• Fully insured group health insurance is an employer-sponsored type of health care coverage for individuals and families. Group health plans can provide coverage for medical, dental and vision care, though not all of these plans are mandated by state and federal guidelines. Questions to ask about group health plans address the types of services covered, eligibility requirements and employer-defined waiting periods.
  
  

What Does Group Healt Insurance Cover?

• According to the Employee Benefits Security Administration, guidelines for employer-sponsored group health insurance are dictated by the Health Insurance Portability and Accountability Act of 1996, or HIPAA, and by individual state regulations. Many group health plans fall within one of the three managed-care network options: point-of-service plans (POS), health maintenance organizations (HMO) and preferred provider organizations (PPO). Each network option covers both inpatient and outpatient treatment services within a select group of providers and facilities. Both POS and PPO plan types allow some leeway in terms of seeing providers outside the network, while HMOs only cover services performed by network providers. In effect, group health plans provide an affordable means for receiving comprehensive health care coverage when compared to individual or self-insurance options.
  
  

Can Employers Exclude Certain Health Conditions From Plan Coverage?

• Under HIPAA guidelines, employers don't have to offer health insurance coverage, but the ones who do are required to cover all employees in a plan regardless of prior medical history. The same rule applies for family coverage in cases where the employee or a family member has a pre-existing health condition, according to the Employee Benefits Security Administration. Individual states may require employers to provide added protection; however, federal HIPAA regulations set the baseline requirements for all employers. Employers can only exclude coverage for a pre-existing condition for up to six months in cases where employees or family members received medical treatment or advice for the condition. In cases where no medical attention was received, the maximum time for an exclusionary period is 12 to 18 months.
  
  

Are There Waiting Periods Before Coverage Begins?

• Under HIPAA and state guidelines, employers do reserve the right to impose a waiting period before new employees become eligible for group health benefits, according to the Employee Benefits Security Administration. Employers must provide a summary plan description that explains plan coverages and provisions as well as any waiting period time lines. In cases where a waiting period applies for new employees as well as for certain pre-existing conditions, both periods must occur at the same time. What this means is a 12-month exclusionary period for a pre-existing condition coupled with a 6-month waiting period for new hires doesn't result in an 18-month waiting period for the pre-existing condition to be covered. The total exclusionary period would only be 12 months.