Group Health Insurance

Question 1

Under group Health insurance, each participant gets a, “___”?

Answer 1

Certificate of coverage

Question 2

Most states require at least ____ amount of employees for an employer to qualify for standard group insurance?

Answer 2

at least 10 employees

Question 3

Terminated participants can convert group coverage to an individual policy without what?

Answer 3

Without proving insurability

Question 4

True or False-
No individual or group medical plan can exclude coverage of existing conditions for any adult applicant or independent.

Answer 4

True

Question 5

Why does it cost less to insure an individual under a group plan rather than a individual plan?

Answer 5

B/c the administrative costs and risks are spread over many people and not just one.

Question 6

Whats the difference between a ‘Group’ self insured plan, and a fully insured plan?

Answer 6

in a self insured plan the employer pays the claims. In a fully insured plan the insurance company pays the claims.

Question 7

Noncontributory plans must cover ___ percent of group members eligible to participate?

Answer 7

100%

Question 8

Contribuatory plans require participation from at least ____ % of group members eligible to participate?

Answer 8

75%

Question 9

Why does an insurer require that a certain percentage of eligible members participate in group health insurance plan?

Answer 9

To avoid adverse selection

Question 10

Who determines the length of the waiting period in group health insurance?

Answer 10

The employer and the insurer

Question 11

What law prohibits employers from discriminating against those who are at least 40 years old?

Answer 11

Age discrimination in Employment Act (ADEA)

Question 12

The womens health and cancer rights act requires group plans that cover mastectomies to also cover what?

Answer 12

to cover breast reconstruction

Question 13

FMLA requires employers *with at least 50 employees) to provide how many weeks of unpaid leave for family and personal medial reasons?

Answer 13

12 weeks unpaid leave

Question 14

What allows employees who are terminated other than gross misconduct to continue group coverage for up to 18 months by paying 102 % of the premium?

Answer 14

COBRA

Question 15

The patient protection and affordable care act (PPACA) prohibits health insurers from excluding coverage for ___?

Answer 15

Prohibits excluding coverage for pre-existing conditions

Question 16

Employers with fewer than how many employees are exempt from COBRA?

Answer 16

20

Question 17

When a person exhausts health insurance coverage under COBRA, HIPPA guarantees that the person will____?

Answer 17

The person will have access to a guaranteed-issue individual health insurance policy, regardless of health.

Question 18

HIPPA requires insurance companies that sell individual health insurance policies to offer them to eligible people who have lost ____ regardless of ____?

Answer 18

lost group coverage regardless of their health.

Question 19

Which federal law regulates group health plans and protects their enrollees?

Answer 19

ERISA (Employee retirement income safety act)

Question 20

What does Cobra guarantee to an employee who voluntarily leaves an employers insured group?

Answer 20

COBRA guarantees the employee the right to continue coverage at the EMPLOYEE’S expense for up to 18 months.

Question 21

Which governments regulate group health insurance?
A. State
B. Federal
C. Both State and Federal

Answer 21

C. Both state and federal

Question 22

Dependents who lose coverage due to divorce or death may extend coverage up to how long under this Law?

Answer 22

up to 36 months under COBRA

Question 23

What Law requires copayments, deductibles, and limitations on treatment for mental health or substance abuse CANNOT be more restrictive than those for other medical benefits?
This act applies to employers with how many employees?

Answer 23

MHPAEA (Mental health parity and addiction equality act)
-Applies to employers with more than 50 employees

Question 24

What is the purpose of COBRA?

Answer 24

To let those who are no longer employed continue their group’s coverage for up to 18 months.
Unless due to divorce or death extension can be up to 36 months.
FORMER EMPLOYEE PAYS PREMIUM

Question 25

Under COBRA- If a medicare eligible participant loses group coverage, the YOUNGER spouse may continue group coverage with medicare benefits even if?

Answer 25

They can still get those Medicare benefits EVEN if the younger spouse is not eligible for Medicare coverage yet. (age 65, etc. )

Question 26

When does COBRA coverage end?
(3 things)

Answer 26

1.After Maximum coverage time period
2. If person is eligible for another group plan
3. If the person fails to pay their premium

Question 27

What law ensures that those who have lost their job or want to change health insurance carriers will continue to qualify for medical insurance when they go to another job?
-This definition is called what under this law?

Answer 27

HIPPA –definition of Portability.

Question 28

HIPPA guarantees that insurers who sell individual health insurance plans must offer them to eligible people who have lost group coverage, regardless of their health. This is called what?

Answer 28

Guaranteed issue

Question 29

Under HIPPA- to be eligible, a person must have exhausted all available COBRA coverage.
Those who are terminated from a group plan and decline COBRA coverage are ____ for a guaranteed issue policy?

Answer 29

NOT ELIGIBLE

Question 30

Group health plans usually provide coverage for how long before renewing?

Answer 30

one year

Question 31

What is No Loss/No Gain AKA No loss of coverage?

Answer 31

If an employer changes plans/insurers, employees CANNOT lose their right to coverage.

Question 32

When an employer gets a new group health insurance plan or insurer, the new plan or insurer CANNOT require a covered employee to do what?

Answer 32

CANNOT require the employee to satisfy a new probationary period, or pay a new deductible IF the employee already did these under the previous plan.

Question 33

Small employers are usually defined as having how many employees?

Answer 33

2-50 employees.
Some states define it as having as few as 1 employee

Question 34

Most states define an eligible employee as one who works for an employer AT LEAST how many hours each week?

Answer 34

25 hours a week

Question 35

What does noncontributory mean, and the plan must cover who?

Answer 35

Non contribuatory= employer pays entire premium and it must cover ALL eligible employees

Question 36

What does a contributory plan mean?

Answer 36

A group plan that BOTH employer and employee pay the premium.
**Employer must pay at least 10% of the group medical insurance premium.

Question 37

With a contributory plan, what percent of eligible employees must participate in the plan?

Answer 37

contributory plan=at least 75% must participate