Group health coverage is offered through an employer or other sponsor. In a common insured group structure, the insurer issues the group policy to the sponsor and covered people receive certificates. A self-funded group plan pays covered health costs from the sponsor's funds under its governing plan documents.
The Consolidated Omnibus Budget Reconciliation Act (COBRA) can allow temporary continuation after certain losses of group coverage. This unit distinguishes continuation from conversion and Marketplace coverage. Current plan notices and applicable federal or state rules determine the details.
Learning path
- Group Health and Marketplace Basics : Group versus individual contracts, employer-sponsored coverage, enrollment concepts, and how to read the group certificate.
- Group Contracts and Continuation Coverage : COBRA continuation, conversion concepts, qualifying events at a high level, and why deadlines and eligibility must be checked in current official guidance.
- Marketplace Coverage and Federal Protections : Comprehensive Marketplace coverage, essential health benefit categories, pre-existing-condition protections, and limited-benefit product distinctions.
Apply the unit
An employee leaves a job and wants to avoid a coverage gap.
- Compare available continuation and Marketplace routes, identify the plan and household facts needed, then check current official enrollment notices and deadlines before advising.
Study checkpoint
- Can you distinguish the group policy from a covered person's certificate in an insured arrangement?
- Can you explain the purpose of continuation coverage?
- Can you avoid extending comprehensive-plan protections to a limited-benefit product?