Group Health Ins

Question 1

What do individual insureds receive as proof of their group health coverage?

Answer 1

Certificate of insurance

Question 2

Who are the parties in a group health contract?

Answer 2

Employer and insurer

Question 3

What is the purpose of COBRA?

Answer 3

To allow continuation of HI coverage for terminated employees

Question 4

In group ins what is the name of the policy?

Answer 4

Master policy

Question 5

What types of groups are eligible for group HI?

Answer 5

Employer sponsored and association sponsored groups

Question 6

How many members must an association have to qualify for group insurance?

Answer 6

100 members

Question 7

How do insurers determine the cost for a group health policy?

Answer 7

Ratio of men to women in the group, average age of the group

Question 8

If the insureds share in the cost of HI premiums with the employers, this is what type of group plan?

Answer 8

Contributory

Question 9

If a group policy covers individuals that reside in more than one state, which state has jurisdiction over the group policy?

Answer 9

The state in which the policy was delivered

Question 10

What is a probationary period in group HI?

Answer 10

Period of time that must lapse before an employee is eligible for group health coverage

Question 11

What is a birthday rule in a coordination of benefits provision?

Answer 11

The coverage of the parent whose birthday is earlier in the year is considered primary

Question 12

In group insurance, who is issued a certificate of insurance?

Answer 12

Individual insured

Question 13

In HI, when would an excess plan pay benefits?

Answer 13

After the primary plan has paid its full promised benefit, the excess plan will pay the balance

Question 14

According to the coordination of benefits provision, if both parents have coverage for a child from their employers policies, which policy will pay first?

Answer 14

Determined by the birthday rule, whoever’s birthday is earlier in the year will be primary

Question 15

Does group health insurance require medical examinations?

Answer 15

No, the underwriter evaluates the group as a whole, rather than each individual

Question 16

Can you form a group just for insurance?

Answer 16

No

Question 17

In noncontributory group plans, what percent of eligible employees must enroll?

Answer 17

100%

Question 18

On contributory group plans, what percent of employees must enroll?

Answer 18

75%

Question 19

Group participation requirements are designed to prevent what?

Answer 19

Adverse selection

Question 20

A group insurance company is between the employer and who

Answer 20

The insurance company

Question 21

What do employees receive as proof of insurance in a group plan?

Answer 21

Individual certificate of insurance

Question 22

Can group policies discriminate in favor of higher paid employees?

Answer 22

No

Question 23

Can an insurer legally non renew a group policy?

Answer 23

Yes but only if the employer stops paying premiums

Question 24

Who can participate in a Multiple Employer Trust?

Answer 24

Employers in the same industry

Question 25

Drawbacks of association group insurance

Answer 25

Higher administrative costs and more subject to adverse selection

Question 26

When can dependents enroll in group coverage?

Answer 26

When employees become eligible

Question 27

Are employees eligible for group coverage after age 65?

Answer 27

Yes

Question 28

What rate do you pay under cobra in group insurance

Answer 28

102% of the group rate

Question 29

Employers with 20 or more employees must offer what to terminated employees

Answer 29

COBRA

Question 30

Is coverage under cobra different than the group coverage?

Answer 30

No it is exactly the same

Question 31

How long can you have COBRA?

Answer 31

18 months

Question 32

You can get cobra if you have a reduction of hours

Answer 32

And if you’re terminated

Question 33

How long can dependents of a deceased or disabled employee stay on group coverage?

Answer 33

36 months