Health and Accident

If an employee contributes 50% towards the disability plan premium provided by an employer, what would be considered the taxable income of a $1,000 monthly disability benefit?

$500.00 (Half of the premium was paid for by the employer.)

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:

60% of the benefit. 60% of an income benefit is taxed to the employee because 60% of the premiums paid come from the employer.

HIPAA considers which of the following as "individually identifiable health information"?

A person's health claim information.

The purpose of the coordination of Benefits provision in group accident and health plans is to:

Avoid overpayment of claims. This is achieved by identifying primary and secondary insurers.

Under the Consolidated Omnibus Budget Reconciliation Act (COBRA), a terminated employee's benefits must:

Be the same and the premiums cannot exceed 102%.

Susan is insured through her Group Health Insurance plan and changed her coverage to an individual plan with the same insurer after her employment was terminated. This change is called a(n):

Conversion. A conversion takes place when an insured individual changes his or her Group Health Insurance to an individual policy with the same insurer at the termination of employment.

Under group health insurance, a certificate of coverage is issued to the:

Employee. The employer is issued the master contract and considered the policyowner.

In an employer-sponsored group accident and health plan, a master contract is issued to the:

Employer

The policyholder for a group health benefit plan is considered to be the:

Employer

Which of the following would be considered a possible applicant and contract policyholder for group health benefits?

Employer

A group Disability Income that pays tax-free benefits to covered employees is considered:

Fully Contributory. Fully Contributory group plans require the employee to pay all premiums cost, therefore, any benefits received by covered employees are received tax-free.

Credit Accident and Health plans are designed to:

Help pay off existing loans during periods of disability.

What does the Consolidated Omnibus Budget Reconciliation Act (COBRA) of 1985 allow an employee to do?

In the event of the employment termination, group health insurance can be kept if the employee pays the premiums.

Health insurance will typically cover which of the following perils?

Injury due to accident

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:

Is eligible for coverage upon hire

Without a Section 125 Plan in place, what would happen to an employee's payroll contribution to an HSA?

It would be considered taxable income to the employee. Contributions to an HSA may be pre-tax under a Section 125 Cafeteria Plan. Without a Section 125 Plan in place, it would be considered taxable income to the employee.

A common exclusion with Vision plans is:

Lasik Surgery

The election of COBRA for continuation of health coverage will:

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

What is the contract called that is issued to an employer for a Group Medical Insurance plan?

Master Policy

An employer is issued a group medical insurance policy. This single contract is known as a (n):

Master policy

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?

May 30. The effective date is the health insurance coverage start date.

According to the Health Insurance Portability and Accountability Act (HIPAA), when can a group health policy renewal be denied?

Participation or contributions rules have been violated.

Coordination of Benefits regulation applies to all of the following plans EXCEPT:

Preferred Provider Organization plan. -Exception include: -Group vision plan -Self-funded group health plan -Group health plan

Under the subrogation clause, legal action can be taken by the insurer against the:

Responsible third party

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

Subrogation.

Justin is receiving disability income benefits from a group policy paid for by his employer. How are these benefits treated for tax purposes?

Taxable income. It's considered to be taxable income.

Which of the following is typically NOT eligible for coverage in a group health policy?

Temporary Employee -Exceptions include: -Full-Time employee -Business owner -Partner in a partnership

When can a group health policy renewal be denied according to the Health Insurance Portability and Accountability Act (HIPAA)?

When contribution or participation rules have been violated.

When are group disability benefits considered to be tax-free to the insured?

When the recipient pays the premiums.

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.

(a "63" day gap.) Under HIPAA, a group plan may not impose a pre-existing condition exclusion if the person has has creditable medical coverage for at least 12 months as long as the person has no more than 63 days with no coverage.

Sole proprietors are permitted tax deductions for health cost paid from their earnings in the amount of:

100% of the cost. 100% of health cost paid by sole proprietors is tax deductible.

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

20 employees. They MUST have 20 employees for a terminated employee to be eligible for COBRA.

Continued coverage under COBRA would be provided to all of the following EXCEPT:

A covered employee is terminated for gross misconduct. A terminated employee is eligible to continue health coverage under COBRA unless they are terminated for gross misconduct. "Former dependent of employee no longer of dependent status" and a "divorced spouse of employee" would both be eligible for COBRA continuation as long as they were covered under the plan the day prior to divorce or losing dependent status. -Exceptions include: -Former dependent of employee no longer of dependent status -terminated employee -divorced spouse of employee

Key Person Disability insurance pays benefits to the:

Employer. Key person disability insurance provides crucial benefits to protect the company financially in the event that a key employee can no longer work due to disability. Key Person coverage provides cash flow to help companies move forward and maintain a profit in the event that a key employee becomes disabled. The employer is the policyowner and pays premiums that are NOT tax-deductible. Benefits, however, are received tax-free to the employer.

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

Group. A master contract and certificate of coverage is usually found in a group policy.

Mark continues working after the age of 65 and is covered through his employer's group health plan. Which of the following statements is TRUE?

Medicare is the secondary payer. If an individual continues to work after the age of 65 and keeps the group plan, primary coverage comes from the group insurance plan and Medicare is considered the secondary payer.

Group health plans may deny participation based upon the:

Member's part-time employment status. Full time employee's are typically eligible. They may not deny it based on member's claims history, member's current age, and members pre-existing condition.