Module 10

Question 1

Another term for “other employee benefit plans” under ERISA

Answer 1

Welfare plans

Question 2

This regulation requires minimum standards for health plan: providing plan information, exercising fiduciary responsibilities in plan administration, establishing a grievance and appeal process, and allowing participants the right to sue

Answer 2

ERISA

Question 3

A law requiring parity with respect to aggregate lifetime and annual dollar limits for mental health benefits

Answer 3

Mental Health Parity and Addiction Equity Act of 2008

Question 4

A law requiring health plans to provide mastectomy, prosthetic device, and reconstructive surgery coverage

Answer 4

Women’s Health and Cancer Rights Act of 1998

Question 5

A law requiring most group health plans to provide temporary continuation of group health coverage that may otherwise be terminated

Answer 5

COBRA

Question 6

The maximum % amount that an employer may require a COBRA participant to pay for coverage

Answer 6

102%

Question 7

Entities that do not have to offer COBRA

Answer 7

Federal government, churches, ERs with less than 20 EEs

Question 8

A common benefit not subject to being offered in COBRA continuation

Answer 8

Life or disability insurance

Question 9

The maximum period of COBRA continuation coverage offered based on employee termination or reduction in hours

Answer 9

18 months

Question 10

Upon the employee divorcing, dying, or qualifying for Medicare, the spouse and dependent child may obtain COBRA for up to how many months?

Answer 10

36 months

Question 11

This legal provision allows additional opportunities to enroll in a group health plan when coverage is lost, the participant gets married, or a new dependent is added

Answer 11

HIPAA

Question 12

HIPAA non-discrimination rules stipulate that employees and their family members cannot be denied eligibility or benefits based on what?

Answer 12

Health factors

Question 13

Starting in 2010, the ACA prohibited plans from imposing this exclusion.

Answer 13

Pre-existing condition exclusions

Question 14

The decision in National Federation of Independent Business v. Sebelius Supreme Court precluded the federal government from ________.

Answer 14

Witholding all Medical federal funding if the state fails to
accept/comply with ACA Medicaid expansion requirements

Question 15

Under the ACA, the 10 core benefits that must be covered such as ambulatory patient services, prescription drugs, and laboratory services are considered what? ____________.

Answer 15

Essential health benefits

Question 16

The ACA designation for the types of coverage that qualify for satisfying the shared responsibility provision for individuals and employers.

Answer 16

Employer mandate or the “play or pay provision”

Question 17

An IRC section requiring applicable large employers to offer health coverage to full-time employees or pay a penalty

Answer 17

4980H

Question 18

For employers to avoid having to make a shared responsibility payment to the IRS, the minimum essential coverage must be both “affordable” and _______.

Answer 18

Provide minimum value

Question 19

The # of hours an employee must work to be considered a full-time employee under employer shared responsibility provisions

Answer 19

30 hours per week or 130 hours per month

Question 20

Those who don’t have employer-sponsored insurance or who don’t qualify for government programs such as Medicare or Medicaid can purchase insurance through a __________.

Answer 20

Health Insurance Marketplace

Question 21

The threshold for FTEs that makes an employer be considered an ALE
(applicable large employer)

Answer 21

50

Question 22

Employers with 50 or fewer employees can purchase health insurance coverage for their employees through the _____________.

Answer 22

Small Business Health Options
(SHOP) Marketplace

Question 23

This type of plan is exempt from many of the ACA market reforms and was in existence prior to March 23, 2010.

Answer 23

Grandfathered plan

Question 24

A law that allows eligible employees of covered employers to take unpaid, job-protected leave for specified family/medical reasons with continuation of group health insurance coverage

Answer 24

FMLA

Question 25

FMLA can be taken in a continuous time frame or on an _________________basis

Answer 25

Intermittent or reduced schedule

Question 26

The Americans with Disabilities Act (ADA) of 1990 covers employers with this number of employees:

Answer 26

15 or more

Question 27

A major concern of employer-sponsored health plans is the applicability of __________________.

Answer 27

Wellness programs

Question 28

USERRA allows those on military duty for more than 30 days to continue employer-sponsored health care for up to 24 months but may require them to pay ____________.

Answer 28

102% of the premium