Group vs. Individual Insurance Policies

Group Insurance Policies

  • Master Policy: A single master policy is issued to the entire group.
  • Individual Coverage: Each covered person within the group possesses her own individual policy certificate.
  • Standardized Benefits/Coverages: Generally, all covered members have the same core set of benefits and coverages.
  • Benefit Selection (Optional): In some group policies, each person may have the option to select certain benefits or coverage levels.
  • Eligibility: Only eligible members of the group can apply for coverage. Eligibility is usually tied to employment or membership in a specific organization.
  • Group Underwriting: Risk assessment is based on the characteristics of the entire group, rather than individual health profiles.
  • Coverage Termination: Coverage typically ceases when the member leaves the group (e.g., terminates employment).
  • Premium Payment: Coverage continues as long as the master policy premium is paid by the group sponsor or the individual members (depending on the group arrangement).
  • Cost: Generally less expensive than individual policies due to the risk pooling and economies of scale.
  • Restrictions: May have fewer options and more standardized coverage compared to individual policies.

Individual Insurance Policies

  • Individual Application: Any individual can apply for coverage.
  • Individual Underwriting: Risk assessment is based on the individual's health history, lifestyle, and other factors.
  • Coverage Continuation: Coverage continues as long as the premium is paid by the policyholder.
  • Cost: Typically more expensive than group policies because the risk is not spread across a larger pool.
  • Flexibility: Often provides more flexibility in terms of coverage options and customization to individual needs but may have more restrictions based on underwriting.