Group Health Insurance Flashcards
In health insurance, when would an excess plan pay benefits?
After the primary plan has paid its full promised benefit
The excess plan will pay the balance
In group insurance, who is issued s certificate of insurance?
Individual insured
How many members must an association have to qualify for group insurance?
100 members
What is a birthday rule in a coordination of benefits provision?
The coverage of the parent whose birthday is earlier in he year is considered primary
What do individual insured’s receive as proof of their group health coverage?
Certificate of insurance
What is the purpose of COBRA?
To allow continuation of health insurance coverage for terminated employees
According to the Coordination of Benefits provision, if both parents have coverage for a child from their employer’s policies, which policy will pay first?
The order of payment will be determined by the birthday rule: the coverage of the parent whose birthday is earlier in the year will be considered primary
In group insurance, what is the name of the policy?
Master policy
If the insured’s share in the cost of health insurance premiums with the employer, this would be known as what type of group health plan?
Contributory
Who are the parties in a group health contract?
The employer and the insurer
If a group health 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 types of groups are eligible for group health insurance?
Employer sponsored and association sponsored groups
What is a probationary period in group health insurance?
The period of time that must lapse before an employee is eligible for group health coverage
Does group health insurance require medical examinations?
No, the underwriter evaluated the group as a whole, rather than each individual member
How do insurers determine the cost for a group health policy?
The main variables are the ratio of men and women in the group, and the average age of the group
