Group Health Insurance
An association group must have at least ______ members to be eligible for group insurance
100 members
Non-contributory plans must include ______ of eligible employees
100%
COBRA applies to employers with at least...
20 employees: employers with 20 employees or more must extend group health coverage to fired employees and their families
What is the maximum period of coverage under COBRA?
36 months
How large does a group have to be for medical information to NOT be required?
50 people or more
What percentage of eligible employees must be enrolled under a contributory health plan?
50%
How long does an individual have to apply for an individual life policy after employment termination without needing evidence of insurability?
60 days.
What is a small employer number?
Any firm with less than 100 employees.
What type of benefit plan is a MANAGED plan developed in conjunction with the Health Benefit plan committee?
Basic Coverage Benefit Plan
How is eligibility for members of group health determined?
By conditions of employment
What benefit plan covers catastrophic illness?
Catastrophic Care Benefit Plan
How is medical expense health insurance for individuals/small groups in New York rated?
Community: all insureds pay SAME premium into predetermined geographic pool
What are COBRA qualifying events?
Divorce, firing, full-time -> part time, death of employee
What group rating uses group EXPERIENCE to change rates?
Experience rating
Which act provides 12 workweeks of leave to care for newborns?
FMLA (Family Medical Leave Act)
Typically, to be eligible for group health insurance via an employer....
FULL-TIME and 1-3 MONTHS of service
Who does blanket insurance mostly cover?
Groups with constantly changing members.
What is one of the ONLY reasons an insurer can terminate a LTC policy?
If the insured doesn't pay premium
What is the difference between individual and group health insurance?
Individual are renewable, coverage options are personally selected, and it is written on an occupational OR nonoccupational basis. Group terminates when the individual leaves the, same coverage for all, ONLY covers NONoccupational.
What is the policy called in GROUP insurance?
Master policy
What is mandatory for a LTC policy?
Noncancellable and guaranteed renewable
Which policy activates coverage once the insured's losses reach a certain level?
Partially-funded plan
What is a factor in underwriting for a small employer carrier?
Percentage of participation
What entity can be hired to handle all employee management tasks?
Professional Employer Organizations (PEOs)
What coverages does ERISA monitor?
Profit-sharing stock bonus, welfare benefit plans, pension plans
Who decides the minimum number of persons insured under group health?
State law
What does ERISA (Employee Retirement Income Security Act) monitor?
Stock profit-sharing plans
How many health benefit plans must a small employer carrier offer?
TWO: basic health benefit and standard health benefit
Who does COBRA (Consolidated Omnibus Budget Reconciliation Act) cover?
Terminated employees and/or dependents for up to 36 months after a qualifying event
According to the Coordination of Benefits (COB) provision, if the insurer overpaid on a claim, it may NOT recover the excess from...
The Insurance Guaranty Association
Who guarantees/administers a conventional fully-insured group plan?
The insurer
Who is the beneficiary in a credit health policy?
The lending institution
Which state has jurisdiction over a group policy that covers individuals that live in more than one state?
The state in which the coverage/policy was delivered.
What is another name for an Administrative-Services Only arrangement?
Third-party administrator: insurer provides certain services to a self-insured entity, like providing printed claim forms, and processing/auditing of claims. No insurance protection is provided.
What is the point of ERISA?
To ensure employees receive pension/benefits promised by employers; tied to provisions of the IRC (Internal Revenue Code) made to encourage employers to provide retirement benefits to employees
Can insurers limit health insurance coverage enrollment to a certain number?
nooooOOOO
