Group health insurance
How many members must an association have to qualify for group insuranxe
100 memebrs
What is the minimum number of employees that a small employer can have
2
Which of the following groups seeking group health insurance would represent a bad risk for underwriters
A group that changes insurance annually
In health insurance when would an excess plan pay benefits
After the primary plan has paid its full promised benefit, the excess plan will pay the balance
What characteristics must be met for a self-funded plan to be dependable
All of the above
Which of the following options best depicts how the legibility of members for group health insurance is determined
By conditions of wmployemwbt
What do individual insured receive as proof of their group health coverage
Certificate of insurance
If the insurers share in the cost of health insurance premiums with the employer this would be known as what type of group health plan
Contributory
What types of groups are eligible for group health insurance
Employer-sponsored and association-sponsored groups
As it pertains to group health insurance cobra stipulates that
Group coverage must be extended for terminated employees up to a certain period of time at the former employee's expense.
In group insurance what is the name of the policy
Master policy
What type of group insurance plan has benefits that are a result of a collective bargaining agreement between a labor organization and an employer
Modified fully insured plan
Can a group that is formed for the sole purpose of obtaining group insurance qualify for group coverage?
No, the group must be formed for a purpose other than obtaining group insurance.
Does group health insurance require medical examinations?
No, the underwriter evaluates the group as a whole, rather than each individual member
Which of the following factors would be an underwriting consideration for a small employer carrier
Percentage of participation
What type of information is not included in a certificate of insurance
The cost the company is paying for monthly premiums
What is the birthday rule in a coordination of benefits provision
The coverage of the parent whose birthday is earlier in the year is considered primary
Who are the parties in a group health contract
The employer and the insurer
In a group policy, who is issued a certificate of insurance?
The individual insured
How do insurers determine the cost for a group health policy?
The main variables are the ratio of men and women in the group, and the average age of the group
According to the Coordination of Benefits provision, if both parents have coverage for a child from their employers' policies, which policy will pay first?
The order of payment will be determined by the birthday rule: the coverage of the parent whose birthday is earlier in the year will be considered primary
What is a probationary period in group health insurance
The period of time that must lapse before an employee is eligible for group health coverage
If a group health policy covers individuals that reside in more than one state, which state has jurisdiction over the group policy?
The state in which the policy was delivered
When employees are actively at work on the date coverage can be transferred to another insurance carrier what happens to coinsurance and deductibles
They carry over from the old plan to the new plan
What is the purpose of cobra
To allow continuation of health insurance coverage for terminated employees
Why do group health providers usually require a certain amount of participation in the plan by eligible employees?
To guard against adverse selection and reduce cost
After a divorce when can a surviving spouse of a certificate holder qualify for continuance of coverage under a group health policy that provides coverage for medical expenses
When the spouse is 55 years of age or older.
What type of benefit plan is a managed plan that is developed in conjunction with the health benefit plan committee
basic coverage benefit plan
