Accountable care. Healthcare Infomatics. Value-based reimbursement. As medical professionals, it seems we are called on more and more to also become insurance experts. The language and logistics of health insurance grow increasingly complicated, but in order to understand the wellness and treatment options our patients may have at their disposal, we need to be educated in the terminology and vocabulary of the insurance industry.
To give an example of terms that are often used interchangeably but actually mean different things, the phrase ’group health plan' versus 'group health insurance plan'. A group health plan is defined as “an employee welfare benefit plan established or maintained by an employer or by an employee organization (such as a union), or both, that provides medical care for participants or their dependents directly or through insurance, reimbursement, or otherwise.”
Private sector group health plans are generally covered by the Employee Retirement Income Security Act (ERISA). ERISA provides protections for the participants and beneficiaries, and also provides guidelines and standards for those who administrate these plans, to ensure that the managers are acting in the best interest of the participants. Self-insured health plans, as well as medical reimbursement plans fall into this category, as well as group health insurance.
Group health insurance, on the other hand, can also be correctly referred to as employer-sponsored health insurance or job-based health insurance. A group health insurance plan is, in fact, a type of group health plan, but one that provides actual health insurance coverage. A group health policy is purchased by the employer or employee organization, and is offered to eligible participants, as well as their dependents.
Put simply, a group health insurance plan is a group health plan, but a group health plan is not always a group health insurance plan.
In addition to our continuing education classes, malpractice assistance, member events and networking opportunities, Emerald Coast Medical Association members also have the benefit of the MCMS Inc. Insurance Trust Fund, which provides affordable health and life insurance to employees, physicians and their families. This is group health insurance which offers better benefits with long term security at lower rates. Click below to learn how physicians and their employees can take advantage of this quality service.