Ch 7 Quiz Flashcards
Which statement best defines a Multiple Employer Welfare Arrangement (MEWA)?
A a group health plan that covers medical expenses arising from work related injuries
B a joining together by employers to provide health benefits for employee
C a plan to provide hospice care for terminally ill employees
D a government health plan that provides healthcare for the unemployed
B a joining together by employers to provide health benefits for employee
A MEWA provides benefits for a number of member groups.
When employees are actively at work on the date coverage can be transferred to another insurance carrier, what happens to coinsurance and deductibles?
A deductible is carryover, but coinsurance is generally higher
B they carryover from the old plan to the new plan
C they have to be reevaluated
D coinsurance carries over, but deductibles are generally higher
B they carryover from the old plan to the new plan
Coinsurance and deductibles may be carried over from the old paint of the new plan. The purpose of coinsurance and deductible carryover provisions is to credit expenses incurred so as to not penalize the insured.
What is the purpose of the ADEA?
A to ensure employees receive pension and other benefits
B to promote employment of minorities
C to allow leave to employees for family needs
D to prohibit age discrimination in employment
D to prohibit age discrimination in employment
The Age Discrimination in Employment Act of 1967 serves to promote employment of older persons based on their ability rather than age, to prohibit arbitrary age discrimination in employment;
Who is the beneficiary in a credit disability income policy? A the lending institution B the insurer C the estate of the borrower D the federal government
A the lending institution
Creditor group, also called credit life and credit disability income insurance, is a specialized use of group live in group health insurance. It protects the lending institution from losing money as a result of a borrower’s death or disability. Generally, the creditor is the owner and beneficiary of the policy, and the debtor is the premium payor.
What type of information is NOT included in a certificate of insurance?
A the procedures for filing a claim
B the length of coverage
C the cost the company is paying for monthly premiums
D the policy benefits and exclusions
C the cost the company is paying for monthly premiums
Do you do visuals covered under the insurance contractor issued certificates of insurance. Their certificate tells what is covered in the policy, how to file a claim, how long the coverage will last, and how to convert a policy to an individual policy.
And insured is covered under 2 group health plans – under his own and his spouses. He suffered a loss of $2000. After the insured paid a total of $500 in deductibles and coinsurance, the primary insure covered $1500 of medical expenses. What amount, if any, would be paid by the secondary insurer? A $0 B $500 C $1000 D $2000
B $500
The pregnancy discrimination act specifically prohibits pregnancy discrimination by employers with a minimum of how many employees? A 15 B 30 C 45 D 100
A 15
Which of the following is considered a qualifying event under COBRA? A relocation B promotion C divorce D marriage
C divorce
Other qualifying events include the voluntary termination of employment; employees change from full-time to part-time; or the death of the employee
Which of the following statements concerning group health insurance is CORRECT?
A the employer is the policyholder
B only the employer receives a certificate of insurance
C each employee receives a policy
D under a group insurance, the insurer may reject certain individuals from coverage
A the employer is the policyholder
Employer receives the master policy; each employee receives a certificate of insurance. All employees have the same coverage under the master contract.
Every small employer carrier shall, as a condition of transacting business in the state with small employers, actively offer to small employers at least how many health benefit plans? A 25 B 2 C 5 D 10
B 2
One plan offered by each small employer carrier shall be a basic health benefit plan, and one plan shall be a standard health benefit.
Which of the following options best depicts how the eligibility of members for group health insurance is determined?
A by the physical conditions of the applicant at the time of employment
B in such a manner as to establish individual selection as to the amount of insurance
C by conditions of employment
D eligibility is not determined, but simply accepted
C by conditions of employment
Need to visual employer normally must provide insurance coverage to all full-time employees. The employer can specify within some limitations how many hours are considered full-time, and whether both salaried and hourly employees will be covered. The employer can also legally exclude a particular group of employees from the eligible class of employees.
The coordination of benefits provision in Utah requires that both primary and secondary plans pay the benefit in equal shares if the plan cannot agree on the order of payment within how many days after receiving the claim information? A 10 days B 30 days C 60 days D 90 days
B 30 days
Plants cannot agree on the order of benefits within 30 days of the receipt of all necessary claim information, these plans will immediately pay the claim and equal shares. However, in these instances, no plan will be required to pay more than his policy limits.
Which of the following statements is NOT correct concerning the COBRA Act of 1985?
A it applies only to employers with 20 or more employees to maintain group health insurance plans for employees
B cobra stands for Consolidated Omnibus Budget Reconciliation Act
C it requires all employers, regardless of the number of age of employees, to provide extended group health coverage
D covers terminated employees and/or their dependence for up to 36 months after a qualifying effent.
C it requires all employers, regardless of the number of age of employees, to provide extended group health coverage
What is a characteristic of a conventional fully – insured plan?
A provide administrative services only, and no insurance protection
B it is funded by small employers for employees dependents
C the insurer assumes the risk of paying the cost of medical expenses occurring outside of the policy.
D the insurer assumes the risk of paying the cost of medical expenses occurring during the policy period
D the insurer assumes the risk of paying the cost of medical expenses occurring during the policy period
Conventional fully insured plan is administered and guaranteed bite insurance company. In return for the premium collected from the insured by the insurer, the insurer assumes the risk of paying the cost of medical expenses that may or may not occur during the policy period
All the following statements describe a MEWA EXCEPT
A MEWAs employers retain full responsibility for any unpaid claims
B MEWAs can be self-insured
C MEWAs are groups of at least three employers
D MEWAs can be sponsored by insurance companies
C MEWAs are groups of at least three employers
MEWAs are groups of at least two employers who pull the rest to self-insure. They can be sponsored by an insurance company, an independent administrator, or another group established provide good benefits for participants.
As a pertains to group health insurance, COBRA stipulates that
A terminated employees must be allowed to convert their group coverage to individual policies
B group coverage must be extended for terminated employees up to a certain period of time at the employers expense
C group coverage must be extended for terminated employees up to a certain period of time at the former employees expense
D retiring employees must be allowed to convert their group coverage to individual policies
C group coverage must be extended for terminated employees up to a certain period of time at the former employees expense
Jason is insured under his employers group health insurance. He splits the cost of the premiums with his employer. This is an example of A a half and half plan B a co-pay plan C a contributory plan D a non-contributory plan
C a contributory plan
Which of the following is the best scenario for self insurance? A unpredictable losses B smaller, frequent losses C larger, and frequent losses D larger, frequent losses
B smaller, frequent losses
Smaller losses which occur frequently are a better subject for self insurance as opposed to large infrequent losses. Self-insurance is frequently used for Worker’s Compensation where losses are fairly predictable and most states have establish regulations for self insurance
Which of the following coverages is not monitored by the employee retirement income security act (ERISA)? A golden parachutes B pension plans C profit-sharing stock bonus D welfare benefits plans
A golden parachutes
ERISA has a complex series of rules that cutter pension, profit-sharing stock bonus and most welfare benefit plans such as health and life insurance.
