What is the difference between individual health insurance policies and group health insurance policies?

The major difference between these two types of policies is that individual policies are underwritten based upon the individual’s age, medical condition(s) and circumstances. These policies are often more expensive than premiums for a group policy, with less benefits available.

Group policies are underwritten based upon assumptions about the general health of the group of people being covered by the policy. We typically think of group policies as insurance that you get from your employment. These policies normally provide major medical coverage with a monthly premium, some choice of deductible and 80%-20% coverage for costs incurred above the deductible (with the insurance paying 80% and you paying 20%).

Some insurance companies are selling “group” policies to individuals who join an association in order to qualify for the group coverage. These policies are vastly different from the kind you get from employment. Many of these group policies are affordable, but do not provide much, if any real health insurance benefits.

These “group” insurance policies play upon the vulnerabilities of people who either cannot qualify for, or cannot afford traditional major medical health insurance. These group insurance policies often falsely advertise their insurance as a low cost way to obtain real health insurance. Usually these policies are advertised on television or the internet and are sold over the phone by an agent from a large call center. If or when a policyholder submits a claim for insurance benefits, the claim is often delayed or denied outright. Jessica Rutzick & Associates has successfully sued many of these insurance companies selling this kind of fraudulent insurance. If you have this kind of “group” policy and your claim has been denied, call Jessica Rutzick right away for help with your claim.