Group Health Insurance Chapter 18 and Misc Questions

Question 1

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

Answer 1

B

Question 2

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

Answer 2

B

Question 3

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

Answer 3

B

Question 4

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

Answer 4

D

Question 5

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

Answer 5

C

Question 6

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

Answer 6

A

Question 7

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

Answer 7

A

Question 8

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

Answer 8

B

Question 9

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

Answer 9

C

Question 10

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

Answer 10

A

Question 11

Employers must provide notification statements to individuals eligible for COBRA continuation within

A. 31 days

B. 30 days

C. 14 days

D. 21 days

Answer 11

C

Question 12

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

Answer 12

C

Question 13

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

Answer 13

C

Question 14

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

Answer 14

C

Question 15

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

Answer 15

B

Question 16

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

Answer 16

B

Question 17

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)

Answer 17

B

Question 18

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

Answer 18

C

Question 19

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

Answer 19

A

Question 20

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

Answer 20

D

Question 21

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

Answer 21

A

Question 22

Under a group health insurance plan, a terminated employee may have which of the following options?

A. to convert the coverage to an individual plan at the same premium

B. to continue the identical coverage at the same premium

C. to continue reduced benefit coverage under the group plan at an adjusted premium

D. to convert the coverage to an individual plan at an adjusted premium

Answer 22

D

Question 23

Marta is covered by 2 group health policies: one provided by her employer and the other provided by her spouse’s employer. The coverage provided by her spouse’s policy is called

A. secondary coverage

B. surplus coverage

C. primary coverage

D. related coverage

Answer 23

A

Question 24

Which of the following is not a characteristic of group health insurance plans?

A. their benefits are more extensive than those under individual plans

B. the cost of insuring an individual is less than what would be charged for comparable benefits under an individual plan

C. employers may require employees to contribute to the premium payments

D. the parties to a group health contract are the employer and the employees

Answer 24

D

Question 25

Emily is 3 months pregnant and receiving prenatal health care from her employer group health plan. When her employer switches plans with a new insurer, Emily’s claim with the original insurer

A. will be transferred to the new insurer plan under the no loss/no gain rule

B. will be continued for the balance of her pregnancy under the no loss/no gain rule

C. will be terminated and she will have to seek coverage from the new plan

D. will be terminated, and she will not be insurable under the new plan because her condition is pre-existing

Answer 25

B

Question 26

Which of the following is not acceptable when advertising group health insurance?

A. not being misleading or obscure

B. providing a summary of benefits that fails to list coverage limitations

C. clearly outlining policy benefits

D. Clearly outlining policy exclusions or limitations

Answer 26

B

Question 27

A qualifying event covers all of the following except

A. bankruptcy of the employer

B. medicaid eligibility for the covered employee

C. divorce of the covered employee from the covered employees spouse

D. reduction in work hours for the covered employee

Answer 27

B

Question 28

What are members of a group health policy given that shows evidence of insurance?

A. a coverage notification

B. a master policy

C. a certificate of coverage

D. a certificate of qualified benefits

Answer 28

C

Question 29

As it pertains to group health insurance, COBRA stipulates that

A. group coverage must be extended for terminated employees up to a certain period of time at the employees expense

B. terminated employees must be allowed to convert their group coverage to individual policies

C. group coverage must be extended for terminated employees up to a certain period of time at the employers expense

D. retiring employees must be allowed to convert their group coverage to individual policies

Answer 29

A

Question 30

When an employer renews the group coverage with the same insurer year to year, this is known as

A. composition

B. plan design

C. persistency

D. administrative capability

Answer 30

C

Question 31

Which of the following would not be a criterion for group underwriting?

A. sex of the group members

B. education level of the group members

C. Ages of the group members

D. income level of the group members

Answer 31

B

Question 32

An employee is eligible to continue his health insurance under COBRA rules. Which of the following statements is correct?

A. he can increase the benefits he will receive from his plan up to 102% of his previous coverage

B. his coverage under COBRA will be identical to that which he had under his group plan

C. his coverage can be continued even if the employer terminates the entire health plan

D. he can continue the coverage for up to 36 months, even if he obtains new coverage elsewhere

Answer 32

B

Question 33

Which of the following employers is not eligible for small employer group health insurance?

A. David, who owns a trucking company that employs 45 full time drivers and 20 independent drivers

B. Kallie, who owns a hardware store that employs 55 full time employees and 12 part time employees

C. Alice, who owns a web design company that employs 12 full time employees and 6 part time interns

D. Tariq, who owns an art supply business that employs 10 full time employees and 8 part time employees

Answer 33

B

Question 34

A group of employers from a similar industry assembled to qualify for group health insurance is

A. an insured union

B. a contributory trust

C. a modified group plan

D. a multiple employer trust

Answer 34

D

Question 35

Under Liz’s group employer disability insurance, she is eligible to receive $1,500 every month. When she becomes disabled, she is also eligible to receive $850 each month form social security. How much will she receive each month from her group disability plan?

A. $1,500

B. $650

C. $850

D. $2,350

Answer 35

B

Question 36

The period of time an employee must wait before becoming eligible to enroll in an employer-sponsored health plan is called

A. the probationary period

B. the delay period

C. the elimination period

D. the eligibility period

Answer 36

A

Question 37

As a result of the Health Insurance Portability and Accountability Act (HIPAA), which of the following is not guaranteed medical coverage?

A. individuals who have exhausted their extension benefits under COBRA

B. individuals who have at least 18 months of aggregate creditable coverage

C. individuals who are not eligible for coverage under Medicare or Medicaid

D. individuals who have had their coverage canceled for nonpayment of premiums

Answer 37

D

Question 38

For group health insurance, employees may be classified for eligibility purposes by all of the following except

A. actively working or on disability leave

B. 65 or older or under age 65

C. full time or part time

D. union or non union

Answer 38

B

Question 39

Under COBRA regulations, which of the following statements regarding coverage of a spouse after divorce from an insured employee is correct?

A. the ex spouses coverage can be converted to an individual policy

B. all coverage ends at the time of the divorce

C. the ex spouses coverage can be continued with an increase in coinsurance and deductible

D. the ex spouses coverage can be continued with identical benefits for a specified period

Answer 39

D

Question 40

Ahana was recently hired by a consulting firm. She must wait before she is eligible to enroll in the employer’s group health insurance plan. This is known as

A. the insurability period

B. the initial eligibility period

C. the probationary period

D. the open enrollment period

Answer 40

C

Question 41

All of the following are requirements which were enacted as a result of HIPAA except

A. eliminating pre-existing conditions for all eligible individuals

B. ensuring the portability of group insurance coverage

C. enforcing the privacy of individuals health information

D. creating various mandated benefits for pregnant women

Answer 41

A

Question 42

Which of the following statements regarding experience versus community rating by group health insurance plans is correct?

A. community rating is more cost effective and competitive

B. community rating takes the groups previous claims experience into account

C. experience rating is based on past and projected medical costs of the group

D. premiums for group insurance are typically not based on experience rating

Answer 42

C

Question 43

Which of the following criteria used in group health insurance underwriting reduces the risk of adverse selection?

A. administrative capability

B. flow of members through the group

C. persistency

D. size of the group

Answer 43

B

Question 44

Which of the following statements regarding the conversion privelege in group health insurance is correct?

A. to obtain a conversion policy, an insured employee must show evidence of insurability

B. an insurer cannot change the premium amount for an insured who is converting to an individual policy

C. During the period when the insured is converting from the group to the individual plan, she is still insured

D. an insured employee who resigns or is terminated has up to 1 year in which to take out a conversion policy

Answer 44

C

Question 45

Which of the following employee populations may an employer legally exclude from group health benefits?

A. married women between the ages of 25 and 40

B. union workers as a class

C. handicapped employees

D. employees over age 62

Answer 45

B

Question 46

Which of the following statements best describes the coordination of benefits provision of group medical expense policies?

A. it prohibits consumers from being covered under more than 1 group medical policy

B. it permits insureds to collect full benefits from every policy under which they are covered

C. it permits all insurers covering a given insured to coordinate benefits so that, among all of them, no more than 80% of a claim is paid

D. it permits insurers covering a given insured to coordinate benefits so that, among all of them, no more than 100% of a claim is paid

Answer 46

D

Question 47

Which of the following would not be an eligible dependent?

A. Lorna, who is 27 and is working on her master’s degree in social work

B. Bonita, who was married last month after celebrating her 25th birthday

C. Arielle, the last of the employees children to graduate high school

D. Alondra, the employee’s adopted daughter, who just turned 18

Answer 47

A

Question 48

Which of the following statements regarding group health insurance is false?

A. the eligibility period follows the probationary period

B. in some cases, union workers as a class may be excluded from coverage

C. coverage must be made available to dependents, other than spouses, up to a certain age

D. an employee may enroll in a group health plan at any time during the year without having to prove evidence of insurability

Answer 48

D

Question 49

Underwriting for group health plans requires

A. a lengthy probationary period during which no benefits will be provided

B. a credit report on each insured

C. a medical examination on each insured

D. no medical examination

Answer 49

D

Question 50

Natasha has paid $200 of her annual deductible through her employer’s group health insurance policy. She recently went to the dermatologist and received a billing statement for $2,000. A week after her appointment, her employer replaces the group health plan with a different insurer, what will Natasha owe the dermatologist?

A. $2,000

B. $1,500

C. $1,800

D. $0

Answer 50

C

Question 51

What was the effect of the 1985 Consolidated Omnibus Budget Reconciliation Act (COBRA) on group health insurance plans?

A. it mandates that group health insurance coverage be extended for terminated employees for up to a specified period

B. it provides tax deductibility for the cost of group health insurance coverage

C. it allows a group insurance participant to convert her coverage to an individual plan in the event of employment termination

D. it requires any group health plan then in operation to cover all employees, without regard to years of service

Answer 51

A

Question 52

All of the following are directly related to ERISA (Employee Retirement Income Security Act) except

A. assistance with medicare

B. protecting participants and their beneficiaries interests

C. mandating standards for fiduciaries

D. requirements regarding qualified pensions

Answer 52

A

Question 53

Prior to the Affordable Care Act, according to HIPAA, a newly hired worker was not subject to a waiting period if she had less than how many days between jobs with no health insurance coverage?

A. 36 days

B. 39 days

C. 93 days

D. 63 days

Answer 53

D

Question 54

Under the COBRA rules for employer group health insurance, which of the following statements is correct?

A. coverage may be continued for up to 36 months for a qualified beneficiary and 18 months for a terminated employee

B. coverage may be continued for up to 18 months for a qualified beneficiary and 36 months for a terminated employee

C. coverage may be continued for up to 18 months for both a qualified beneficiary and a terminated employee

D. coverage may be continued for up to 36 months for both a qualified beneficiary and a terminated employee

Answer 54

A