1. 429 POINTS
    Thomas Schaffer
    Financial Service Professional, New York Life Insurance, Raleigh,NC
    Employer based Group health plans are considered guaranteed issue, and cannot deny coverage to any individual. Some plans can impose waiting periods on certain pre-existing conditions, but no more then a year. If the employer does not really have a group plan but just pays for a series of individual plans, there could be a possibility of denial based on underwriting
    Answered on March 15, 2015
  2. 11498 POINTS
    Jason Goldenzweig
    Co-Founder, TermInsuranceBrokers.com, Goldenzweig Financial Group, Las Vegas, Nevada
    Are you asking in reference to whether setting up a group health plan can be denied or can a claim by someone under a group health plan be denied?

    Setting up a group health plan is considered guaranteed issue, but typically certain requirements are necessary to do so. For guaranteed issue status, most companies would require at least 10 people to be active under the plan (some may go to 5 as a minimum).

    Whether you're viewed as a small business or large business is essential to understand as well as they require different things for underwriting and the programs available feature varying benefit structures.

    Group health insurance quotes can vary greatly on these and other factors such as type of plan (HSA, HMO, PPO, etc.) - there are no online instant quotes for this type of coverage. These types of quotes are based on the size of your business, the industry’s SIC code, age of employees, and average employee health (although some states may not require medical underwriting). There are no instant online quotes for group health insurance.

    To secure a quote, you will need to consult with a health insurance agent (with a background in group health insurance). I would suggest consulting with an independent agent who can shop the case for you and compare options from multiple companies.

    In regards to the second part of my initial clarification question, if you're asking whether a claim can be denied if you belong to a group health plan, the answer is yes. A claim can be denied just like an individual plan if the service completed was not deemed to be medically necessary (e.g. elective cosmetic surgery). It's important to review the benefits under your health plan.

    If you'd like some help gathering the most accurate quotes and securing the coverage at the lowest cost, please send me an e-mail via the contact me button next to my name with your name and contact information to reach you at. We have an agent in our group who has a strong background in group health plans.

    I hope the information is helpful - thanks very much.
    Answered on March 16, 2015
  3. Did you find these answers helpful?

Add Your Answer To This Question

You must be logged in to add your answer.

<< Previous Question
Questions Home
Next Question >>