Group Health Ins Flashcards
What do individual insureds receive as proof of their group health coverage?
Certificate of insurance
Who are the parties in a group health contract?
Employer and insurer
What is the purpose of COBRA?
To allow continuation of HI coverage for terminated employees
In group ins what is the name of the policy?
Master policy
What types of groups are eligible for group HI?
Employer sponsored and association sponsored groups
How many members must an association have to qualify for group insurance?
100 members
How do insurers determine the cost for a group health policy?
Ratio of men to women in the group, average age of the group
If the insureds share in the cost of HI premiums with the employers, this is what type of group plan?
Contributory
If a group policy covers individuals that reside in more than one state, which state has jurisdiction over the group policy?
The state in which the policy was delivered
What is a probationary period in group HI?
Period of time that must lapse before an employee is eligible for group health coverage
What is a birthday rule in a coordination of benefits provision?
The coverage of the parent whose birthday is earlier in the year is considered primary
In group insurance, who is issued a certificate of insurance?
Individual insured
In HI, when would an excess plan pay benefits?
After the primary plan has paid its full promised benefit, the excess plan will pay the balance
According to the coordination of benefits provision, if both parents have coverage for a child from their employers policies, which policy will pay first?
Determined by the birthday rule, whoever’s birthday is earlier in the year will be primary
Does group health insurance require medical examinations?
No, the underwriter evaluates the group as a whole, rather than each individual
Can you form a group just for insurance?
No
In noncontributory group plans, what percent of eligible employees must enroll?
100%
On contributory group plans, what percent of employees must enroll?
75%
Group participation requirements are designed to prevent what?
Adverse selection
A group insurance company is between the employer and who
The insurance company
What do employees receive as proof of insurance in a group plan?
Individual certificate of insurance
Can group policies discriminate in favor of higher paid employees?
No
Can an insurer legally non renew a group policy?
Yes but only if the employer stops paying premiums
Who can participate in a Multiple Employer Trust?
Employers in the same industry
Drawbacks of association group insurance
Higher administrative costs and more subject to adverse selection
When can dependents enroll in group coverage?
When employees become eligible
Are employees eligible for group coverage after age 65?
Yes
What rate do you pay under cobra in group insurance
102% of the group rate
Employers with 20 or more employees must offer what to terminated employees
COBRA
Is coverage under cobra different than the group coverage?
No it is exactly the same
How long can you have COBRA?
18 months
You can get cobra if you have a reduction of hours
And if you’re terminated
How long can dependents of a deceased or disabled employee stay on group coverage?
36 months
