Group Health Insurance

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

75%

Which statement best defines a Multiple Employer Welfare Arrangement (MEWA)?

A joining together by employers to provide health benefits for employee

All of the following can qualify as a trust EXCEPT

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

The classification "small employer" means any person actively engaged in a business that during the preceding year employed

At least 2 and not more than 50 persons

What is the benefit of experience rating?

It allows employers with low claims experience to get lower premiums

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

MEWAs are groups of at least 3 employers

In a group insurance, what is the policy called?

Master Policy

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

A 55-year-old employee has worked part-time for his new employer for 3 months now, but has not been offered health insurance. What factor has limited the employee's eligibility?

Number of hours worked per week

In a 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

Which of the following factors would be an underwriting consideration for a small employer carrier? a. Percentage of participation b. Claims experience c. Health status d. Medical history of the employees

a) Percentage of participation

All of the following cases show when a Small Employer Medical plan cannot be renewable EXCEPT a. When the employer chooses to renew the plan b. For nonpayment of required premiums c. When the Commissioner/Director finds that the continuation of the coverage would not be in the best interests of the policyholders d. When the small employer carrier elects to nonrenew all its health benefit plans delivered or issued for delivery to small employers

a) When the employer chooses to renew the plan

Which of the following options best depicts how the eligibility of members for group health insurance is determined? a. By the physical conditions of the applicants at the time of employment b. In such a manner as to establish individual selection as to the amounts of insurance c. By conditions of employment d. Eligibility is not determined, but simply accepted

c) By conditions of employment

After a person's employment is terminated, it is possible to obtain individual health insurance after losing the group health coverage provided by the employer. Which of the following is NOT true? a. The employee can convert from group to individual insurance within a specified number of days after termination b. The premium of the individual health insurance policy can be higher than the original policy c. By law, the new individual policy must provide the same benefits as the group insurance policy d. Continuation of group coverage need not include dental, vision, or prescription drug benefits

c) By law, the new individual policy must provide the same benefits as the group insurance policy

Which of the following statements is NOT correct concerning the COBRA ACT of 1985? a. It applies only to employers with 20 or more employees that maintain group health insurance plans for employees b. COBRA stands for Consolidated Omnibus Budget Reconciliation Act c. It requires all employers, regardless of the number or age of employees, to provide extended group health coverage d. It covers terminated employees and/or their dependents for up to 36 months after a qualifying event

c) It requires all employers, regardless of the number or age of employees, to provide extended group health coverage

In order to be eligible for group health insurance, all of these are conditions an employee must meet EXCEPT a. Must be actively at work b. Must be a full-time employee c. Must have dependents d. Must be working in a covered classification

c) Must have dependents

Which of the following groups seeking group health insurance would represent a bad risk for underwriters? a. A group that pays a low premium b. A group that has a noncontributory plan c. A group that has a large number of members d. A group that changes insurance annually

d) A group that changes insurance annually

What type of group rating uses the actual experience of the group as a factor in developing the rates to be charged?

Experience rating

An association could buy group insurance for its members if it meets all of the following requirements EXCEPT

Has at least 50 members

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

What type of information is NOT included in a certificate of insurance

The cost the company is paying for monthly premiums

In a group policy, the contract is between

The employer and the insurance company

Who is the beneficiary in a credit health policy?

The lending institution

Which of the following is true regarding METs?

They allow several small employers purchase less expensive insurance together

When employees are actively at work on the date coverage can be transferred to another insurance carrier, what happens to coinsurance and deductibles?

They carry over from the old plan to the new plan

Why do group health providers usually require a certain amount of participation in the plan by eligible employees?

To guard against adverse selection and reduce cost

If an employee terminates her employment, which of the following provisions would allow her to continue health coverage under an individual policy, if requested within a specified period of time? a. Conversion b. Replacement c. Grace period d. Renewability

a) Conversion

An insured has a primary group health plan and an excess plan, each covering losses up to $10,000. The insured suffered a loss of $15,000. Disregarding any copayments or deductibles, how much will the excess plan pay?

$5,000

COBRA applies to employers with at least

20 employees

What is the period of coverage for events such as death or divorce under COBRA?

36 months