Health and Accident Insurance
If an employee contributes 50% toward the disability plan premium provided by an employer, what would be considered the taxable income of a $1,000 monthly disability benefit?
$500
What percentage of eligible employees must participate in a noncontributory group health plan before it can be put in effect?
100%
Sole proprietors are permitted tax deductions for health costs paid from their earnings in the amount of?
100% of costs
How many employees must an employer have for a terminated employee to be eligible for COBRA?
20
The Consolidated Omnibus Budget Reconciliation Act (COBRA) applies to employers who employ at least?
20 employees
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
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
In regards to a group health insurance plan, which statement is CORRECT?
A non-contributory group health plan must cover all eligible members
HIPAA considers which of the following as "individually identifiable health information"?
A person's health claim information
During the underwriting process for a group health policy, it was discovered that 15 out of 50 members of the group have major health issues. How would the insurer handle this?
Accept or reject the whole group
Under a disability income policy, which provision would be payable if the cause of an injury is unexpected and accidental?
Accidental bodily injury provision
Which of the following does Coordination of Benefits allow?
Allows the secondary payor to reduce their benefit payments so no more than 100% of the claim is paid.
Which of the following is INELIGIBLE to participate in a Section 125 Plan?
An S-Corp Owner with a greater than 2% share
The purpose of the Coordination of Benefits provision in group accident and health plans is to...
Avoid overpayment of claims
Which type of business insurance is meant to cover the costs of continuing to do business while the owner is disabled?
Business overhead expense policy
What is issued to each employee of an employer health plan?
Certificate
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
The problem of overinsurance is addressed in which health insurance provision?
Coordination of benefits
When a claim has coverage under more than one health plan, which group medical plan provision applies?
Coordination of benefits
When a claimant has coverage under more than one heath plan, which group medical plan provision applies?
Coordination of benefits
Under the Health Insurance Portability and Accountability Act (HIPAA), the employee's new Group Health Plan will verify Creditable Coverage so that the
Employee's waiting period for coverage of a preexisting condition can be reduced under the new employer's health plan
In an employer-sponsored group accident and health plan, a master contract is issued to the?
Employer
Key Person Disability Insurance pays benefits 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
An eligible individual who would like to obtain group health insurance without providing evidence of insurability must?
Enroll within a specified eligibility period
The limited period of time given to all members to sign up for a group health plan is called the
Enrollment period
Which of the following is NOT typically covered under vision care insurance?
Eye Surgery
A master contract and certificate of coverage can be found in which type of policy?
Group
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 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
Who is financially liable for the payment of covered claims in a fully insured group health plan?
Insurer
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
A common exclusion with Vision plans is...
Laski surgery
Buy-Sell Plans are typically funded by which two types of insurance?
Life insurance and Disability insurance
The election of COBRA for continuation of health coverage will...
Maintain the same coverage and increase premium.
An employer is issued a group medical insurance policy. The single contract is known as a(n)?
Master Policy
What is the contract called that is issued to an employer for a Group Medical Insurance Plan?
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
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.
According to the Health Insurance Portability and Accountability Act (HIPAA), when can a group health policy renewal be denied?
Participation or contribution rules have been violated
Which of the following would evidence ownership in a participating health insurance contract?
Policy ownerships
Coordination of Benefits regulations applies to all of the following plans EXCEPT?
Preferred Provider Organization Plan
Coverage is limited for vision and dental insurance in all of the following ways, EXCEPT?
Specific dollar amount for examinations
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
Which of the following is typically NOT eligible for coverage in a group health policy?
Temporary employee
Which of the following decisions would a Health Saving Account (HSA) owner NOT be able to make?
The amount contributed by the employer
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
Continued coverage under COBRA would be provided to all of the following EXCEPT?
a covered employee is terminated for gross misconduct
Under the Consolidated Omnibus Budget Reconciliation Act (COBRA), a terminated employee's benefits must
be the same and the premium cannot exceed 102%
Business Overhead Expense Insurance pays for?
business expenses when a business owner becomes disabled
Under group health insurance, a certificate of coverage is issued to the
employee
A group Disability Income plan that pays tax-free benefits to covered employees is considered?
fully-contributory
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
A person covered with an individual health plan?
is issued a policy
Group health plans may deny participation based upon the...
member's part-time employment status
Minimum participation standards exist for group health insurance plans in order to
prevent adverse selection
Under the subrogation clause, legal action can be taken by the insurer against the?
responsible third party
Health insurance involves two perils, accident and _________.
sickness.
