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Understanding the Four Tier Based Group Health Insurance Programs

Many HR personnel and employees ask about what tier plan they have. To clear up the confusion below is a simple layout of tier based plans and the corresponding metal category from the National Association of Health Underwriters website.

Tier Based Group Health Insurance ProgramsHealth Insurance

“The tiers are based on the percentage the plan pays of the average overall cost of providing essential health benefits to members:

  • Platinum plans are the most generous and more expensive. These are designed to pay as much as 90% of medical expenses
  • Gold plans are designed to pay 80% of medical expenses
  • Silver plans are expected to pay 70% of medical expenses
  • Bronze plans are expected to pay 60% of medical expenses.

It’s important to note that the metal tiers reflect what the plans will pay on average. These percentages are not the same as coinsurance, which calls for an individual to pay a specific percentage of the cost of a specific service.”

Understand that these are very broad guidelines and every plan is different.  If you an employee, I encourage you to go to your HR director or whoever handles your group health insurance for your company to get plan specifics.

For full details on group health insurance read the full article from the National Association of Health Underwriters website.

http://www.nahu.org/consumer/groupinsurance.cfm

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