Health - Group Accident And Health Insurance - Quiz

In the event of a divorce, which of the following would allow a divorcee to continue receiving group health coverage under an insured spouse's plan for an additional 36 months? A) COBRA B) MSA C) HIPAA D) Social Security

A) COBRA Correct! Dependents of employees are eligible to receive group health insurance under the employee's plan. If the employee and the dependent become legally separated or divorced, or if the employee dies, the dependent will be eligible for COBRA benefits for up to 36 months.

In a group policy, who is issued a certificate of insurance? A) The individual insured B) The health care provider C) The insurance company D) The employer

A) The individual insured Correct! The individuals covered under a group insurance contract are issued certificates of insurance. The certificate tells what is covered in the policy, how to file a claim, how long the coverage will last, and how to convert the policy to an individual policy.

In group insurance, what is the policy called? A) Certificate of insurance B) Master policy C) Entire contract D) Certificate of authority

B) Master policy Correct! In group insurance the policy is called the master policy and is issued to the policyowner, which could be the employer, an association, a union, or a trust.

Can a group that is formed for the sole purpose of obtaining group insurance qualify for group coverage? A) Yes, but only if the group is over 35 people. B) No, the group must be formed for a purpose other than obtaining group insurance. C) No, a group of individuals cannot apply for group coverage unless represented by an association or trust. D) Yes, any group can apply for group coverage.

B) No, the group must be formed for a purpose other than obtaining group insurance. Correct! In order to qualify for group coverage, the group must be formed for a purpose other than obtaining group insurance; the coverage must be incidental to the group.

What is it called when a company engages in the same types of activities as a commercial insurer in dealing with its own risks? A) Group insurance B) Self-insurance C) Association D) Corporate insurance

B) Self-insurance Under some circumstances, it is possible for a business or other organization to engage in the same types of activities as a commercial insurer dealing with its own risks. When these activities involve the operation of the law of large numbers and predictions regarding future losses, they are commonly referred to as self-insurance.

A husband and wife are insured under group health insurance plans at their own places of employment, and as dependents under their spouse's coverage. If one of them incurs hospital expenses, how will those expenses likely be paid? A) The insured will have to select a plan from which to collect benefits. B) The benefits will be coordinated. C) Neither plan would pay. D) Each plan will pay in equal shares.

B) The benefits will be coordinated. Correct! Benefits will be coordinated when individuals are covered under two or more health plans.

What is a characteristic of a conventional fully-insured plan? A) The insurer assumes the risk of paying the cost of medical expenses occurring outside of the policy period B) The insurer assumes the risk of paying the cost of medical expenses occurring during the policy period C) It provides administrative services only, and no insurance protection D) It is funded by small employers for its employees and dependents

B) The insurer assumes the risk of paying the cost of medical expenses occurring during the policy period Correct! A conventional fully-insured plan is administered and guaranteed by an insurance company. In return for the premium collected from the insured by the insurer, the insurer assumes the risk of paying the cost of medical expenses that may or may not occur during the policy period.

What is the purpose of the ADEA (Age Discrimination in Employment Act of 1967)? A) To allow leave to employees for family needs B) To prohibit age discrimination in employment C) To ensure employees receive pension and other benefits D) To promote employment of minorities

B) To prohibit age discrimination in employment Correct! The Age Discrimination in Employment Act of 1967 serves to promote employment of older persons based on their ability rather than age, to prohibit arbitrary age discrimination in employment; to help employers and workers, and to find ways of meeting problems arising from the impact of age on employment.

J is covered under 2 group health insurance plans, his own and his wife's. After a loss, he submitted a claim to both plans. After 30 days, the plans still have not agreed on the order of the benefits to be paid. Which of the following needs to happen immediately? A) Since the primary plan hasn't paid, the secondary plan is obligated to pay the benefit in full. B) The Commissioner will order the primary plan to pay the benefit in full. C) Each plan must pay the benefit in equal shares. D) The claim will be turned over to the Department of Insurance.

C) Each plan must pay the benefit in equal shares. Correct! If plans cannot agree on the order of benefits within 30 days of the receipt of all necessary claim information, these plans will immediately pay the claim in equal shares. Review Content Next Question

All of the following statements describe a MEWA EXCEPT A) MEWA employers retain full responsibility for any unpaid claims. B) MEWAs can be self-insured. C) MEWAs are groups of at least 3 employers. D) MEWAs can be sponsored by insurance companies.

C) MEWAs are groups of at least 3 employers. Correct! MEWAs are groups of at least 2 employers who pool their risks to self-insure. MEWAs can be sponsored by an insurance company, an independent administrator, or another group established to provide group benefits for participants.

Which of the following factors would be an underwriting consideration for a small employer carrier? A) Health status B) Medical history of the employees C) Percentage of participation D) Claims experience

C) Percentage of participation Coverage under a small employer health benefit plan is generally available only if at least 75% of eligible employees elect to be covered.

Which of the following statements concerning group health insurance is CORRECT? A) Each employee receives a policy. B) Under group insurance, the insurer may reject certain individuals from coverage. C) The employer is the policyholder. D) Only the employer receives a certificate of insurance.

C) The employer is the policyholder. Correct! The employer receives the master policy; each employee receives a certificate of insurance. All employees have the same coverage under the master contract.

Who is the beneficiary in a credit disability income policy? A) The estate of the borrower B) The Federal Government C) The lending institution D) The insurer

C) The lending institution Correct! Creditor group, also called credit life and credit disability income insurance, is a specialized use of group life and group health insurance. It protects the lending institution from losing money as the result of a borrower's death or disability. Generally, the creditor is the owner and the beneficiary of the policy, and the debtor is the premium payor.

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 A) 100 or more. B) 25 or more. C) Fewer than 50. D) 50 or more.

D) 50 or more. Correct! In groups of 50 or more, medical information cannot be required of plan participants.

What is the benefit of experience rating? A) It helps employers with high claims experience to get group coverage. B) It helps employees with low claims experience to become exempt from group premiums. C) It allows employers with high claims experience to obtain insurance. D) It allows employers with low claims experience to get lower premiums.

D) It allows employers with low claims experience to get lower premiums. Correct! Group health insurance is usually subject to experience rating where the premiums are determined by the experience of this particular group as a whole. Experience rating helps employers with low claims experience because they get lower premiums.