Group Health Insurance Flashcards
A(n) _________ is issued to the sponsor of the group, and employees receive an outline of coverage or other summary of benefits, which offers information about the plan’s major benefits and principal exclusions.
A
Master policy
B
Certificate of authority
C
Individual policy
D
Certificate of insurance
A
Master policy
In noncontributory group health plans, how many eligible employees must be covered by the plan?
A
75%
B
100%
C
At least 50%
D
At least 90%
B
100%
The employees of a corporation must each pay a portion of the premium for their group insurance. This means they are members of a _____________.
A
Noncontributory group plan
B
Nonparticipating plan
C
Contributory group plan
D
Participating plan
C
Contributory group plan
All of the following are correct regarding employer group health insurance eligibility requirements and benefits, EXCEPT:
A
Newly hired employees must usually satisfy a probationary period before they can enroll in the plan
B
Employees can enroll at any time without restrictions
C
Employees must be considered full-time and actively at work
D
Employees must sign up during the enrollment period to avoid providing proof of insurability
Excellent!
B
Employees can enroll at any time without restrictions
When the employer pays some or all of the cost of health insurance for its employees, the benefits paid to each employee are ___________.
A
Taxable to the employer
B
Taxable to the insurance company
C
Deductible to the employer
D
Not taxable to the employee
D
Not taxable to the employee
Benefits are always non-taxable to the employee, regardless of who pays the premiums.
When comparing individual and group health insurance plans, which of the following is a characteristic of group health insurance?
A
Premiums are paid solely by the employee
B
The group plan usually offers a conversion privilege
C
An insurance policy is issued to each employee
D
The employee is required to provide evidence of insurability
B
The group plan usually offers a conversion privilege
When an employee is terminated, COBRA provides for the continuation of:
A
Health insurance for the employee only for a minimum of 36 months
B
Life and health insurance at the employer’s expense for up to 29 months
C
Life and health insurance if an employee quits, is fired, or laid-off
D
Health insurance at the employee’s expense for up to 18 months
D
Health insurance at the employee’s expense for up to 18 months
How much time after a qualifying event has occurred and notice is given of their right to continue insurance does an employee or dependent have to elect continuation of the group health plan under COBRA?
A
60 days
B
18 months
C
90 days
D
36 months
A
60 days
What percentage of employee participation is required for a contributory employer group plan?
A
75%
B
100%
C
25%
D
50%
A
75%
Events that will cause termination of continuing health coverage under COBRA include all of the following, except:
A
The employer ceases to maintain any group health insurance plan
B
The employee fails to convert to an individual health insurance plan on the day it is offered
C
The employee becomes eligible for Medicare benefits
D
Timely premium payments are not made
B
The employee fails to convert to an individual health insurance plan on the day it is offered
Which of the following is incorrect regarding the group underwriting process?
A
Evidence of insurability is not required since premiums are adjusted annually by evaluating the group and the claims experience
B
New employees usually become eligible to enroll after a waiting period
C
The insurer’s office location is not a cost factor
D
Adverse selection is not a concern for group contracts
D
Adverse selection is not a concern for group contracts
Adverse selection is a major underwriting concern for group contracts.
Which statement would be considered inaccurate regarding the underwriting of a group plan?
A
Contributory plans require 100% employee participation
B
The insurer can require a minimum percentage of the group to be enrolled to guard against adverse selection
C
The cost of a group policy is determined by the type, size, and average age of the group and claims experience with previous insurers
D
The corporate home office of the group normally is the group’s address
A
Contributory plans require 100% employee participation
**75% is accurate
All of the following are true of the Coordination of Benefits Provision under a group plan, except:
A
In a spousal situation, the insurer for the claim of an employee is primary, with the spouse’s plan being secondary
B
It is a method of determining primary and secondary coverage when an insured is covered by more than one group policy
C
In the event children are covered under two group plans, the insurer for the parent who is the oldest is primary, and the other parent’s plan is secondary
D
Secondary carriers will only pay claims that are in excess of the primary carrier’s responsibility
C
In the event children are covered under two group plans, the insurer for the parent who is the oldest is primary, and the other parent’s plan is secondary
When underwriting group life, the underwriter treats the group as if it were:
A
A substandard risk
B
One individual
C
Two groups, with all the males in one group and all the females in the other
D
A number of separate individuals
B
One individual
When an insurer relies on the prior claims history of the group to be insured in determining the rate to be charged, it is called:
A
Community rating
B
Claims rating
C
Experience rating
D
Cost rating
C
Experience rating
