Insurance · General

What is a key difference between group health insurance and individual health insurance?

Correct answer

Group insurance covers members of a group (typically employees of an employer) under one master policy, often with lower per-person cost and simplified underwriting; individual insurance is purchased by a person directly and individually underwritten/rated

  1. A Group insurance is always worse
  2. B Group insurance covers members of a group (typically employees of an employer) under one master policy, often with lower per-person cost and simplified underwriting; individual insurance is purchased by a person directly and individually underwritten/rated
  3. C Individual insurance has no premiums
  4. D They are identical

Why this is the answer

GROUP vs INDIVIDUAL HEALTH INSURANCE: GROUP INSURANCE: Covers members of a GROUP (typically employees of an employer, or members of an association) under one MASTER POLICY held by the employer/group; ADVANTAGES: often LOWER per-person cost (risk spread over the group, employer often pays part of the premium); SIMPLIFIED or NO individual underwriting (guaranteed coverage for eligible members — the group is underwritten, not each person); a certificate of coverage is issued to members; INDIVIDUAL INSURANCE: Purchased by a person DIRECTLY (e.g., via the ACA marketplace or directly from an insurer); historically individually underwritten/rated (though ACA limits health-based rating for major medical); the individual owns the policy (portable — not tied to a job); EMPLOYER GROUP plans: a major source of coverage in the US; ACA: Changed individual market underwriting (guaranteed issue, no health rating); the group vs individual distinction (group = master policy, lower cost, simplified underwriting, employer-based; individual = directly purchased, portable) is fundamental health insurance exam content.
Source: Health Insurance — Group vs Individual Insurance

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