Netcare Benefits Group

    Large Group  Plans

    Large group health insurance contracts, it is defined as
    greater than 50 lives and in some states may be greater that
    100. Unlike small group health insurance contracts, do not
    have to be offered on a guaranteed-issue basis, so a health
    insurance company could reject an entire large employer
    group based on its claims history. However, no individual
    employee who is eligible for benefits can be excluded from
    large group coverage based on medical history. If a carrier
    issues a policy to a large employer, then all of its eligible
    employees must be issued coverage.
    deral law mandates all group insurance contracts, including
    large group contracts, be renewed every year at the
    employer's discretion, unless there is non-payment of
    premium, the employer has committed fraud or intentional
    misrepresentation, or the employer has not complied with
    the terms of the health insurance contract.

    The law also requires health insurance companies to give
    employees credit against any exclusionary period for pre-
    existing conditions if they have had prior health insurance
    coverage within 63 days of obtaining the group coverage
    from the large employer.   Many employer-based health
    insurance plans are fully insured by a health insurance
    company. This means the employer contracts with a health
    insurance company to provide its employees benefits, pays
    premiums for such coverage, and the insurance company
    assumes all claims risk. The states regulate fully insured
    group plans.
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