Group Health Insurance

If a company has 2,000 employees eligible for a contributory group life insurance program, how many would be required to participate?

1,500

What is the greatest concern of underwriters in issuing group insurance?

Adverse Selection. Adverse selection in group plans can adversely affect the plan and is generally the greatest concern to group underwriters.

What is the minimum number of group members required for maternity benefits to be covered on the same basis as nonmaternity benefits in a group medical expense plan?

15 or more. If maternity benefits are included as a part of a group plan, the group must have 15 members or more to include maternity benefits on the same basis as nonmaternity benefits.

Mark is covered under his wife's group health plan. After she is killed in an auto accident, Mark is eligible to continue coverage under COBRA for how long?

36 months. Benefits triggered by the death of a covered spouse will continue under COBRA for 36 months.

You were covered by an employer group for three years, at which time you lost your job and insurance coverage. You did not get a new job or insurance until 6 months later. Since you had a break in coverage which exceeded ___ days, preexisting condition limitations may be applied under the new plan.

63

Of the following, which individuals would probably not be considered a qualified beneficiary under COBRA?

A dependent child of the employee not currently covered under the employee's health plan. A qualified beneficiary is any individual who is covered under group health plan on the day before a qualifying event. Children adopted or born during the coverage period are considered qualified beneficiaries.

In a noncontributory group life insurance plan

all eligible employees become covered immediately after the probationary period is completed

If a company has 2,000 employees eligible for a noncontributory group life insurance program, how many would be required to participate?

2,000. Noncontributory group life plans require 100% participation.

If you or your dependents lose group medical coverage because your employment is terminated, you may be able to continue your group health coverage under:

COBRA.

Which of the following is true about conversion from group life insurance to an individual policy?

Premiums for the new policy will be based on the insured's attained age.

All of the following statements are false except:

The probationary period must run before the eligibility period.

You were covered by an employer group plan for two years before leaving your job. You acquired coverage under your new employer's group plan; however, there was a break between the two plans of 45 days during which you had no health insurance. Since the break in coverage did not exceed ____ days, the new insurer must credit you for ____ years of coverage and cannot apply a preexisting condition limitation.

63/2

When a person converts from a group health policy to an individual policy:

the individual plan will not provide the same benefits as the group plan.

When an employer sets up a group plan for its employees, the contract of coverage is between who?

The employer and the insurer. Since the employer is issued a master contract from the insurer, the contract is between the employer and the insurer. The covered employees receive a certificate of insurance which serves as proof of coverage only.

What group insurance provision is designed to eliminate duplication of benefit payments and overinsurance when an individual is covered by more than one group health plan?

Coordination of Benefits. Coordination of benefits (COB) is designed to eliminate duplication of benefit payments and overinsurance when an individual is covered by more than one group health plan. The provision does not limit the maximum amount of benefits the insured is entitled to; rather, it is designed to offer insureds the most coverage possible while eliminating overinsurance.

Which of the following statements regarding to the conversion privilege in group health insurance policies is false?

Insureds who voluntarily leave or who are terminated have 180 days to convert their coverage to an individual policy. With the conversion privilege in group health insurance, an employee who quits their job or is terminated has 31 days to exercise their right to convert without having to show evidence of insurability.

Dave started work at ABC Plumbing on May 15. ABC offers a noncontributory group life insurance plan to its employees after a probationary period. If the probationary period is the normal time period, Dave will be eligible for group life insurance on:

August 15. Typical probationary period is 90 days.

Barney and Betty are a young married couple with two small children. Each have employer sponsored major medical coverage for the entire family. Barney was born on July 22, 1982, and Betty was born on February 14, 1987. Under the gender rule, whose plan is primary for the children?

Barney's plan

Barney and Betty are a young married couple with 2 small children. Each have employer-sponsored major medical coverage for the entire family. Barney was born on July 22, 1982, and Betty was born on February 14, 1987. Under the birthday rule, whose plan is primary for the children?

Betty's plan. Birthday Rule: The coverage of the parent whose birthday is earliest in the year will be considered primary.

All of the following are characteristics of group life insurance except:

Each insured receives a policy. Each insured receives a certificate of insurance rather than an individual policy.

When underwriting a group health plan, company underwriters evaluate each individual employee of the group before making a decision to accept the group or not.

FALSE

You've been covered for 6 months under a group health policy covering 10 employees. You then decide to take a job with a larger company with a group health plan. How long must you wait to be covered under the new employer group plan?

Immediate Coverage. * In this situation, HIPPA provides that if you go to work for an employer with a group plan covering 2 or more employees, you would be covered immediately.

For those who have group health coverage and want to work past the age of 65, which coverage becomes secondary?

Medicare. For those who want to work past the age of 65, Medicare becomes the secondary payer while their group insurance remains the primary payer. The group health plan will pay first, while Medicare pays secondary.

You have been covered under your employer's group health plan for 13 months when you are offered a position with another company. Assuming the new employer's group plan covers 2 or more employees, how would the new plan treat preexisting conditions?

There would be no preexisting conditions waiting period in the new plan. If you have been covered for at least 12 months under your current group plan, and then leave your current plan, you will receive a Certificate of Prior Creditable Coverage, and your time in service under the previous plan erases the preexisting conditions limitation of your new employer's plan if you make timely entry into the new plan.

In underwriting group insurance, companies use all of the following underwriting guides to guard against adverse risk EXCEPT:

medical examinations. Medical examinations are not typically required for during the initial enrollment period for group plans.