ShopBenefits Case Study – Group Medical Insurance

By Guest Author Al Schiebel of ShopBenefits

A good friend of mine sent me an email with the following situation regarding health insurance.

“I am not sure what to do: individual health care insurance vs.  group – in my situation I am trying to decide what to do: 50s business owner, daughter 24 FT student, one female contractor in her 20s (husband not insured), life partner 60 who helps her is currently with an individual policy – do I consolidate them all into one group?  Do I recommend to them to get their own individual? Do I do nothing?  None of us have anywhere near adequate coverage – something must be done.  But what?  I am sure I am not the only small business owner with these issues and it is all so confusing, and so expensive – especially when no one gets good coverage it seems to me – no matter what we pay!  Maybe that is only a perception on my part.  But I feel the only thing we are doing is covering catastrophic debt – not covering actual health care for people.  Please write something that can help sort this out.  We don’t mind Grady (Local public Hospital) – but we would much rather be solid citizens paying our own way.”

Every day there are folks who are facing similar dilemmas. Every situation is different and that is why a person should to talk to a qualified agent.

Since she had given me the employee info, I had more questions to ask my friend

  • How is every one’s income being reported? W-2 or 1099. At least in Georgia, most group carriers will require an employee/employer relationship to get group coverage.
  • Known medical conditions- while there are HIPAA restrictions on what to ask, information must be provided in order to get accurate rates.
  • What benefits are you looking for? Remember that cheap will result in low benefits. High benefits will mean high cost. Things to ask about – Deductibles, Co-payments, Co-insurance, Out of Pocket expenses, RX coverage, Networks. Ask about what each means.
  • How much are looking to pay for each employee. Current rules require that every employee must receive the same contribution regardless of their position. Also, in most cases, the employer must pay 50% of the cost.

While I am still coming up with solutions for my friend, the bottom line is to make sure that you speak with a person who knows what he/she is doing. Why not get advice from a local agent? You will get the same rates as if you bought on-line.

I need your help! I am looking for topics to write articles about.  Thanks.

If you need help with life, disability, health, dental and long term care insurance please contact Al Schiebel at 404-256-2171 or email

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