Health Insurance, Part 4

How many employees must an employer have for a terminated employee to be eligible for COBRA?

20

Ron has a new employer and wishes to enroll in the company's group health plan. In determining whether his pre-existing health condition applies, Ron cannot have more than a ____ day gap without previous health insurance

63 days

A person covered with an individual health plan: A. is issued a policy B. is issued a certificate of medical costs C. does not contract directly with the insurance company D. is not subject to medical underwriting

A

According to HIPAA, when an insured individual leaves an employer and immediately begins working for a new company that offers group health insurance, the individual: A. is eligible for coverage upon hire B. must wait 360 days to be eligible for coverage C. must continue coverage with the previous employer D. is eligible for only health insurance, not life or dental insurance

A

Under the subrogation clause, legal action can be taken by the insurer against the ___ A. responsible third party B. beneficiary C. policyowner D. State

A

Coordination of Benefits regulation applies to all of the following plans EXCEPT: A. group vision plan B. preferred provider organization plan (PPO) C. self-funded group health plan D. group health plan

B

Which of the following would be considered a possible applicant and contract policyholder for group health benefits? A. human resource department B. employer C. insured employee D. insurance company

B

The election of COBRA for continuation of health coverage will: A. increase the coverage and lower premium B. maintain the same coverage and increase premium C. increase out-of-pocket costs and lower premium D. decrease out-of-pocket costs and maintain same premium

B. Continuation of coverage under COBRA results in the same coverage with increased premiums up to 102% of prior premium

Justin is receiving a disability income benefits from a group policy paid for by his employer. How are these benefits treated for tax purposes? A. Partially taxable income B. non-taxable income C. taxable income D. conditionally taxable income

C

Under the Health Insurance Portability and Accountability Act (HIPAA), the employee's new Group Health Plan will verify Creditable Coverage so that the: A. employee's benefits still owed can be claimed B. employee cannot be excluded from the new employer's health plan C. employee's waiting period for coverage of a preexisting condition can be reduced under the new employer's health plan D. new health insurance carrier will have a clear record of any chronic conditions that exist

C

In an employer-sponsored contributory group Disability Income plan, the employer pays 60% of the premium and each employee pays 40% of the premium. Any income benefits paid are taxed to the employee at: A. employee has no tax liability B. 40% of the benefit C. 60% of the benefit D. 100% of benefit

C. because 60% of the premiums paid come from the employer

Sonya applied for a health insurance policy on April 1. Her agent submitted the information to the insurance company on April 6. She paid the premium on May 15 with the policy indicating the effective date being May 30. On which date would Sonya have coverage?

D. the "effective date" is the health insurance coverage start date which is May 30

COBRA covers termination for both let go and misconduct

FALSE. Misconduct is not covered under COBRA

A master contract and certificate of coverage can be found in which type of policy?

Group

Health insurance involves two perils, accident and ____

sickness

An insurer has the right to recover payment made to the insured from the negligent party. These rights are called:

subrogation