HealthPlan Advantage for State Bar of Georgia members

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Individual Medical vs. Employer Group Medical (Law Firms)

A question that we are often asked is "Which is the better option for me?" The table below outlines the primary differences between the two options:

	Individual Medical	Employer Group Medical
Who is the contract issued to?	The contract is issued to the individual as the primary policyholder.	The contract is issued to the employer. Each covered employee receives a certificate of coverage.
How am I eligible for coverage?	As an individual, you may purchase coverage for yourself and your eligible dependents.	The employer must sponsor the coverage.
Are there any participation requirements?	No.	Yes, a certain percentage of the eligible employees must participate in the plan.
Can I be denied coverage for medical conditions?	Yes, companies can decline applications for coverage based on health conditions. Certain health conditions may also be excluded from coverage or be cause for higher premiums.	No, if the group qualifies for coverage, all employees will be eligible for coverage.
Are pre-existing conditions covered?	Some individual policies are subject to pre-existing condition limitation periods.	Typically, if you have had credible coverage for at least 1 continuous year, pre-existing conditions will be covered.
How is maternity covered?	Some plans have limited maternity coverage available as an optional rider.	Covered as any other condition.
What plans types are available?	POS, PPO and Health Savings Accounts (HSAs).	HMO, POS, PPO, and Health Savings Accounts (HSAs).

Questions to ask yourself when trying to decide which is best for you:

Are there specific medical conditions that you are concerned about being covered?
Is anyone to be covered taking more than two prescriptions (not including birth control)?
Is maternity coverage important to you and your family?
Do you own any part of the law firm that you work for?
If necessary, would you pay at least 75% of the premium to cover your employees?

If you answered "yes" to most or all of these questions, employer group coverage is likely a better fit for you. Our consultants are waiting to assist you, Call Us at 1-800-282-8626.