Group coverage

Group medical coverage refers to a single policy issued to a group (typically a business with employees, although there are other kinds of groups that can get coverage) that covers all eligible employees and sometimes their dependents.


The total amount that must be paid in advance in order obtain coverage for a particular level of services. Usually health insurance premiums are billed and paid on a monthly basis.

Managed care

Under managed care plans such as HMOs and PPOs, the insurer or health plan pays doctors or hospitals directly for some or all of the cost of the medical services its members receive. For example, physicians may be paid a fixed annual per-member (“capitation”) rate, regardless of how many times the covered individual visits the physician.


The amount a patient pays out-of-pocket for health services before the health insurance plan pays the remaining costs. Deductibles generally apply per person per calendar year.


In many health plans, patients must pay a portion of the services they receive. This payment is called “coinsurance” and is usually a small percentage of the service cost after the plan pays benefits. For example, if the plan pays 70% of the cost, the patient pays 30% of the cost. Coinsurance is common in PPO products and less common in HMOs.

Small group market

Generally refers to the insurance marketplace for employers with fewer than 50 employees seeking group coverage. While employers with fewer than 50 full-time employees are not required to provide group insurance, group plans are offered in most states to businesses of this size. These employers can use the SHOP website to find a broker or agent in their area to help navigate their insurance options.