22 - Group Health Insurance

Which federal law requires employers with more than 20 employees to include in their group insurance plan a continuation of benefits provision for all eligible employees? A) COBRA B) OBRA C) ERISA D) TEFRA

A COBRA requires employers with more than 20 employees to include in their group insurance plan a continuation of benefits provision for all eligible employees

Which of the following is considered a disqualifying event under COBRA? A) The employer ceases to maintain any group health plan B) The employee is no longer eligible for the group health plan because of a change in the covered classes C) The employee voluntarily leaves employment with the employer D) the employee's employment is terminated by the employer

A Ceasing to maintain any group health plan is considered a disqualifying event for an employer under COBRA

Which federal law extends the minimum continuation of coverage period from 18 to 29 months for qualified beneficiaries disabled at the time of termination or reduction in hours A) COBRA B) OBRA C) ERISA D) TEFRA

B OBRA extends the minimum continuation of coverage period from 18 to 29 months for qualified beneficiaries disabled at the time of termination or reduction in hours

Which federal law is intended to accomplish pension equity but also protects group insurance plan participants? A) COBRA B) OBRA C) ERISA D) TEFRA

C ERISA is intended to accomplish pension equity but also protects group insurance plan participants

Which of the following is NOT Part of the qualification process for legal dependency? A) relationship to the insured B) residency in the home C) eligibility for insurance D) Listing on the insured's tax return as ta dependent

C Eligibility for insurance is not part of the qualification process for legal dependency.

Which federal law is intended to prevent group term life plans from discriminating in favor of key employees A) COBRA B) OBRA C) ERISA D) TEFRA

D TEFRA is intended to prevent group term life plans from discriminating in favor of key employees

The Americans with Disabilities Act A) does not apply to acquired diseases such as AIDS B) permits exclusion of benefits for individual distinct groups of afflictions, such as cancer, muscular dystrophy, or kidney disease C) applies to all employers with 25 or more employees D) requires that employees with disabilities be given equal access to whatever health insurance is provided to other employees

D The American with Disabilities Act requires that employees with disabilities be given equal access to whatever health insurance is provided to other employees

The conversion privilege allows the insured to continue group coverage without A) paying individual premiums B) filling out an application C) providing proof of termination of employment D) providing evidence of insurability

D The conversion privilege allows the insured to continue group coverage without providing evidence of insurability.

The coordination of benefits provides that when a person is covered under more than one plan, the total benefits cannot exceed A) the greater of the benefits provided B) the lesser of the benefits provided C) both of the benefits combined D) the total medical expenses or loss of wages

D The coordination of benefits provision provides that when a person is covered under more than one plan, the total benefits cannot exceed the total medical expenses or loss of wages.

Which of the following provisions is NOT a part of HIPAA? A) Employers must make full health care coverage available immediately to newly hired employees who were previously covered for at least 18 months B) New mothers and their babies must be allowed to stay in the hospital for at least 48 hours after regulatory delivery C) Small employers may not be denied group health insurance coverage because one or more employees is in poor health D) Annual limits and lifetime spending limits may be applied to mental health coverage

D Applying annual limits and lifetime spending limits to mental health coverage is not a part of HIPAA

Carla enrolls in group insurance when she is eligible under her employer's plan. Because of an administrative error, her enrollment form is never sent to the company. When she later has a claim, the insurer will A) deny the claim because it has no record of her policy B) force the employer to pay the claim because it was the employer's error C) pay the claim only if the insurer is proven to have made an error D) accept the enrollment form and all of the past due premium and pay the medical claim

D In case of an administrative error, the insurer will accept the enrollment form and all of the past due premium and pay the medical claim.

When both parents have employer-provided group coverage, the children are covered under A) the father's plan B) the mother's plan C) the plan of the parent whose birthday falls closest to the child's birthday D) the plan of the parent whose birthday falls closest to the start of the calendar year

D When both parents have employer-provided group coverage, the children are covered by the plan of the parent whose birthday falls closest to the start of the calendar year.

The Age Discrimination in Employment Act applies to employees age A) 40 or older B) 45 or older C) 50 or older D) 55 or older

A The Age Discrimination in Employment Act applies to employees age 40 or older

Under OBRA, an employer may terminate COBRA coverage because of coverage under another health plan A) as soon as the coverage is in force B) as long as the other health plan does not limit benefits for the insured's preexisting conditions C) as long as the other health plan limits for the insured's preexisting conditions D) only if the premiums for the new plan are paid entirely by the insured's new employer

B Under OBRA, an employer may terminate COBRA coverage because of coverage under another health plan as long as the other health plan does not limit benefits for the insured's preexisting conditions.

Under the coordination of benefits rule, the primary company pays A) if there is no other coverage B) as if there were no other coverage C) whatever the other coverage does not pay, up to the policy limits D) only if the other coverage refuses the claim

B Under the coordination of benefits rule, the primary company pays as if there were no other coverage.

An individual is NOT eligible for the conversion privilege if A) the insured's employment is terminated B) the insured becomes ineligible for coverage because the insured's class is no longer eligible for coverage C) the insured fails to make the conversion within 31 days D) the insured's dependent child reaches the age specified in the policy as the age of terminated dependent coverage

C The conversion period is 31 days.

Under the coordination of benefits rule, the secondary company pays A) if there is no other coverage B) as if there were no other coverage C) whatever the other coverage does not pay, up to the policy limits D) only if the other coverage refuses the claim

C Under the coordination of benefits rule, the secondary company pays whatever the other coverage does not pay, up to the policy limits

All of the following could be considered dependents except the insured's A) adopted children B) parents C) 25-year-old child who became physically disabled at 24 D) 21-year-old child who is attending college full time

C The insured's 25-year-old child who becomes physically disabled at age 24 cannot be considered a dependent.