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
a firm hired to administer a self-insured plan for a company
Third party administrators
sports team or bus passenger policy is a form of ________________
blanket policy
how many employees to require maternity
15
max age for children to be covered on parent policy
26
when is payment due for newborn
31 days
how many employees for COBRA to be required
20
what is the COBRA election period for the employee after a qualifying event
60 days
how long can an employee keep COBRA coverage after a qualifying event
18 months
how long is COBRA available for dependents after death, divorce, Medicare or dependency status change
36 months
