Pre-Licensing Insurance Course Chapter 16

What is the minimum number of months COBRA permits employees to continue their coverage under the group insurance plan? a. 6 b. 12 c. 18 d. 29

c. 18

COBRA only applies to employers with ____ or more employees. a. 2 b. 10 c. 20 d. 100

c. 20

How many months may dependents be covered under COBRA if the insured's coverage is terminated because of legal separation? a. 12 b. 24 c. 36 d. 48

c. 36

For small group plans, the Patient Protection and Affordable Care Act mandates insurance companies to spend what percentage of all premiums collected on health care? a. 60% b. 70% c. 80% d. 90%

c. 80%

What is the Medical Loss Ratio (MLR) for individual and small business plans? a. 70% b. 75% c. 80% d. 85%

c. 80%

Employees are usually required to fulfill a ______-day probationary period before they are eligible for coverage. a. 10 b. 15 c. 90 d. 180

c. 90

Which legislation requires continuation of group health coverage based on qualifying events for up to 18 months? a. FCRA b. OBRA c. COBRA d. ADA

c. COBRA

Which group arrangement allows several small businesses to obtain health insurance coverage collectively? a. Self-funded plan b. Small employer group health plan c. MET d. HMO

c. MET

All of the following groups may purchase group health insurance coverage, EXCEPT: a. Sally's Flower Shop with 15 employees b. Judy's Handmade Card Shop with 5 employees c. Maggie's Piano Studio with 1 employee d. Fran's Furniture Land with 50 employees

c. Maggie's Piano Studio with 1 employee

HIPAA applies to employers with ___ or more employees. a. 1 b. 2 c. 10 d. 20

b. 2

Association groups applying for group health insurance must have a minimum of: a. 1 member b. 10 members c. 100 members d. 1,000 members

c. 100 members

Based on HIPAA legislation, pre-existing conditions can be imposed for a maximum of ____ months for employer-sponsored health plans. a. 5 b. 9 c. 12 d. 18

c. 12

Under HIPAA, employers can set pre-existing condition limitations for up to: a. 6 months b. 9 months c. 12 months d. 18 months

c. 12 months

The Patient Protection and Affordable Care Act defines a full-time employee as one who works at least how many hours a month? a. 120 hours b. 140 hours c. 144 hours d. 160 hours

a. 120 hours

Rebecca has a contributory employer group health plan for her employees. How many employees must participate in the group health plan? a. 75% of the eligible employees b. 75% of the employees c. 100% of the eligible employees d. 100% of the employees

a. 75% of the eligible employees

All of the following are eligible groups for group health insurance, EXCEPT: a. ABC group, which banded together to obtain insurance coverage b. DEF group, a welding shop that has been in existence for 50 years c. GHI group, a credit union d. JKL group, an individual employer

a. ABC group, which banded together to obtain insurance coverage

How frequently must employer-sponsored group health plans offer open enrollment? a. Annually b. Semi-annually c. Quarterly d. Monthly

a. Annually

What is the name of the document provided to insured individuals under a group health plan? a. Certificate of coverage b. Master contract c. Summary of benefits form d. Outline of coverage

a. Certificate of coverage

What is the main reason most health insurance coverage is purchased through group plans? a. Coverage is cheaper. b. Coverage is more expensive. c. Coverage is readily available. d. The application for coverage is simpler.

a. Coverage is cheaper.

Which of the following CAN have a deductible or co-pay? a. Drug misuse screening b. Alcohol misuse screening c. Diabetes screening d. Obesity screening

a. Drug misuse screening

The master contract for a group health plan is issued to the: a. Employer b. Employee c. Insured d. Insurer

a. Employer

Group health insurance policy rates are usually based on: a. Experience rating b. Community rating c. Individual rating d. None of the above

a. Experience rating

George and Jane are married and have five children. Both George and Jane are employed and covered by their respective employer group health plan. George's date of birth is March 3, 1979. Jane's date of birth is February 13, 1980. Which plan will be considered primary for the children? a. Jane's b. George's c. Both d. Neither

a. Jane's

What type of eligible group for health insurance consists of two or more employers or labor unions? a. MET and MEWA b. Individual employer group c. Credit union d. Alumni association

a. MET and MEWA

Per HIPAA, all of the following are considered pre-existing conditions, EXCEPT: a. Maternity b. Chronic headaches c. Hemorrhoids d. Celiac disease

a. Maternity

Which of the following terms describes a situation where an employer keeps the same group health plan for many years? a. Persistency b. Underwriting c. Rating d. Coordination of benefits

a. Persistency

All of the following statements are true regarding creditor group health insurance, EXCEPT: a. Premiums are typically paid by the lender. b. The lender is the policy's beneficiary. c. Creditor group health insurance protects lenders for losses resulting from disability or death of borrower. d. Creditor group health insurance provides specialized insurance for lenders to protect against nonpayment of a loan when a borrower becomes disabled or dies, and cannot repay the loan.

a. Premiums are typically paid by the lender.

The primary goal of the coordination of benefits provision is to: a. Prevent overinsurance b. Prevent overutilization of policies c. Determine eligibility under group policies d. Provide extra coverage under additional group health policies

a. Prevent overinsurance

Which of the following best describes creditable coverage? a. Prior health coverage b. Credit health insurance c. Insurance issued by a credit union d. None of the above

a. Prior health coverage

What does the Patient Protection and Affordable Care Act require before an employee's health insurance plan's coverage can be rescinded? a. Prior written notice must be given to the affected employee b. Prior written notice must be given to the Maryland Insurance Board c. Prior written notice must be given to the federal Patient Protection and Affordable Care Department d. All of the above

a. Prior written notice must be given to the affected employee

What type of group health coverage is offered to employees through noninsured plans by establishing a trust that pays the employee's health benefits directly to the medical provider or to the employee? a. Self-funded plan b. Employer-sponsored group c. Creditor group d. MEWA

a. Self-funded plan

Group health insurance policies are regulated by: a. State insurance laws b. Insurance companies c. The NAIC d. Social Security

a. State insurance laws

This federal law mandates that Medicare is secondary to group health plan coverage. a. TEFRA b. COBRA c. OBRA d. ADA

a. TEFRA

Which is not a disqualifying event under COBRA? a. The insured loses their dependency status b. Premiums are not paid by the end of the grace period c. Benefit period ends d. Insured is eligible for Medicare benefits

a. The insured loses their dependency status

Blain's Spa and Salon has a group health plan for his employees. Blain pays for the entire cost of coverage. Which of the following is true? a. The plan is noncontributory and all eligible employees must participate in the plan. b. The plan is contributory and 75% of all eligible employees must participate in the plan. c. The plan is noncontributory and only the hairstylists must participate in the plan. d. The plan is contributory and 100% of all eligible employees must participate in the plan.

a. The plan is noncontributory and all eligible employees must participate in the plan.

Noncontributory plans require: a. 75% of eligible employees enroll b. 100% of eligible employees enroll c. 100% of premiums paid by employees d. 75% of all employees enroll

b. 100% of eligible employees enroll

Employers with at least ____ employees must comply with the Americans with Disabilities Act. a. 10 b. 15 c. 20 d. 30

b. 15

For a health plan to be "grandfathered" in and exempt from some provisions of the Patient Protection and Affordable Care Act it must have been formed before which of the following dates? a. 23-Mar-09 b. 23-Mar-10 c. 23-Mar-11 d. 23-Mar-12

b. 23-Mar-10

Employees eligible for coverage under employer-sponsored group health plans are usually required to work a minimum of ____ hours per week. a. 15 b. 30 c. 40 d. 70

b. 30

How long is the annual open enrollment period for employer-sponsored group health plans? a. 10 days b. 30 days c. 180 days d. 1 full year

b. 30 days

Bethany's group health coverage is terminated because she changed jobs. How many days does Bethany have to convert her group health coverage to an individual health insurance policy? a. 20 b. 31 c. 90 d. 180

b. 31

George's group health plan is terminated because he left work to become a stay-at-home dad. How many days is George given to convert his group health coverage to an individual health insurance policy? a. 20 b. 31 c. 60 d. 90

b. 31

HIPAA requires that hospital stay benefits are provided to mothers for ___ hours after a normal vaginal delivery. a. 36 b. 48 c. 72 d. 96

b. 48

According to HIPAA, what is the maximum number of days an individual can go without creditable coverage to avoid incurring a waiting period? a. 30 days b. 63 days c. 90 days d. 180 days

b. 63 days

The Patient Protection and Affordable Care Act requires a gold health insurance plan to meet what specific actuarial value? a. 70% b. 80% c. 90% d. 100%

b. 80%

The Americans with Disabilities Act applies to employers with: a. At least 10 employees b. At least 15 employees c. At least 20 employees d. At least 50 employees

b. At least 15 employees

How many months of creditable coverage must a person have to be eligible for HIPAA guaranteed issue under a new employer's health plan? a. At least 12 b. At least 18 c. At least 24 d. At least 36

b. At least 18

Per HIPAA, what is the minimum number of months of creditable coverage a person must have to avoid pre-existing condition exclusions under a new group health plan? a. At least 12 b. At least 18 c. At least 24 d. At least 36

b. At least 18

The coordination of benefits provision in group health contracts is used to: a. Avoid duplicate premium charges to an employer for the same employee b. Avoid double payment of benefits to an insured who has duplicate group coverages c. Integrate disability income benefits with medical expenses benefits d. Integrate Medicare payments with supplementary insurance payments

b. Avoid double payment of benefits to an insured who has duplicate group coverages

Jacob has a group health insurance policy and pays the same premium as all other insureds under the policy. What rating was used? a. Primary rating b. Community rating c. Individual rating d. None of the above

b. Community rating

Most group health plans are sponsored by: a. METs and MEWAs b. Employers c. Creditors d. Alumni associations

b. Employers

Which law protects the coverage of individuals and their families when they change or lose their jobs? a. COBRA b. HIPAA c. TEFRA d. ERISA

b. HIPAA

The Patient Protection and Affordable Care Act provides a tax credit for a small business that meets all the following criteria except - a. Have 25 or less full-time equivalent employees for the taxable year. b. Have a net profit less than $5,000 times the number of employees c. Pay Employees less than $50,000 average annual wages. d. Pay at least 50% of each employee's health care insurance premium.

b. Have a net profit less than $5,000 times the number of employees

All of the following must be met by associations in order to be eligible for group health insurance, EXCEPT: a. Have at least 100 members b. Have been organized for at least 4 years c. Have a constitution and bylaws d. Hold meetings at least annually

b. Have been organized for at least 4 years

A group health insurance plan that pays the entire cost of premiums is termed: a. Contributory b. Noncontributory c. Par d. Nonpar

b. Noncontributory

Group health plans can: a. Discriminate in favor of certain employees b. Not discriminate in favor of certain employees c. Deny coverage to eligible employees d. Deny coverage to eligible dependents of eligible employees

b. Not discriminate in favor of certain employees

Which of the following coverages is not provided by group health contracts? a. Disability income b. Occupational injuries c. AD&D d. Medical expense

b. Occupational injuries

Which of the following terms means medical advice, diagnosis, care or treatment recommended or received within no more than six months before the date of the enrollment of the policy? a. Creditable coverage b. Pre-existing conditions c. Policy conditions d. COBRA

b. Pre-existing conditions

Premiums for COBRA are paid by: a. The former employer b. The former employee c. The NAIC d. All of the above

b. The former employee

Amanda is covered by a group medical expense plan through her work. She is also covered under her husband's health plan through his work. If Amanda incurs a covered loss of $3,200 and each plan would pay up to $2,500 for the loss, how much will Amanda's primary coverage pay? a. $0 b. $700 c. $2,500 d. $3,200

c. $2,500

Jerry is covered by a group medical expense plan through his employer. He is also covered under his wife's employer-sponsored group medical expense plan. If Jerry incurs a covered loss of $4,500 and each health plan would pay up to $3,250 for the loss, how much will Jerry's primary coverage pay? a. $1,250 b. $2,500 c. $3,250 d. $4,500

c. $3,250

The Patient Protection and Affordable Care Act defines a "small employer" as a business with up to how many employees? a. 25 b. 50 c. 100 d. 150

c. 100

All of the followings statements regarding group health insurance are true, EXCEPT: a. The policyholder is the employer, union, or other association, not the insured members. b. Each member is issued a certificate of coverage. c. Maternity does not need to be covered. d. Enrollees typically do not need to undergo a medical exam.

c. Maternity does not need to be covered.

What term describes the situation where an employer changes group plan coverage to another insurer, and all employees eligible for coverage by the old plan are automatically covered under the new plan without any probationary period? a. Persistency b. Rollover c. No-loss no-gain d. Rating

c. No-loss no-gain

Arthur's group health coverage is terminated, but he is permitted to extend his coverage for up to 29 months. What federal legislation permits Arthur's coverage to continue? a. HIPAA b. TEFRA c. OBRA d. COBRA

c. OBRA

Jane's group health coverage is terminated; however, she is allowed to extend her coverage for a maximum of 29 months. Jane's coverage continuation is permitted through which federal program? a. TEFRA b. COBRA c. OBRA d. ERISA

c. OBRA

The Federal Patient Protection and Affordable Care Act is sometimes referred to as: a. National Health Insurance b. Federal Healthcare c. Obama Care d. Romney Care

c. Obama Care

The coordination of benefits provision specifies that the primary insurer: a. Is the only coverage that pays b. Pays remaining bill up to the policy limits c. Pays benefits as if secondary coverage does not exist d. Pays benefits if the insured is denied coverage under other policies

c. Pays benefits as if secondary coverage does not exist

What is the purpose of the coordination of benefits provision? a. Prevent overutilization of policies b. Provide extra coverage under additional group health policies c. Prevent overinsurance d. All of the above

c. Prevent overinsurance

Will has a physically disabled child, who is in high school, and is incapable of self-sustaining employment. Which of the following statements accurately describes the child's coverage under Will's health insurance? a. The child may continue to be covered under Will's plan as long as the child is a full-time student. b. The child will be unable to continue coverage under Will's plan after high school, but may enroll in an individual plan. c. The child may continue to receive coverage under Will's plan as long as the child continues to be disabled and financially dependent on Will. d. The child's coverage under Will's plan ceases at age 26.

c. The child may continue to receive coverage under Will's plan as long as the child continues to be disabled and financially dependent on Will.

Child A is hospitalized for an illness. Both her mother and her father have group health insurance plans at their jobs that cover this dependent child. Which plan will be primary? a. The plan that was issued first b. The _breadwinner's_ plan c. The plan of the parent whose birthday comes earlier in year d. The plan of the youngest parent

c. The plan of the parent whose birthday comes earlier in year

Abe and Lisa are married. Each is insured under their employer-sponsored group health insurance. Whose plan will their children be insured under? a. Abe's plan b. Lisa's plan c. The plan of the parent whose birthday is earliest in the calendar year d. The plan of the parent who is older

c. The plan of the parent whose birthday is earliest in the calendar year

What is the purpose of the coordination of benefits clause in group health plans? a. To coordinate premium payments from employees b. To prevent duplicate premium payments from employees c. To prevent duplicate benefit payments from employees who are insured under multiple coverages d. To streamline insurance coverages under Medicare and Medigap

c. To prevent duplicate benefit payments from employees who are insured under multiple coverages

Xavier is enrolled in his employer's group LTC plan. When he reaches the age of 65, he will no longer be eligible for group coverage. Which of the following is true? a. COBRA requires by law that Xavier may continue coverage under the group plan indefinitely. b. HIPAA requires that Xavier be allowed to remain on the group coverage for 18 months. c. Xavier must be permitted to convert his group coverage to individual coverage within 31 days of his ineligibility under the group plan. d. Xavier may remain on the group coverage indefinitely as long as he pays a higher premium.

c. Xavier must be permitted to convert his group coverage to individual coverage within 31 days of his ineligibility under the group plan.

Group insurance generally contains a provision for extension of benefits to covered employees or dependents who become totally disabled. The extension of benefits usually lasts for a period of at least ______ months or until the individual is no longer totally disabled. a. 2 b. 5 c. 6 d. 12

d. 12

According to the Affordable Care Act, pre-existing conditions cannot be imposed on children under the age of: a. 26 b. 23 c. 21 d. 19

d. 19

What is the Medical Loss Ratio (MLR) for large group plans? a. 70% b. 75% c. 80% d. 85%

d. 85%

HIPAA requires that hospital stay benefits are provided to mothers for ___ hours after a cesarean delivery. a. 36 b. 48 c. 72 d. 96

d. 96

This federal law prohibits age discrimination, and is applicable to employers that have at least 20 employees: a. ERISA b. TEFRA c. COBRA d. ADEA

d. ADEA

Group health plans must explicitly state which of the following eligibility requirements? a. Who is eligible b. When individuals are eligible to enroll c. Minimum plan participation requirements d. All of the above

d. All of the above

The Patient Protection and Affordable Care Act requires an employer who gives an "Adverse determination" notice to a claimant to provide which of the following? a. The reasons for the denial of the claim b. To tell the claimant what information might be missing c. How to appeal d. All of the above

d. All of the above

Under which of the following circumstances does the Patient Protection and Affordable Care Act allow dependent children to remain on their parents' insurance plan? a. They no longer live with their parents b. They are married c. They are not dependents on their parents' income tax return d. All of the above

d. All of the above

What is outlined in the certificate of coverage for a group health insurance policy? a. Benefits b. Claim procedures c. Conversion rights d. All of the above

d. All of the above

Which of the following is a disqualifying event for continuation of coverage under COBRA? a. COBRA benefit period ends b. All group health coverages are terminated by the employer c. The insured is eligible for Medicare d. All of the above

d. All of the above

Which of the following is used to establish premium rates and whether or not group health coverage should be issued? a. Age b. Sex c. Occupation d. All of the above

d. All of the above

Which of the following types of health insurance may be offered as group policies? a. AD&D b. Disability income c. Medical expense d. All of the above

d. All of the above

Which of the following would be considered unfair advertising for group health insurance? a. Using insurance jargon b. Contrived testimonials c. Incomplete comparisons of other insurers_ group health insurance products d. All of the above

d. All of the above

COBRA applies to employers with how many employees? a. At least 2 b. 2 to 50 c. At least 10 d. At least 20

d. At least 20

Which federal program permits employees to extend their group health coverage for up to 18 months after employer-sponsored group coverage is terminated? a. NAIC b. DOD c. TEFRA d. COBRA

d. COBRA

The Patient Protection and Affordable Care Act does NOT require which of the following to provide Essential Health Benefits? a. Individual health insurance plans b. Small group health insurance plans c. Basic health programs d. Grandfathered health insurance plans

d. Grandfathered health insurance plans

Which federal law made Medicare secondary to group health coverage? a. ADA b. ADEA c. ERISA d. TEFRA

d. TEFRA

All of the following are disqualifying events under COBRA, EXCEPT: a. Insured is eligible for Medicare benefits b. Benefit period ends c. Premiums are not paid by the end of the grace period d. The insured loses their dependency status

d. The insured loses their dependency status

Jen and Jake are married. They are each insured under their own employer-sponsored group health plan. Whose plan will their three children be insured under? a. Jen's plan b. Jake's plan c. The plan of the parent who is older d. The plan of the parent whose birthday is earliest in the calendar year

d. The plan of the parent whose birthday is earliest in the calendar year

What does the coordination of benefits provision specify? a. The primary insurer is the only coverage that pays benefits. b. The primary insurer pays the remaining bill up to the policy limits. c. The primary insurer pays benefits if the insured is denied coverage under other coverages. d. The primary insurer pays benefits as if the secondary coverage does not exist.

d. The primary insurer pays benefits as if the secondary coverage does not exist.

As mandated in the Patient Protection and Affordable Care Act, what will be the lifetime dollar limit for health insurance plans? a. $3,000,000 b. $5,000,000 c. $10,000,000 d. There will be no lifetime dollar limits.

d. There will be no lifetime dollar limits.