Chapter 13

How much time after a qualifying event has occurred and notice is given of their right to continue insurance does an employee or dependent have to elect continuation of the group health plan under COBRA?

60 days

The employee or the beneficiary must notify the employer within ______ days if they elect to continue coverage under COBRA.

60

Payment of the first premium and an application must be submitted to an insurer for individual coverage within how many days to convert group coverage to an individual policy not requiring proof of insurability?

31 days

All of the following are correct regarding employer group health insurance eligibility requirements and benefits

-Employees must be considered full-time and actively at work -Employees must sign up during the enrollment period to avoid providing proof of insurability -Newly hired employees must usually satisfy a probationary period before they can enroll in the plan

Which of the following is correct regarding the group underwriting process?

-New employees usually become eligible to enroll after a waiting period -Evidence of insurability is not required since premiums are adjusted annually by evaluating the group and the claims experience -The insurer's office location is not a cost factor

In noncontributory group health plans, how many eligible employees must be covered by the plan?

100%

regarding a group Accidental Death and Dismemberment policy

Any benefits received are not taxable to the recipient

All of the following groups are eligible for group rates, except:

Groups formed to reduce premiums

When an employee is terminated, COBRA provides for the continuation of:

Health insurance at the employee's expense for up to 18 months

A(n) _________ is issued to the sponsor of the group, and employees receive an outline of coverage or other summary of benefits, which offers information about the plan's major benefits and principal exclusions.

Master policy

Group health plans usually cover:

Nonoccupational injury or disease

When the employer pays some or all of the cost of health insurance for its employees, the benefits paid to each employee are ___________.

Not taxable to the employee

Coordination of Benefits is a provision designed to reduce ________ when an insured is covered under multiple health plans.

Overinsurance

Under COBRA, coverage for dependents of an employee may continue up to 36 months for any of the following events, except:

Termination of the employee

Which is not a qualifying event for the continuation of dependent coverage under the Consolidated Omnibus Budget Reconciliation Act?

Termination of the employee for theft

When comparing individual and group health insurance plans, which of the following is a characteristic of group health insurance?

The group plan usually offers a conversion privilege

If a child is covered under more than one group health insurance plan how is it determined which carrier is primary?

The plan covering the parent whose birthday occurs first in the calendar year will be the children's primary coverage

An employer group health insurance sponsor does all of the following

-Pays the premium -Apply for coverage -Provide underwriting information

Hicks Corp. wants to install a contributory group plan. It employs 200 people. How many employees must participate in order to install the plan?

150

COBRA applies to employers with ______ or more employees.

20

COBRA is a federal law requiring employers with _____ or more employees to provide the option of continuing the employee's existing health coverage for dependents for up to _____ months following certain qualifying events such as death of the employee.

20, 36

For an employee to be eligible to participate in an employer's group health insurance plan, he/she must be considered full-time and work a minimum of _____ hours as established by the Affordable Care Act.

30

Experience rating utilizes _______ in determining the rate the insurer will charge for group coverage in each year of coverage.

Actual loss experience of the group

When are LTC premiums deductible for an employer:

Any time premiums for employee policies are paid by the employer

Concerning COBRA, which of the following is correct?

Applies to employers with 20 or more employees

Contributory plans

require both the employee and employer to pay a portion of the premium. Contributory plans require a minimum of 75% participation of the eligible employees.

Which statement would be considered accurate regarding the underwriting of a group plan?

-The cost of a group policy is determined by the type, size, and average age of the group and claims experience with previous insurers -The insurer can require a minimum percentage of the group to be enrolled to guard against adverse selection -The corporate home office of the group normally is the group's address

An employer may require a former employee who has COBRA coverage to pay up to _____% of the premium.

102

The employees of a corporation must each pay a portion of the premium for their group insurance. This means they are members of a _____________.

Contributory group plan

Which provision of group health plans is used to determine primary and secondary coverage when an insured is covered by more than one insurance plan?

Coordination of Benefits

Group Accidental Death and Dismemberment premiums are _______ by the company paying the premiums as a business expense.

Deductible

Which of the following is consistent with group health underwriting?

Each member of the group is covered regardless of his or her health history

Individual Health Insurance

-Insured receives a policy -Evidence of insurability required; a detailed underwriting process is based on the individual applicant -Probationary period is set by the insurer and immediately applies after the policy is issued to limit coverage due to pre-existing conditions -Individual can purchase the policy at any time -Premiums payable solely by the individual -Policy typically has lower limits and higher deductibles -Policy typically has lower limits and higher deductibles

If a plan offers coverage to dependents, eligible dependents includes all children, natural and adopted, married and unmarried, up to age ______.

26

Noncontributory plan

premiums are paid entirely by the employer and require 100% participation of the eligible employees.

Group Health Insurance

-Insured/employee receives a certificate of insurance -Underwriting is based on the characteristics of the group, not the individual -Probationary period is set by the employer sponsor and starts when the employee is hired to determine enrollment eligibility -Employee must wait for the probationary period to end and enroll during the enrollment period without insurability -Premiums paid either entirely by the employer or by both employer and employee -Policy typically has higher limits and lower out-of-pocket expenses -Benefits are usually more comprehensive, dependent coverage usually offered, and employee has conversion rights