6 - Statues and Regulations Specific to Health Insurance Flashcards
Insurer must deliver or mail a copy of the application…
-within 15 days after the receipt of the request
Insurers must notify Group certificate holders how many days before the cancellation of a Group Health policy if the employer has failed to pay the premium?
-15 days before
“free look” period
-10 days
Punishment if a group health fiduciary willfully fails to pay the premiums on a group health plan and does not inform certificate holders?
-Class H felony
Employer sponsored Franchise health plans require how many employees for Accident and Health?
-5 or more employees
If an applicant has the Hemoglobin C Trait, what will the underwriters do on the application?
-ignore the condition
under state continuation, the premium is paid by…
-premiums will be paid fully by the certificate holder
Whenever replacement of existing Group insurance occurs, liability for coverage must begin….
-within 15 days by the new insurer
Health policies, applications, or riders cannot be used until the expiration of a ________ period after they have been filed unless the Commissioner gives a written approval
-90 days
An insured covered by an employer group health policy resigns from the company. The former employee has two (2) options to continue his group health insurance program. The individual elects to continue his benefits under the state continuation program. How will the premium be paid for the coverage?
-The former employee will pay the full group rate for the coverage with a 2% administrative charge.
Any company or Producer who issues or delivers a health policy in willful violation of insurance regulations is guilty of a….
-Class 3 Misdemeanor
A group health policy fiduciary must provide notice of intent to cancel the group plan with how much notice to certificate holders?
-45 days notice
Members of an association may obtain a Blanket Accident and Health insurance policy if the association has at least ______ members.
-25
When is State Continuation not available?
- if have access to another group health plan
- if there is no active group plan with the employer
Fraternal Benefit Society
- Non-profit
- Lodge System
- It’s members only