Group Health Insurance Quiz

HIPAA applies to groups of

2 or more

COBRA applies to employers with at least

20 employees; 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.

In order to qualify for group coverage, associations must insure at least

25 members

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 contributory plan; both the employee and employer pay part of the premium

Who is automatically qualified to enroll in a health insurer's mandatory, guaranteed issue policy?

All small employers

To protect personally identifiable information, state Exchanges must establish safeguards that include all of the following EXCEPT A. Disclosing such information only to authorized individuals. B. Returning copies of paperwork featuring such information to individuals. C. Destroying such information in an appropriate manner. D. Protecting such information from reasonably anticipated threats.

B; The Exchange must establish and implement operational, technical, administrative and physical safeguards to protect personally identifiable information in a variety of ways, including destroying the information appropriately, protecting the information from threats, and disclosing the information only to authorized individuals.

An association could buy group insurance for its members if it meets all of the following requirements EXCEPT A. Holds annual meetings. B. Is contributory. C. Has at least 50 members. D. Has a constitution and by-laws.

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

What type of group rating uses the actual experience of the group as a factor in developing the rates to be charged?

Experience rating

What is the benefit of experience rating?

It allows employers with low claims experience to get lower premiums; 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.

In group insurance, what is the policy called?

Master policy; is issued to the policyowner, which could be the employer, an association, a union, or a trust.

A 55-year-old employee has worked part-time for his new employer for 3 months now, but has not been offered health insurance. What factor has limited the employee's eligibility?

Number of hours worked per week; In order to be eligible for group health insurance through an employer, an employee must typically work full-time and must have devoted one to three months of service. In this case, the employee has been with the employer long enough, but he does not work enough hours per week.

What is true regarding METs?

They allow several small employers purchase less expensive insurance together; Those small employers who cannot qualify for group health insurance band together for the purpose of buying insurance.

If an insurer terminates a small group disability plan's coverage, it cannot issue those plans for

the next 5 years.

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? A. The employee can convert from group to individual insurance within 31 days of termination. B. The premium of the individual health insurance policy can be higher than the original policy. C. By law, the new, individual policy must provide the same benefits as the group insurance policy. D. Continuation of group coverage need not include dental, vision, or prescription drug benefits.

C; Terminated employees have 31 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.