Mid-Size Group Health Insurance Overview
Also referred to as "mid-market" group health insurance by some insurance companies, mid-size group health insurance may offer more plan choices than those offered to small groups. Each health insurance company may have their own requirements on the number of employees required to fall into mid-size group health insurance, however, the mid-sized classification is usually the next level of benefits offered after a company exceeds the 50 employee maximum for small business health insurance. A larger portfolio of plans is available under this classification and some of the plans may have greater benefits than those offered to smaller groups.
The other important distinguishing difference is that mid-size group health insurance for businesses is not guaranteed issue. This means that an insurance company may decline to insure a mid-sized group if there are too many employees with the company that have health issues. To determine this, the insurance company may ask for a claims history report from the previous health insurance company or they may have a health questionnaire that will ask about the number of employees with specific conditions such as cancer, pregnancy, diabetes or other medical conditions with high claims payouts. Individual health questionnaires are not normally required from each employee. The group is reviewed as an entity. A company that has a large proportion of employees with medical conditions or other health concerns may find it difficult to find a mid -market group health insurance company that is willing to assume the risk of insuring the group or they may find coverage at a much higher monthly premium. Usually, a company that has reached the mid-market classification will already have a group health insurance plan in effect. A high claims ratio in the previous year may prevent their current insurance company from renewing their coverage at open-enrollment. This usually falls on the anniversary date the policy was originally written. It is during this open-enrollment period that the business may make modifications to their coverage choices and insured members on the group plan may add eligible dependents. During this open-enrollment period the insurance company will also review the claims history of the group for the past year and decide if they want to renew the health insurance policy or charge a higher premium.
In researching an insurance company that offers mid-size group health insurance in your state, make sure to consider several of the options that are available to you. Also ask for quotes to be provided as both age-rate and composite. An age-rated health insurance policy will calculate the insurance premium per employee. This is based on the age and gender of the employee in most cases. Premiums will usually increase in relation to the age of the insured member. A composite mid-market group health insurance rate will provide you with one flat rate that we will be charged per employee, regardless of their age. A company may prefer composite rating because it simplifies book keeping if there is a share of cost charged to their employee's paychecks. Many companies may request their employees to pay a certain percentage of their monthly premium. With a composite rate, each employee's premium contribution will be the same.
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