| Definition | Insurance coverage provided to a group of individuals, typically employees of a company or members of an organization, under a single policy. | Insurance coverage purchased by an individual or family directly from an insurance provider or through a government exchange. |
| Policyholder | The employer or organization sponsors and holds the policy on behalf of the group members, who are typically employees or members. | The individual or family purchases and holds the policy, with no group affiliation required. |
| Coverage Selection | Group policies often offer a limited selection of plans chosen by the employer or organization, with some flexibility for employees to choose among them. | Individuals have a broader range of plans to choose from, allowing for customization based on their specific needs and preferences. |
| Premium Payment | Premiums are typically shared between the employer and employees, with contributions deducted from employees' paychecks. | Individuals are responsible for paying the entire premium, often on a monthly basis. |
| Enrollment Period | Enrollment usually occurs during specific periods, such as during initial employment or during open enrollment periods designated by the employer. | Individuals can purchase or change plans during specific enrollment periods or qualifying life events, with more flexibility in timing. |
| Portability | Coverage may be lost or limited if an employee leaves the group (employer) responsible for the policy. COBRA may provide temporary continuation coverage. | Policies are portable, and individuals can maintain coverage even if they change jobs or affiliations, as long as premiums are paid. |
| Eligibility and Participation | Eligibility is often contingent on employment or membership in the sponsoring organization, with participation required for eligible members. | Eligibility is not tied to employment or membership in an organization, allowing individuals to purchase coverage independently. |
| Plan Customization | Plans are often standardized and may have limited options for customization, with the employer selecting the plans offered to employees. | Individuals have the flexibility to choose from a variety of plans with different coverage levels, deductibles, and benefits. |
| Cost Sharing | Employers may subsidize a portion of the premium costs for employees, reducing the financial burden on individuals. | Individuals are responsible for the full cost of premiums, which can be affected by factors such as age, location, and chosen coverage level. |
| Coverage Duration | Coverage typically remains in force as long as the individual remains employed by the sponsoring organization or until the policy is terminated by the employer. | Coverage duration is determined by the individual, and policies can be maintained as long as premiums are paid, regardless of employment status. |
| Benefit Negotiations | Employers or organizations often negotiate with insurers to secure favorable rates and benefits for their group members. | Individuals negotiate directly with insurance providers and have less bargaining power compared to large groups. |
| Flexibility for Dependents | Group plans may offer coverage for dependents, but the terms and eligibility criteria vary depending on the employer's policies. | Individuals can often include dependents in their individual health insurance plans, with clear options for family coverage. |
| Control over Coverage Details | Employers or organizations have control over the selection of plans, benefits, and coverage details, limiting individual customization. | Individuals have greater control and choice in selecting coverage options, allowing for more personalized plans. |
