What is commercial insurance?
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What Is Commercial Insurance and How Does It Work?

For the most part, commercial health insurance is defined as a health insurance plan not administered by the government. (Medicare Advantage, which is a government plan, is administered by private insurance companies approved by Medicare).

You may receive commercial insurance through your employer or your spouse’s employer, or as part of your family’s plan if you meet certain criteria. Nearly half of Americans receive commercial insurance through their job, according to data from the Kaiser Family Foundation.

You can also purchase health insurance directly from an insurance carrier, through the federal marketplace, or through an insurance broker.

If you have questions about full, in-network access to UPMC doctors and hospitals, please call our help line at 1‑855‑646‑8762.

Individual vs. Group Health Insurance Coverage

Commercial insurance plans are available in two varieties: individual or group. What your employer offers is considered group coverage. Sometimes professional associations and other organizations offer group coverage as well.

  • Group plans may include varying options in coverage, and some employers offer more than one insurance carrier from which to choose. Additionally, employers often cover part of the premium’s cost for their employees.
  • Individual coverage is a health insurance plan you purchase for yourself or your family on your own. When you buy commercial insurance as an individual, you will be choosing from a list of available plans through insurers who provide them in your state.

Usually when you select a health insurance plan, you have a choice of different levels of coverage. You may opt for a plan with a high deductible but lower premium or a plan with a higher premium that requires only co-pays for doctor visits. You may also have a set list of hospitals or doctors you can see depending on the type of plan you get.

Questions about your current policy and coverage are best directed to the appropriate representative at your company, such as a supervisor or human resources representative, or by calling the customer service number on the back of your insurance card.

If you are looking to make changes to your coverage, it is important to note when your company will be having open enrollment. You can also inquire about when you are able to make changes outside of open enrollment.

If you have questions about full, in-network access to UPMC doctors and hospitals, please call our help line at 1‑855‑646‑8762.