Group health insurance
Dependent Eligibility
- A spuse - A child younger than the limiting age - Disabled children who are incapable to self-support because of a physical or mental disability
Associations(Alumni, Professional, other)
- Can buy group insurance for its members - The group must have at least 100 members
Customer groups( Depositors, Creditor-debtor, Other)
- group life and group health insurance that covers debtors - The contract owner is the creditor, such as a bank, a small-loan company, or a credit union - The debtor is the premium payor, lending institution is the beneficiary
Employment-related groups
-(a partnership, cooperation or a sole proprietorshi) provides group coverage to its employees - Must be full time workers
COBRA
-requires any employer with 20 or more employees to extend group health coverage - to terminate one of these must happen, Voluntary termination of employment, Termination of employment for reasons other than gross misconduct, Employment status change
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?
102- The employer is permitted to collect a premium from the terminated employee at a rate of no more than 102% of the individual's group premium rate
An insured has a primary group health plan and an excess plan, each covering losses up to $10,000. The insured loss of $15,000. Disregarding any copayments or deductibles, how much will the excess plan pay?
5,000-
Jason is insured under his employer's group health insurance. He splits the cost of the premiums with his employer. This is an example of
A contributory plan
Which statement best defines a Multiple employer welfare arrangement (MEWA)?
A joining together by employers to provide health benefits for employee
Which of the following options best depicts how the eligibility of members for group health insurance is determined?
By conditions of employment
Individual health insurance use what for premium determination?
Community/pool rating- Where the premium is based upon the overall claims experience of the insurance company
In a group policy, the contract is between?
Employer and insurance company
What type of group rating uses the actual experience of the group as a factor in developing the rate to be changed?
Experience rating
As it pertains to group health insurance, COBRA stipulates that
Group coverage must be extended for terminated employees up to a certain period of time at the former employee's expense
What is the benefit of experience rating?
It allows employers with low claims experience to get lower premiums.
In group insurance, what is the policy called?
Master policy
In group underwriting can NOT have a group more than 50 why?
Medical information cannot be required of plan participants
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
Which of the following factors would be an underwriting consideration for a small employer carrier?
Percentage of participation
What type of information is NOT included in a certificate of insurance? a. The policy benefits and exclusions b. The procedures for filing a claim c. The length of coverage d. The cost the company is paying for monthly coverage
The cost the company is paying for monthly premiums
In group insurance the policy owner receives what?
The master policy and the certificate of insurance
Which group amended the National Labor Relations Act? a. ERISA b. ADEA c.MET d. Taft-Hartley
Traft-Hartley
Annual open Enrollment
a 30-day open-enrollment period is available once a year to employees who reject coverage during the inital enrollment period and later wish to have cover or to add dependent coverage
Group health insurance use what for premium determination?
experience rating- where the premiums are determined by the experience of this particular group as a whole
Which of the following would be a qualifying event as it relates to COBRA?
termination of employment due to downsizing