Across most states, a small group health plan is characterized by covering 50 or fewer enrollees. Regulated by the Affordable Care Act, the benefit design of small group health plans is crucial in ensuring compliance.
For small groups seeking adherence to large group rules, association health plans present an opportunity for multiple small groups to collaborate on a shared large group health insurance plan.
Irrespective of size, a group health insurance plan serves as a cost-effective medical coverage instrument, offering healthcare benefits to a group’s members, typically employees, at a more favorable cost compared to individual insurance. The reduced cost is attributed to various factors, including the greater predictability of claims within a group and the enhanced bargaining power with insurers due to the higher revenue represented by the group coverage.
Employees enrolled in group health plans often benefit from employer contributions toward the insurance coverage cost, a contrast to individually purchased health insurance where enrollees are responsible for the full monthly premium cost, unless income qualifies for subsidization under the Affordable Care Act.