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From helping you create holistic health engagement programs to providing customer service 24/7/365 days a year, we help make sure you get the right combination of benefits and services, while reducing the stress and time it takes to administer a plan.Learn how we helped this 200-person self-funded group dramatically expand its employee wellness program to address the potential for high health risks and the costs and unscheduled absences that come with them.We’ll cover more essential details in Part Two: Getting Covered.
Below, we outline the basics behind group coverage.
Group medical coverage refers to a single policy issued to a group (typically a business with employees, although there are other kinds of groups that can get coverage) that covers all eligible employees and sometimes their dependents.
In most states, Cigna offers group insurance coverage to employers with more than 50 full time employees, as well as administrative services for self-funded plans with as few as 25 full-time employees.
For information about your state, contact a Cigna representative.
With individual coverage, the insurer has historically based its premium rates (or denied coverage) on the detailed medical history of the person or family.
(The Affordable Care Act brought important changes to the individual market, including eliminating the ability of insurers to deny coverage based on preexisting conditions.) With groups such as small businesses, the insurer determines a premium price based on risk factors balanced over the entire group, using general information on members of the group, such as age or gender.Then we help you build a sustainable, winning benefits strategy that is designed to improve individual health and employee productivity while achieving long-term cost savings.Once the plan is in place, we're there when you and your employees need us.Dependents cannot enroll for coverage unless the employee has enrolled.Under the Affordable Care Act, group insurance plans are required to extend coverage to adult dependents through age 26.If you do choose to offer coverage, there are regulations you will have to follow—the most important of which we explain on this site.Though large companies may face penalties if they do not offer coverage under the Affordable Care Act, small businesses with fewer than 50 full-time-equivalent employees will not be penalized if they do not provide coverage.Some states define the self-employed as “groups of one” and require insurers to guarantee issue them coverage in the small group market.The general rule is that if an employer offers group health coverage to any full-time employees, the employer must offer coverage to all full-time employees.If you have at least 50 full-time-equivalent employees but none receive an individual premium tax credit or cost-sharing reductions (both based on income), there’s no penalty—whether or not you offer health insurance.Under federal law, small employers are guaranteed group coverage should they choose to purchase it, regardless of the employees’ health status.