HOW WE ACQUIRE OUR HEALTH INSURANCE

Most insured Americans get their health insurance through an employer sponsored health plan, which usually is a group plan.

These plans are usually partially subsidized by the employer with the employee paying a percentage of the premium.  The types of insurance offered and the amount the employee has to pay is up to the employer.

An employer is not required by law to provide health insurance for employees but generally offers it in some form as a fringe benefit. 

Increasingly, smaller businesses simply cannot afford to offer health insurance for its employees due to the high price of covering this potential benefit.

The insurance can be bought by the employer as a fully insured plan or a self-funded plan by the employer.  The differences in payment structure are the same but there are differences in the regulation of these products and how they are governed.  A fully insured product is regulated by the Georgia Office of Insurance and Fire Safety and that office can be contacted at www.gainsurance.org if there are problems with the insurance. This type of plan also must follow Georgia law on services that are mandated to be covered.   A self funded plan is a plan that is financed using the money from the employer as an insurer.  Also, these plans receive some oversight from the Georgia Department of Labor http://www.dol.state.ga.us/ for regulation or complaints.

These group plans may enable the employee to cover a spouse or partner, and their dependent children if they meet certain qualifications.

Children are covered under group plans until the age of nineteen or twenty-five if they remain a full time student.

SOME PURCHASE PRIVATE PLANS

Around 8% of insured Georgians utilize the option to purchase an individual plan.  Individual plans are quite cost prohibitive and hard to obtain. 

GOVERNMENT PROGRAMS
Many Georgians also receive health coverage through government programs on a federal or state level. These plans include: Medicare, Medicaid, Peachcare for Kids, and Veterans’ Benefits.