Chapter 20-Group Health Flashcards
when an insurance company has too many poor risks
Adverse Selection
contributory % or participation
75%
Non-contributory % or participation required
100%
period of time when an employee can enroll with little or no health questions
Enrollment Period
period of time, chosen by the employer, prior to eligibility for enrollment
Probationary period
small employers of common industry coming together to purchase insurance
Multiple Employer Trust (MET)
group that comes together to SELF insure
Multiple Employer Welfare Arrangement (MEWA)
contract between employer and insurer
Master policy
employee proof of coverage
Certificate of insurance
rating based on groups claim experience
experience rating (better for large group)
rating based on bundling the group with others of similar size and location
community rating (better for smaller groups)
annual period when an employee can make changes
open enrollment
Consolidated Omnibus Budget Reconciliation Act of 1985
COBRA
makes it possible for an individual to move from one employer to another and receive immediate coverage for preexisting conditions
HIPAA
certificate that is proof of prior coverage from another group plan
Creditable Coverage
