Group Health Insurance

In a noncontributory health insurance plan, what percentage of eligible employees must participate in the plan before the plan can become effective? A100% B75% C50% D25%

One hundred percent of eligible employees must participate in a non-contributory health insurance plan for the plan to become effective.

All of the following cases show when a Small Employer Medical plan cannot be renewable EXCEPT AWhen the employer chooses to renew the plan. BFor nonpayment of required premiums. CWhen the Commissioner/Director finds that the continuation of the coverage would not be in the best interests of the policyholders or certificate holders or may impair the carrier's ability to meet its contractual obligations. DWhen the small employer carrier elects to nonrenew all of its health benefit plans delivered or issued for delivery to small employers.

a As well as noncompliance with the carrier's minimum participation requirements, noncompliance with the carrier's employer contribution requirements, repeated misuse of a provider network provision, all of the above are exceptions to replacement.

When employees are actively at work on the date coverage can be transferred to another insurance carrier, what happens to coinsurance and deductibles? ADeductibles carry over, but coinsurance is generally higher. BThey carry over from the old plan to the new plan. CThey have to be reevaluated. DCoinsurance carries over, but deductibles are generally higher.

b Coinsurance and deductibles may be carried over from the old plan to the new plan. The purpose of coinsurance and deductible carryover provisions is to credit expenses incurred so as to not penalize the insured.

When compared with the administrative cost found in individual coverage, the per capita administrative cost in group health insurance is AEqual. BLower. CHigher. DComparable.

b The per capita administrative cost in group health insurance is less than the administrative cost found in individual coverage.

Which statement best defines a Multiple Employer Welfare Arrangement (MEWA)? AA government health plan that provides health care for the unemployed BA group health plan that covers medical expenses arising from work related injuries CA joining together by employers to provide health benefits for employee DA plan that provides hospice care for terminally ill employees

c A MEWA provides benefits for a number of member groups.

What is the benefit of experience rating? AIt helps employees with low claims experience to become exempt from group premiums. BIt allows employers with high claims experience to obtain insurance. CIt allows employers with low claims experience to get lower premiums. DIt helps employers with high claims experience to get group coverage.

c Group health insurance is usually subject to experience rating where the premiums are determined by the experience of this particular group as a whole. Experience rating helps employers with low claims experience because they get lower premiums.

Which of the following is considered a qualifying event under COBRA? ARelocation BPromotion CDivorce DMarriage

c Other qualifying events include the voluntary termination of employment; an employee's change from full time to part time; or the death of the employee.

After a person's employment is terminated, it is possible to obtain individual health insurance after losing the group health coverage provided by the employer. Which of the following is NOT true? AThe employee can convert from group to individual insurance within a specified number of days after termination. BThe premium of the individual health insurance policy can be higher than the original policy. CBy law, the new individual policy must provide the same benefits as the group insurance policy. DContinuation of group coverage need not include dental, vision, or prescription drug benefits.

c Terminated employees have a specified number of days to convert to an individual health insurance policy, without having to provide proof of insurability. The insurer can adjust the new, individual health policy's premium as it sees fit, as long as coverage is provided. The new policy could offer lesser benefits than the original group health policy.

Why do group health providers usually require a certain amount of participation in the plan by eligible employees? ATo ensure a higher profit for the insurer BTo ensure the employer is being fair to employees CTo guard against adverse selection and reduce cost DTo promote preventive care

c The reason for the minimum participation requirement is to guard against adverse selection and to reduce administrative costs for the insurer.

COBRA applies to employers with at least A60 employees. B50 employees. C20 employees. D80 employees.

c Under the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA), any employer with 20 or more employees must extend group health coverage to terminated employees and their families.

Jason is insured under his employer's group health insurance. He splits the cost of the premiums with his employer. This is an example of AA half and half plan. BA co-pay plan. CA contributory plan. DA noncontributory plan.

c With a contributory plan the eligible employees contribute to payment of the premium (both the employee and employer pay part of the premium).

All of the following can qualify as a trust EXCEPT AA group that has the Commissioner's permission to issue a group health insurance policy. BAn employer insuring at least 5 employees for the benefit of that employer. CA labor union that insures at least 25 members. DA group formed by two or more employers in the same field.

b A group health insurance policy issued to a trust cannot benefit the employer.

An association could buy group insurance for its members if it meets all of the following requirements EXCEPT AIs contributory. BHas at least 50 members. CHas a constitution and by-laws. DHolds annual meetings.

b All of the above characteristics would make an association group eligible for buying group insurance, except the group must have at least 100 members.

Which of the following options best depicts how the eligibility of members for group health insurance is determined? ABy the physical conditions of the applicants at the time of employment BIn such a manner as to establish individual selection as to the amounts of insurance CBy conditions of employment DEligibility is not determined, but simply accepted

c The individual employer normally must provide insurance coverage to all full-time employees. The employer can specify within some limitations how many hours are considered full time, and whether both salaried and hourly employees will be covered. The employer can also legally exclude a particular group of employees from the eligible class of employees.

Can a group that is formed for the sole purpose of obtaining group insurance qualify for group coverage? ANo, a group of individuals cannot apply for group coverage unless represented by an association or trust. BYes, any group can apply for group coverage. CYes, but only if the group is over 35 people. DNo, the group must be formed for a purpose other than obtaining group insurance.

d In order to qualify for group coverage, the group must be formed for a purpose other than obtaining group insurance; the coverage must be incidental to the group.