the best plan, it’s about finding the best plan that fits your health needs. If you go to the doctors quite a bit, you may need a plan that is more comprehensive, while someone who doesn’t go as often, may fit into the lowest cost option. One thing worth taking a close look at when selecting your plan is the maximum out-of-pocket. This is the maximum amount of money you are required to pay for your medical expenses throughout the year. Your monthly premiums are not included in these amounts.  

      While there are many misconceptions out there about group health insurance, these three are the ones that I encounter the most. When you’re selecting a group health plan, make sure that you’re making an educated decision. The best way to do this is by working with a knowledgeable agent and by doing research.