Understanding the Costs Within Group Health Insurance

If you get group health insurance through your employer, you’ll both bear responsibility for some of the costs associated with the plan. Sometimes, you’ll pay out of pocket. Other times, your insurer will pick up the check. How do you know what’s your responsibility to pay as an employee?

Group health coverage is generally relatively simple in its cost breakdowns. However, you’ll need to take a close look at your cost benefits to understand where you need to pull out your wallet.

Understanding Your Premium Structure

All health insurance policies come at a cost. That is your premium for the service. Most insurance customers, regardless of if they have group coverage, have to pay a premium.

The thing about a group plan is that you often don’t pay the full premium for the policy. Your company will supplement the cost of part of your coverage. For example, the premium per plan participant might be $200 per month. Your employer might agree to pay $140 of this coverage. That way, you’ll only pay $60 out of your own pocket. Some employers might support the full premium cost of some or all your coverage.

How much your employer pays for your coverage will likely vary. Still, they will often tell you what your individual contribution to your plan will be. That way, you will know if you can expect any automatic deductions from your paycheck. Keep in mind, your premium costs will likely vary. This often depends on whether you only insure yourself or dependents as well.

Other Costs Under Your Plan

Most health insurance binds a participant to pay for some or all the costs of certain services. What you pay will depend on the stipulations of your individual plan.

• If your plan does not cover a certain service, you will have to pay the cost of the care in-full.
• Some plans cover certain essential health benefits at 100%. You might have to pay nothing for the service.
• For most services, you’ll have to pay a copayment. This is a fee you pay your doctor’s office. It’s generally minimal but might vary based on the type of care you receive. For example, if you see a specialist as opposed to a general practitioner, you might pay a higher copay.
• Many plans require you to reach a deductible before they pay for certain service. You’ll pay for all the costs of your medical care until you surpass the cost of the deductible. Nevertheless, you generally can receive many covered services without paying towards the deductible.

To find out how you and your employer share costs, ask them for a copy of the benefits sheet. If your employer can provide one, it will likely tell you how you will have to pay for certain services.