Group vs Individual Health Insurance in California.


Group health plans are superior to individual and family plans and are offered from 2 employees and up.

How many employees do you need for group health insurance?

There are several levels to group health insurance.

Small group is from 1 employee to 99 employees. If you have 2 or more employees you can offer up to 8 health companies, and 117 different and plans each employee can select from.

Midsize group is from 100 to 2,999 employees.

Large group is 3,000 or more employees.

The advantage to group over individual health insurance.

Group health insurance premiums are lower due to spreading the cost of a much larger group (many companies) than just one individual or family. The company will contribute to the employee’s premium. The company may contribute to the dependents. Many doctors today prefer, or will only take, group health insurance over individual and family plans. You normally will have a large choice of companies and plans to select from depending on your location.

Different types of group health insurance.

PPO (Preferred Provider Organization) The PPO plans offer coverage in and out of the provider network. It costs more if you go out of the network. You do not need to have a primary care physician refer you to a specialist. You can self-refer to any provider The cost is higher for the PPO plans than for the HMO or EPO.

HMO (Health Maintenance Organization) The HMO plans offer coverage only through their network. You will pay less for the HMO than for a PPO or EPO. You do need to have a primary care physician and they must refer you to a specialist.

EPO (Exclusive Provider Organization) An EPO plan is in the middle of an PPO and HMO plan. You do not need a primary care physician to refer you to a specialist. However, you cannot go out of network. You must use the providers in the EPO network. You will pay a premium that is somewhere between a PPO and HMO which makes this a very desirable plan.


There may be similar group health insurance plan for individual and family health insurance. However, if you are offered a company plan it is best to compare the plans benefits and premiums to make a choice.