Group health insurance quiz

An insured is covered under 2 group health plans - under his own and his spouse's. He had suffered a loss of $2,000. After the insured paid the total of $500 in deductibles and coinsurance, the primary insurer covered $1,500 of medical expenses. What amount, if any, would be paid by the secondary insurer?

500

How many eligible employees must be included in a contributory plan?

75%

All of the following can qualify as trust EXCEPT? a. A group that has the Commissioner's permission to issue a group health insurance policy. b. An employer insuring at least 5 employees for the benefit of that employer c. A labor union that insures at least 25 members d. A group formed by two or more employers in the same field.

An employer insuring at least 5 employees for the benefit of that employer

Which of the following options best depicts how eligibility of member for group health insurance is determined?

By conditions of employment

Which of the following is considered a qualifying event under COBRA?

Divorce

When compared with the administrative cost found in individual coverage, the per capita administrative cost in group health insurance is?

Lower

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

MEWAs are groups of at least 3 employers

Can a group that is formed for the sole purpose of obtaining group insurance qualify for group coverage?

No, the group must be formed for a purpose other than obtaining group insurance

If a firm has between 2 and 50 employees that are actively engaged in business during the preceding calendar year, what is its classification

Small employer

Which act amended the National labor relations act?

Taft-Hartley

Which of the following would be a qualifying event as it relates to COBRA?

Termination of employment due to downsizing

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?

The benefits will be coordinated

Which of the following statements concerning group health insurance is CORRECT? a. The employer is the policyholder b. Only the employer receives a certificate of insurance c. each employee receives a policy d. Under group insurance, the insurer may reject certain individuals from coverage.

The employer is the policyholder

In group policy, who is issued a certificate of insurance?

The individual insured

A man works for Company A and his wife works for company B. The spouses are covered by health plans through their respective companies that also cover the other spouse. If the husband files a claim.

The insurance through his company is primary