Chapter 13

If an employee under a group policy becomes entitled under the terms of the policy to have an individual policy issued without evidence of insurability and is not given notice of this right within ______ days prior to the expiration period, the employee must be given an additional period to exercise this right. A 25 B 15 C 20 D 30

15

A Group Health plan with _____ or more employees is primary to Medicare and pays first. A 2 B 20 C 10 D 15

20

COBRA applies to employers with: A 2 to 50 employees B 20 or more employees C 51 or more employees D 10 or fewer employees

20 or more employees

COBRA is a federal law requiring employers with _____ or more employees to provide the option of continuing the employee's existing health coverage for dependents for up to _____ months following qualifying events. A 15, 36 B 25, 45 C 20, 18 D 20, 36

20, 36

An employee is considered full time and eligible for small employer medical expense insurance if he or she works a minimum of ________ hours per week. A 30 B 25 C 40 D 20

30

A carrier replacing employer group coverage is not required to cover all employees and dependents covered by, or eligible for, coverage under the previous policy if the replacement takes place more than _____ days after of the previous policy's termination. A 90 B 10 C 30 D 60

60

Until yesterday, J. J. worked for his father's company and was covered by the company's large group health plan. He stopped working to go to college. He is 26 years of age and wants to keep the same coverage until he earns his degree in approximately 24 months. Which of the following statements is true? A A good option for J.J. is to exercise the COBRA option under his father's group plan B J.J. can obtain coverage under COBRA, but it won't be the same coverage he had under his father's group plan C As a student, J.J. is still covered under his father's group plan D J.J.'s only option is to buy a personal plan of coverage

A good option for J.J. is to exercise the COBRA option under his father's group plan

Regarding ERISA employer-sponsored employee retirement and welfare and benefit plans, which one of the following is false? A An employer is required to provide a Summary Plan Description filed with the Department of Labor explaining benefits to the employee on an annual basis B ERISA provides protections for participants and beneficiaries in employee benefit plans, including providing access to plan information C An annual financial report must be filed with the state of California's Department of Insurance D Individuals who manage plans (and other fiduciaries) must meet certain standards of conduct under the fiduciary responsibilities specified in the law

An annual financial report must be filed with the state of California's Department of Insurance

Which of the following types of policies would a sports team purchase to obtain coverage for a season? A Limited Sickness B Blanket C AD&D D Limited Accident

Blanket

An individual policy obtained through a group conversion will have higher premiums because the: A Administrative charge the employer and/or insurer can impose on the individual policy issued from a group conversion B Conversion policy will be issued at the attained (current) age of the insured C Likelihood that the employee will no longer be in as good of health as when he/she became eligible for the group coverage initially D Conversion policy will be issued at the original age of the insured at time of acceptance into the group

Conversion policy will be issued at the attained (current) age of the insured

An insurer may require the insured to verify the domestic partnership status by providing a copy of a valid ____________, an equivalent document issued by a local agency of this state, another state, or a local agency of another state under which the partnership was created. A Marriage license B Pre-marriage Counseling Certificate C Drivers license D Declaration of Domestic Partnership filed with the Secretary of State

Declaration of Domestic Partnership filed with the Secretary of State

The Americans with Disabilities Act (ADA) regulations require that disabled employees be given _______ access to the same health benefits that are provided to other employees. A Enhanced B Reduced C Limited D Equal

Equal

All of the following are true of the Coordination of Benefits Provision under a group plan, except: A It is a method of determining primary and secondary coverage when an insured is covered by more than one group policy B In the event children are covered under two group plans, the insurer for the parent who is the oldest is primary, and the other parent's plan is secondary C Secondary carriers will only pay claims that are in excess of the primary carrier's responsibility D In a spousal situation, the insurer for the claim of an employee is primary, with the spouse's plan being secondary

In the event children are covered under two group plans, the insurer for the parent who is the oldest is primary, and the other parent's plan is secondary

In the event that a group health plan changes __________, employees must be fully credited with all expenses that have accumulated toward the annual deductible and/or out-of-pocket limit. A Eligibility requirements B Insurers at the end of the plan year C Insurers in mid-year D Insurance plans with the same insurer

Insurers in mid-year

The Mental Health Parity Act prevents group health plans and health insurance issuers that provide mental health or substance use benefits from imposing ___________ on those benefits than on medical/surgical benefits. A More favorable benefits B Stricter termination requirements C Higher premiums D Less favorable benefit limitations

Less favorable benefit limitations

When group health insurance is being replaced, ongoing claims under the former policy must continue under the new policy, overriding any preexisting condition exclusion. This is a requirement under which of the following? A Replacement Regulations for Group Policies B The Preexisting Conditions Provision C The Level of Benefits Provision D No Loss - No Gain Statutes

No Loss - No Gain Statutes

A replacing insurer must assume liability for paying ongoing existing claims under which law? A ERISA B No-Loss, No-Gain C COBRA D HIPAA

No-Loss No-Gain

Group health plans usually cover: A Nonoccupational injury or disease B Occupational injury or disease C Neither occupational nor nonoccupational injury disease D Both occupational and nonoccupational injury or disease

Nonoccupational injury or disease

When underwriting group life, the underwriter treats the group as if it were: A Two groups, with all the males in one group and all the females in the other B A number of separate individuals C One individual D A substandard risk

One individual

When an individual carries more accident and health insurance than he/she would need for a loss, it is called: A Extra coverage B Excess insurance C Overinsurance D Well covered

Overinsurance

Which of the following might be done to protect against adverse selection when underwriting group medical insurance? A Enroll the business owner first B Allow coverage to begin immediately C Require a minimum percentage of the group to enroll D Include all dependents to make the group larger

Require a minimum percentage of the group to enroll

A firm with 50 employees replaces its existing group health plan. With regard to ongoing existing claims, the replacing insurer will be: A Required to stop paying them under COBRA B Required to keep paying them under the Dual Choice Provision C Required to continue paying them under the No Loss-No Gain law D Allowed to deny claims over 60 days old under ERISA

Required to continue paying them under the No Loss-No Gain law

Group blanket insurance covers a group of individuals whose membership changes frequently, such as students, passengers traveling on a common carrier, sports teams, volunteer firefighters, or other groups of people while being exposed to a(n) _______ risk: A Quantifiable B Guaranteed C Specific D Uninsurable

Specific

Under COBRA, coverage for dependents of an employee may continue up to 36 months for any of the following events, except: A Termination of the employee B The employee's eligibility for Medicare benefits C Death of the employee D Divorce or legal separation between employee and spouse

Termination of the employee

Which is not a qualifying event for the continuation of dependent coverage under the Consolidated Omnibus Budget Reconciliation Act? A Divorce or legal separation B The employee's eligibility for Medicare benefits C Death of the employee D Termination of the employee for theft

Termination of the employee for theft

Which statement is incorrect regarding COBRA? A The employee or beneficiary must respond to the notification of his/her right to continue coverage within 90 days, if he/she wants to continue the coverage B Coverage continues for 29 months for individuals receiving Social Security disability C The employer may require the former employee or beneficiary to pay an amount equal to 102% of the premium D Evidence of insurability is not required to continue coverage under COBRA

The employee or beneficiary must respond to the notification of his/her right to continue coverage within 90 days, if he/she wants to continue the coverage The employee or beneficiary must notify the employer within 60 days if he/she wants to continue the coverage.

When a group is covered by a MET, who is issued the Master Policy? A The trust B A representative for the insureds C The insurer D The sponsor

The trust