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Fundamentals of Group Insurance

Horizontales
a large proportion of the eligible employees must elect to participate. Lower percentage such as 50-75% is typically required.
the actual loss experience of the group is a major factor in determining the premiums charged.
include both life and health insurance companies that sell both individual and group medical expense plans.
employer-sponsored benefits, other than wages, that enhance the economic security of individuals and families
the employer pays the entire premium, and 100 percent of the eligible employees are covered.
the employer pays part or all of the cost of providing health insurance to the employees.
One month’s duration, typically in the fall before the year of coverage. During this period, employees who are not enrolled and already covered employees may join the plans without evidence of insurability
the characteristics of the group are used to determine the premium, not the characteristics of the individuals in the group
typically a short time period such as 31 days after new employees report to work. During this time eligible employees can choose to be covered without providing evidence of insurability.
a commercial insurer will pay claims that exceed a certain dollar amount overall, or for a particular participant
Verticales
with certain expectations, if the employee is absent from work on the day the insurance becomes effective because of sickness, accident, or other reasons, coverage does not begin. Coverage comes into force when the employee first comes to work.
contract formed between the group policyholder and insurer for the benefit of the individual members.