Group Health Plans

Group health plans are insurance plans that provide health care coverage to groups of people. These are typically offered by employers.

You can always enroll for group health insurance but insurance firms will always inquire about pre-existing medical conditions or any mental or physical health ailment that was acquired before you applied for any medical insurance. Employers also inquire about your health status prior to this application. This can also happen if you make a claim during your first year of coverage. The provider may check for any conditions and can exclude coverage for services associated with that disorder for a specific duration. Fortunately, both federal and state legislation protect the citizen by imposing restrictions on these pre-existing exclusion periods under these group health plans.

How Group Health Insurance Works

Group health insurance considers cases where the policy holder received or obtained the recommendation to receive medical advice, diagnosis and treatment during the six months immediately prior to enrollment in that specific plan. This is with regards to pre-existing medical conditions. It is referred to as the look-back phase. Likewise, these plans cannot apply said conditions for circumstances such as pregnancy, birth, adoption of children and cases involving genetic information. Coverage for pre-existing conditions may be ruled out only for a limited point in time. The most is one year and you will receive credit towards the exclusion period for any preceding continuous health insurance coverage.

Once you enroll late for this group policy after you are formally hired and not for the duration of any special or regular enrollment period, it is likely that you will have longer omission period. This is meant particularly for late enrollees who are given 18 months. Potential employers can be approached for additional information. Group health insurance plans that enforce these exclusion periods should extend you credit for any prior permanent coverage.  Majority of private and government sponsored health coverage can be deemed creditable. This is computed as unbroken provided it is not disrupted by an interruption of more than 63 days continuously. The group plan is described as an employee welfare benefit policy. It is maintained by an employer or employee organization like a labor union or both. It extends medical care to participants or their direct dependents through insurance and reimbursement.


Numerous health insurance plans in the private sector are covered by the Employee Retirement Income Security Act or ERISA. On the other hand, the Employee Benefits Security Administration is accountable for administering and enforcing the provisions of ERISA. As part of implementing its responsibilities, the Department of Labor provides consumer information on health insurance plans together with compliance assistance for employers and service providers to assist them in complying with ERISA. For its part, the Fair Labor Standards Act does not address benefits such as life and long-term care insurance, medical insurance accounts or wellness benefits. These benefits are more of an arrangement between an employer and an employee. The protection may be different if you shift to a group health insurance plan which gives more benefits compared to your previous plan. Plans can go back to ascertain whether your previous plan included prescription medicine, mental health issues, substance abuse, dental treatment, and eye care.