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Large Group Health Insurance Offers More Optional Benefits

By Jeannie Monette


Usually when an insurance contract is negotiated by a business owner an account of 51 employees or more is considered a large group health insurance policy. There may be a higher number required by some insurers. Others may only consider how many of the available employees actually enroll in the plan and pay monthly premiums.

Since there are no legal requirements placed on the classifications, each insurer is free to set the number. On average, a large policy is usually considered to be over 50. However it can be higher or lower.

An insured company may start out as a small, or mid-size health care group. As the number of employees grows, that company can be moved to the next largest size group. Since a has flexibility in setting standards and percentages required to qualify for certain groups, the requirements will vary from insurer to insurer.

The higher the number of people paying premiums, the more options can be offered to the enrollees. Of course, the biggest category can afford to pay the highest benefits to them. There may be one stationary set of benefits and a number of optional ones the employee is allowed to choose from. Once a company is categorized as the biggest, there is usually no upper limit to that number imposed.

There are many factors that an insurance company takes into consideration when an applicant is being considered. The number of pregnancies is one such factor. Insurance coverage for sizable businesses can afford certain risks because a low percentage of members will suffer a specific illness and a low percentage will have an accident.

For example, a policy covers 75 individuals and five pregnancies must be paid for, the cost is high. However, if 375 are covered and the five pregnancies occur, the cost is spread out and the insurer can still make a profit. The risk ratio rises as the number of insured individuals goes up.

The corporation that applies for coverage for the employees they have will be put into a category based on either total number of people working for the corporation, or the total number of employees who will enroll in the plan. Negotiations begin with some flexibility on both sides, but they must be kept within parameters that make the policy cost effective.

In some cases, a large employer will gather their employees together and learn what their preferences are. They contract with the insurer based on those choices. Most insurers will be flexible when it comes to providing optional benefits. This makes it more likely that an employer will select their policy when it comes to providing large group health insurance.




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