Group Health Insurance Chapter 18 and Misc Questions Flashcards
If the insurer cancels policy, unearned premium will be returned to the insured
A. via registered mail
B. on a pro rata basis
C. as a flat cancellation
D. on a short rate basis
B
Which of the following items is not typically covered under a medical expense policy’s miscellaneous expense benefit?
A. use of the operating room
B. surgeon’s fees
C. x-rays
D. laboratory fees
B
A rider on a whole life policy that adds temporary coverage for a spouse and children is
A. a multiple protection policy
B. a family term rider
C. a family income rider
D. a family maintenance rider
B
A health insurance plan may pay benefits for all the following except
A. dental work
B. a disabling injury or sickness
C. nursing home care
D. over the counter drugs
D
Which of the following statements regarding multiple employer trusts (METs) is not correct?
A. an employer desiring coverage for its employees from a MET must subscribe by becoming a member of the trust
B. METs are most typically used by smaller employers
C. METs provide coverage only on a self-funded basis
D. METs are established to provide group benefits within a specific industry, such as construction
C
Maria is a new full time employee who has just completed her probationary period with her employer. She is married with three children. Which of the following persons are not eligible to participate in her group plan?
A. her 26 year old son Juan
B. her husband Fernando
C. her 24 year old daughter Tina who just got married
D. her 29 year old disabled son
A
Eric works for J&G Corporation and is recently divorced. His 56 year old ex spouse, Sophie, wants to know if she can maintain coverage under Eric’s group medical insurance plan. Which of the following statements best describes how this situation might be treated?
A. Sophie would be able to continue coverage for up to 3 years by paying up to 102% of the premium required for the group coverage
B. Sophie would be able to continue coverage until age 65 by paying up to 102% of the premium required for the group coverage
C. Sophie would be able to qualify for coverage under an individual policy, provided she submits to individual underwriting and pays a premium communsurate with her risk
D. Sophie would no longer qualify for coverage under Eric’s group medical plan because she no longer is a dependent
A
Which of the following was enacted to protect the interests of participants in qualified benefit plans as well as group insurance plans?
A. HIPAA
B. ERISA
C. PPACA
D. COBRA
B
Which of the following statements concerning a coordination of benefits provision is correct?
A. this provision can be found in both group and individual policies
B. the provision allows all policies that cover an individual to divide equally all health care costs
C. the purpose of the coordination of benefits provision is to avoid duplication of benefit payments and overinsurance
D. coordination of benefits provisions are found most often in family policies where the insured is still paying for a dependent’s health care
C
Which of the following events would not terminate Brian’s COBRA before the 18 month time limit?
A. the fifth day his premium is overdue
B. the day his coverage is effective at the new job
C. the day his former employer goes bankrupt
D. the day he becomes eligible for Medicare
A
Employers must provide notification statements to individuals eligible for COBRA continuation within
A. 31 days
B. 30 days
C. 14 days
D. 21 days
C
After working 2 years with a competitor, Sergey immediately goes to work for MEP Company. Having been fully covered under his employer’s group disability income plan, Sergey enrolls in his new employer’s plan at his first opportunity to do so. As a new employee with MEP, when does the exclusing period for pre-existing conditions end?
A. only after he has provided proof of insurability
B. after no more than 18 months
C. there is no exclusion period
D. After no more than 12 months
C
Angela’s fiance gets a job with an architectural firm of 20 employees. He obtains medical expense coverage through his employer’s group plan. Angela and her fiance marry, and he lists Angela as a dependent under his plan. She becomes pregnant. What coverage, if any can she expect from her spouses group policy?
A. medical care during pregnancy is not covered
B. routine maternity care is partially covered because of Angela’s status as a dependent
C. routine maternity care will be covered in full
D. care for complications arising from the pregnancy is excluded
C
All of the following are underwriting criteria for group health insurance except
A. persistency
B. size of the group
C. geographic location of the group
D. composition of the group
C
The HIPAA privacy regulations require health care providers, insurers and producers to respect the privacy of all of the following except
A. the insured’s medical information
B. the insured’s age, make and model of car
C. the insured’s prescription drug information
D. the insured’s health information
B
Which of the following situations regarding covered employees is not considered a qualifying event?
A. Doreen becomes legally separated from her spouse
B. Laurie becomes eligible for Medicaid
C. Dimitris hours are reduced
D. Santino’s son who no longer meets their dependent status
B
A single plan that covers the employees of two or more unrelated employers is called
A. a multiple administrative plan (MAP)
B. a multiple employer welfare arrangement (MEWA)
C. a multiple employer trust (MET)
D. a combined risk plan (CRP)
B
When an employee’s coverage terminates under a group health policy, the employee has the option to elect continuation within
A. 10 days
B. 45 days
C. 60 days
D. 30 days
C
ERISA requires certain information concerning group insurance plans be made available to all of the following except
A. the department of commerce
B. plan participants and their beneficiaries
C. the department of labor
D. the IRS
A
Which of the following was the primary purpose of the Health Insurance Portability and Accountability Act of 1996 (HIPAA)?
A. to establish government benefits for otherwise uninsurable individuals
B. to require employers to provide medical coverage for all employees
C. to provide government subsidies for indigents insurance
D. to expand coverage eligibility to many people that are uninsured
D
Under COBRA regulations, group health coverage of terminated employees must be continued up to
A. 18 months
B. 8 months
C. 12 months
D. 6 months
A