Group Health Insurance

All of the following are differences between individual and group health insurance EXCEPT a. individual insurance doesn't require medical examinations, while group insurance does b. in individual policies, the individual selects the coverage options, while in a group plan all employees are covered for the same coverage which is chosen by the employer c. individual coverage can be written on an occupation or nonoccupational basis, while group plans cover only nonoccupation d. individual policies are renewable at the option of the insured, while group usually terminates when the individual leaves the group

A

COBRA applies to employers with at least a. 20 employees b. 80 employees c. 60 employees d. 50 employees

A

Can a group that is formed for the sole purpose of obtaining group insurance qualify for group coverage? a. no, the group must be formed for a purpose other than obtaining group insurance b. no, a group of individuals cannot apply for group coverage unless represented by an association or trust c. yes, any group can apply for group coverage d. yes, but only if the group is over 35 people

A

What is the purpose of COBRA? a. to provide continuation of coverage for terminated employees b. to provide coverage for the dependents c. to provide health coverage for people with low income d. to protect the insureds against insolvent insurers

A

Which of the following factors would be an underwriting consideration for a small employer carrier? a. percentage of participation b. claims experience c. health status d. medical history of the employees

A

What type of information is NOT included in a certificate of insurance? a. length of coverage b. cost the company is paying for monthly premiums c. the policy benefits and exclusions d. the procedures for filing a claim

B

Which of the following statements concerning group health insurance is CORRECT? a. under group insurance, the insurer may reject certain individuals from coverage b. the employer is the policyholder c. only the employer receives a certificate of insurance d. each employee receives a policy

B

Who is the beneficiary in a credit health policy? a. the federal government b. the lending institution c. the insurer d. the estate of the borrower

B

All of the following statements describe a MEWA except a. MEWAs can be self-insured b. MEWAs are groups of at least 3 employers c. MEWAs can be sponsored by insurance companies d. MEWA employers retain full responsibility for any unpaid claims

B at least 2

A man works for company A and his wife works for company B. The spouses are covered by health plans through their respective companies that also cover the other spouse. If the husband files a claim, A. the insurance plans will split the coverage evenly B. both plans will pay the full amount of the claim C. the insurance through his company is primary D. the insurance through his wife's company is primary

C

An employee insured under a group health plan has been paying $25 monthly premium for his group health coverage. The employer has been contributing $75, for the total monthly cost of $100. If the employee leaves the company, what would be his maximum monthly premium for COBRA coverage? A. $25.50 B. $100 C. $102 D. $25

C

In a group policy, the contract is between a. the employer and the union b. the employer and the employee c. the employer and the insurance company d. the individual and the insurance company

C

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 a. a half and half plan b. co-pay plan c. contributory plan d. noncontributory plan

C

As it pertains to group health insurance, COBRA stipulates that a. retiring employees must be allowed to convert their group coverage to individual policies B. terminated employees must be allowed to convert their group coverage to individual policies C. group coverage must be extended for terminated employees up to a certain period of time at the employer's expense D. group coverage must be extended for terminated employees up to a certain period of time at the former employee's expense

D

How many eligible employees must be included in a contributory plan? a. 90% b. 100% c. 50% d. 75%

D

What is the period of coverage for events such as death or divorce under COBRA? a. 60 days b. 31 days c. 12 months d. 36 months

D

Which of the following groups seeking group health insurance would represent a bad risk for underwriters A. group that pays a low premium B. group that pays a noncontributory plan C. group that has a large number of members D. group that changes insurance annually

D

Which of the following is considered a qualifying event under COBRA? a. marriage b. relocation c. promotion d. divorce

D

Which of the following is true regarding METs? a. they make deals with local hospitals to provide low cost coverage to the needy. b. they provide insurance for larger corporations. c. they provide insurance companies with medical information on applications. d. they allow several small employers purchase less expensive insurance together.

D

Which of the following options best depicts how the eligibility of members for group health insurance is determined? a. eligibility is not determined, but simply accepted b. by the physical conditions of the applicants at the time of employment c. in such a manner as to establish individual selection as to the amounts of insurance d. by conditions of employment

D