Group Health Insurance

An association group must have at least ______ members to be eligible for group insurance

100 members

Non-contributory plans must include ______ of eligible employees

100%

COBRA applies to employers with at least...

20 employees: employers with 20 employees or more must extend group health coverage to fired employees and their families

What is the maximum period of coverage under COBRA?

36 months

How large does a group have to be for medical information to NOT be required?

50 people or more

What percentage of eligible employees must be enrolled under a contributory health plan?

50%

How long does an individual have to apply for an individual life policy after employment termination without needing evidence of insurability?

60 days.

What is a small employer number?

Any firm with less than 100 employees.

What type of benefit plan is a MANAGED plan developed in conjunction with the Health Benefit plan committee?

Basic Coverage Benefit Plan

How is eligibility for members of group health determined?

By conditions of employment

What benefit plan covers catastrophic illness?

Catastrophic Care Benefit Plan

How is medical expense health insurance for individuals/small groups in New York rated?

Community: all insureds pay SAME premium into predetermined geographic pool

What are COBRA qualifying events?

Divorce, firing, full-time -> part time, death of employee

What group rating uses group EXPERIENCE to change rates?

Experience rating

Which act provides 12 workweeks of leave to care for newborns?

FMLA (Family Medical Leave Act)

Typically, to be eligible for group health insurance via an employer....

FULL-TIME and 1-3 MONTHS of service

Who does blanket insurance mostly cover?

Groups with constantly changing members.

What is one of the ONLY reasons an insurer can terminate a LTC policy?

If the insured doesn't pay premium

What is the difference between individual and group health insurance?

Individual are renewable, coverage options are personally selected, and it is written on an occupational OR nonoccupational basis. Group terminates when the individual leaves the, same coverage for all, ONLY covers NONoccupational.

What is the policy called in GROUP insurance?

Master policy

What is mandatory for a LTC policy?

Noncancellable and guaranteed renewable

Which policy activates coverage once the insured's losses reach a certain level?

Partially-funded plan

What is a factor in underwriting for a small employer carrier?

Percentage of participation

What entity can be hired to handle all employee management tasks?

Professional Employer Organizations (PEOs)

What coverages does ERISA monitor?

Profit-sharing stock bonus, welfare benefit plans, pension plans

Who decides the minimum number of persons insured under group health?

State law

What does ERISA (Employee Retirement Income Security Act) monitor?

Stock profit-sharing plans

How many health benefit plans must a small employer carrier offer?

TWO: basic health benefit and standard health benefit

Who does COBRA (Consolidated Omnibus Budget Reconciliation Act) cover?

Terminated employees and/or dependents for up to 36 months after a qualifying event

According to the Coordination of Benefits (COB) provision, if the insurer overpaid on a claim, it may NOT recover the excess from...

The Insurance Guaranty Association

Who guarantees/administers 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 live in more than one state?

The state in which the coverage/policy was delivered.

What is another name for an Administrative-Services Only arrangement?

Third-party administrator: insurer provides certain services to a self-insured entity, like providing printed claim forms, and processing/auditing of claims. No insurance protection is provided.

What is the point of ERISA?

To ensure employees receive pension/benefits promised by employers; tied to provisions of the IRC (Internal Revenue Code) made to encourage employers to provide retirement benefits to employees

Can insurers limit health insurance coverage enrollment to a certain number?

nooooOOOO