Module 5 Flashcards
1
Q
A plan where the plan sponsor assumes full liability for the financial, legal, and administrative costs of the plan.
A
self insured
2
Q
An alternate
term for “selfinsured”.
A
self funded
3
Q
An insured group
plan’s premium
surplus or deficit.
A
experience results
4
Q
An annual process for insurers to determine the premium for the contract year.
A
premium rate renewal
5
Q
A renewal method where the insurer amalgamates claims experience for an entire book of business into one pool.
A
fully pooled premium rate renewal
6
Q
A renewal method where the group’s own claims experience determines premium rates.
A
prospectively rated premium renewal rate
7
Q
The amount of money an employer is willing/able to contribute from revenue and plan member contributions to pay for group benefits
A
funding sources
8
Q
Determination of who bears the underlying risk for paying claims and expenses for a group benefits plan.
A
funding arrangement
9
Q
A fully insured plan
with no risk to the
plan sponsor.
A
insured non refund
10
Q
A fully insured plan
with some risk to
plan sponsor.
A
insured refund
11
Q
A financial report prepared by an insurer for plans underwritten on a refund arrangement.
A
annual financial accounting report
12
Q
An annual statement prepared by a contracted service provider to reconcile plan sponsor payments to claims and expenses plus cash flow interest for the period.
A
annual financial accounting
13
Q
Protection against
exposure to large
individual claims.
A
large amount pooling
14
Q
Protection against potentially catastrophic claims that occur with low frequency. This applies to the entire claim.
A
pooling from first dollar
15
Q
Protection against an unexpectedly high level of total claims in any one contract period for one benefit.
A
aggregate stop loss pooling
16
Q
Protection against financial risk beyond a specified number of years for a disability claim, assumed by the insurer.
A
duration pooling
17
Q
The charge paid by the plan sponsor to the insurer for assuming the risk for claims above a pooling threshold.
A
pooled premium
18
Q
A fund established by the insurer from plan surpluses for the purpose of offsetting a future deficit.
A
claims fluctuation reserve CFR
19
Q
An agreement a plan sponsor enters into with an insurer or third party administrator to administer a plan, with financial and legal responsibility for all plan costs remaining with sponsor.
A
admin services only ASO
20
Q
Projected claims and expenses paid by monthly deposits similar to how premiums are billed.
A
billed in advance (budget aso)
21
Q
Claims and expenses are reimbursed to the insurer or TPA with a cheque payment in the following month.
A
monthly billed in arrears
22
Q
Reimbursement to an insurer for claims and expenses is by automatic funds transfer from the plan sponsor’s account, on the basis of cheques issued and expenses.
A
billed in arrears
