Module 10 Flashcards

1
Q

Another term for “other employee benefit plans” under ERISA

A

Welfare plans

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

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

A

ERISA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

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

A

Mental Health Parity and Addiction Equity Act of 2008

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

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

A

Women’s Health and Cancer Rights Act of 1998

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

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

A

COBRA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

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

A

102%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Entities that do not have to offer COBRA

A

Federal government, churches, ERs with less than 20 EEs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

A common benefit not subject to being offered in COBRA continuation

A

Life or disability insurance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

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

A

18 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

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

A

36 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

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

A

HIPAA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

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

A

Health factors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

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

A

Pre-existing condition exclusions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

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

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

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

A

Essential health benefits

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

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

A

Minimum essential coverage

17
Q

Under the ACA, tax credits are offered to those with incomes of ________________.

A

100% to 400% of the poverty line

18
Q

Another name for the shared responsibility mandate under the ACA

A

Employer mandate or the “play or pay provision”

19
Q

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

A

4980H

20
Q

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

A

Provide minimum value

21
Q

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

A

30 hours per week or 130 hours per month

22
Q

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 __________.

A

Health Insurance Marketplace

23
Q

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

A

50

24
Q

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

A

Small Business Health Options (SHOP) Marketplace

25
Q

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

A

Grandfathered plan

26
Q

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

A

FMLA

27
Q

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

A

Intermitten or reduced schedule

28
Q

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

A

Wellness programs

28
Q

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

A

15 or more

29
Q

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

A

102% of the premium