Health Insurance chapter 6
Welfare benefits include all of the following EXCEPT
Holiday pay
If an employer provides health insurance for its employees, which of the following is true regarding pregnancy coverage?
It must be covered to the same extent as any other medical condition
What provision may allow a small employer health benefit plan to exclude coverage for a pregnancy existing on the effective date of the coverage?
Pre-existing condition
Which of the following is monitored by ERISA?
Stock profit-sharing plans
The husband will have to select a plan from which he wants to collect benefits
The benefits will be
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
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
Who guarantees a conventional fully- insured group plan?
The insurer
Who is the beneficiary in a credit health policy
The lending institution
Which state has jurisdiction over a group policy that covers individuals that reside in more than one state?
The state in which the policy was delivered
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 the coinsurance and deductibles?
They carry over from the old plan to the new plan
What is the purpose of a medicare carve-out or supplements?
They pay deductibles or copayments that are not paid by medicare
All of the following cases show when a Small Employer Medical plan cannot be renewable EXCEPT
When the employer chooses to renew the plan.
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
An insured is covered under 2 group health plans-under his own and his spouse's. He had suffered a lose of $2,000. After the insured paid the total of $500 in deductible and coinsurance, the primary insurer covered $1,500 of medical expenses. What amount, if any, would be paid by the secondary insurer?
$500
In a noncontributory health insurance plan, what percentage of eligible employees must participate in the plan before the plan can become effective?
100%
The pregnancy Discrimination Act specifically prohibits pregnancy discrimination by employers with the minimum of how many employees?
15
What is the minimum number of employees that a small employer must have?
2 employees
Every small employer carrier must actively offer to small employers at least how many health benefits plans?
2 plans
COBRA applies to employers with at least
20 employees
A small employer can have a maximum of
50 employees
How many eligible employees must be included in a contributory plan?
75%
Jason is insured under his employers group health insurance he splits the cost of the premiums with his employer this is an example of
A Contrinutory plan
Which statement best define a Multiple Employers Welfare Arrangement (MEWA)?
A joining together by employers to provide health benefits for employees
If the head of the Department of Insurance has rules a group can apply for group health insurance, it is considered a
Discretionary group
Which of the following are unlawful with regard to the ADEA?
All of the above are unlawful
Under the Age Discrimination Employment Act, if the obligation of the employer to provide retiree health benefits, what will an individual younger than 65 receive in benefits each year?
At least the value of the Social Security benefits
Employees actively at work on the date coverage is transferred to another insurance carrier are
Automatically covered and exempt from any probationary period
Which of the following options best depicts how the eligibility of members for group health insurance is determined?
By conditions of the employment
In the event of a divorce, which of the following would allow a divorcee to continue receiving group health coverage under an insured spouse's plan for an additional 36 months?
COBRA
Which of the following statements is not correct concerning the COBRA ACT of 1985?
It requires all employees, regardless of the number or age of employees to provide extended group health coverage.
All of the following statements describe a MEWA EXCEPT
MEWAs are groups of at least 3 employers
In cases where a covered employee is eligible for Medicare benefits to treat end stage renal disease with dialysis for kidney transplant, which of the following is correct?
Medicare is the secondary payer during the first 30 months of treatment
In order to be eligible for group health insurance, all of these are conditions an employee must meet EXCEPT
Must have dependents
Which of the following factors would be a underwriting consideration for a small employer carrier?
Percentage of participation
Which of the following would be a qualifying event as it relates to COBRA?
termination of employment due to downsizing
