Group Health and Blanket Insurance
The Insurance Guaranty Association
According to the Coordination of Benefits provision in health insurance in this state, if insurer overpaid on a claim, the insurer may recover the excess from all of the following EXCEPT
Individual insurance does not require medical examinations, while group insurance does require medical examinations
All of the following are differences between individual and group health insurance EXCEPT
Has at least 50 members
An association could buy group insurance for its members if it meets all of the following requirements EXCEPT
$102
An employee insured under a group health plan has been paying $25 monthly premium for his group health coverage. The employer has been contributing $75, for the total monthly cost of $100. If the employee leaves the company, what would be his maximum monthly premium for COBRA coverage?
Group coverage must be extended for terminated employees up to a certain period of time at the former employee's expense
As it pertains to group health insurance, COBRA stipulates that
20 employees
COBRA applies to employers with at least
No, the group must be formed for a purpose other than obtaining group insurance
Can a group that is formed for the sole purpose of obtaining group insurance qualify for group coverage?
Nonpayment of premium
For which of the following reasons could an insurer terminate a long-term care insurance policy?
Small employer
If a firm has 50 employees at the point it applies for health coverage, what is its classification?
Community Rated
In New York, how must all medical expense health insurance sold to individuals or small groups be rated?
The employer and the insurance company
In a group policy, the contract is between
The individual insured
In a group policy, who is issued a certificate of insurance?
Master policy
In group insurance, what is the policy called?
All of the above (children at a school, children at a camp, volunteer fire department)
New York law allows for which of the following groups to provide blanket accident and health insurance?
50 or more
One of the differences between group underwriting and individual underwriting is that there is little or no medical information required regarding plan participants in groups of...
Blanket
The First Street Church plans to sponsor a summer camp for the youth of their congregation. They would like to purchase insurance that would pay benefits should one of the youth get injured while participating in the camp activities. the type of policy they would likely need is a/an
Employees receive the pension and other benefits promised by their employers
The main purpose of ERISA is to ensure that
State law
The minimum number of persons to be insured under a group health insurance plan is established by
50%
To be acceptable to insurance companies, what percentage of eligible employees must be enrolled under a contributory group health insurance plan?
Third party administrator
What is another name for an Administrative- Services Only arrangement?
It allows employers with low claim experience to obtain insurance
What is the benefit of experience rating?
36 months
What is the period of coverage for events such as death or divorce under COBRA?
To provide continuation of coverage for terminated employees
What is the purpose of COBRA?
They pay deductibles or copayments that are not paid by Medicare
What is the purpose of a Medicare Carve-out or Supplements?
Catastrophic Care Benefit Plan
What type of benefit plan for group health insurance will provide coverage in the event of catastrophic illness or injury?
Basic Coverage Benefit Plan
What type of benefit plan is managed plan that is developed in conjunction with the Health Benefit plan committee?
Experience rating
What type of group rating uses the actual experience of the group as a factor in developing the rates to be charged?
Blanket insurance
What type of health insurance would be used to cover children at a Girl Scout Camp?
The cost the company is paying for monthly premiums
What type of information is NOT included in a certificate of insurance?
Partially-funded plan
What type of policy contains a coverage that is only activated upon the insured's losses reaching a certain level?
FMLA
Which of the following acts provides an employee with 12 workweeks of leave to care for a son or daughter born to that employee?
Percentage of participation
Which of the following factors would be an underwriting consideration for a small employer carrier?
A group that changes insurance annually
Which of the following groups seeking group health insurance would represent a bad risk for underwriters?
Golden parachutes
Which of the following is NOT monitored by the Employee Retirement Income Security Act - ERISA
Professional Employer Organization
Which of the following is an entity that can be hired by an employer to handle all its employee management tasks?
Divorce
Which of the following is considered a qualifying event under COBRA?
Stock profit-sharing plans
Which of the following is monitored by ERISA?
By conditions of employment
Which of the following options best depicts how the eligibility of members for group health insurance is determined?
The employer is the policyholder
Which of the following statements concerning group health insurance is CORRECT?
It requires all employers, regardless of the number or age of employees, to provide extended group health insurance
Which of the following statements is NOT correct concerning the COBRA Act of 1985?
Noncancellable and guaranteed renewable
Which renewal provisions must be included in a long term care policy issued to an individual?
The state in which the policy was delivered
Which state has jurisdiction over a group policy that covers individuals that reside in more than one state?
The insurer
Who guarantees a conventional fully- insured group plan?
The lending institution
Who is the beneficiary in a credit health policy?
