Group Health Insurance

Front 1

Which of the following is not part of the qualification process for legal dependency?

Back 1

Eligibility for insurance

Front 2

When both parents have employer-provided group coverage, the children are covered under:

Back 2

the plan of the parent whose birthday falls closest to the start of the calendar year

Front 3

Under the coordination of benefits rule, the primary company pays:

Back 3

as if there were no other coverage

Front 4

The Records Provision:

Back 4

If there is an error or omission in the administration of a group policy, the person's insurance is considered to be "what it would be" if there had been no error or omission.

Front 5

What does the federal law that requires employers with more than 20 employees to include in their group insurance plan a continuation of benefits provision for all eligible employees?

Back 5

COBRA

Front 6

What is the federal law that extends the minimum continuation of coverage period from 18-29 months for qualified beneficiaries disabled at the time of termination or reduction in hours:

Back 6

OBRA

Front 7

What provisions is not a part of HIPPA any longer?

Back 7

Annual limits and lifetime spending limits may no longer apply to mental health coverage

Front 8

When an employer ceases to maintain any group health plan this is a disqualifying event under what:

Back 8

COBRA

Front 9

Under OBRA, an employer may terminate COBRA coverage because of coverage under another health plan

Back 9

as long as the other health plan does not limit benefits for the insured's preexisting condition

Front 10

The Age Discrimination in Employment Act applies to employees who are:

Back 10

40 or older

Front 11

What kind of insurance is a group coverage that pays benefits for lost earnings resulting from accident or sickness disability:

Back 11

Disability income insurance

Front 12

What is AD&D

Back 12

Accidental death and dismemberment. Another type of group coverage that deals with accidental loss of life or loss of one or more limbs or of eyesight.

Front 13

What is a Conversion Privilege

Back 13

Allows the insured to convert his or her group coverage to individual coverage without evidence of insurability (31 days from time of ineligibility to convert to new plan)

Front 14

Coordination of Benefits Provision:

Back 14

a provision in most health plans that allow families with two wage earners covered by health benefit plans to receive up to 100% coverage for medical services.

Front 15

How is it determined with COB who covers the children first:

Back 15

The Birthday Rule determines primary coverage. The "Birthday Rule" places primary responsibility for children based on whom, you or your spouse, was born earliest in the year.

Front 16

HIPPA

Back 16

Health Insurance Portability and Accountability Act

Front 17

COBRA

Back 17

Consolidated Omnibus Budget Reconciliation Act or - Continuation of Benefits Act is a federal law that requires employers with 20 or more employees to provide for a continuation of benefits under the employer's group health insurance plan for former employees and their families at their own expense.

Front 18

What are COBRA qualifying events:

Back 18

An occurrence that triggers an insured's protection. Death of a covered employee, termination or reduction of work hours of a covered employee, medicare eligibility for the covered employee, divorce or legal separation, the termination of a child's dependent status and the bankruptcy of the employer.

Front 19

What is NOT a qualifying event if it is the result of gross misconduct by the covered employee

Back 19

Termination

Front 20

Qualified Beneficiary

Back 20

any individual covered under an employer-maintained group health plan on the day before the qualifying event, including children born or adopted during the 18 month coverage period.

Front 21

Employers are obligated to provide written notification statements to individuals eligible for ______

Back 21

COBRA continuation.

Front 22

How many days following the notification of eligibility for continuation of benefits does an individual have to elect such continuation?

Back 22

60 days

Front 23

What is the maximum period of coverage continuation for termination of employment or a reduction in hours of employment

Back 23

18 months.

Front 24

for all other qualifying events except termination what is the maximum period of coverage continuation

Back 24

36 months

Front 25

What are the 4 disqualifying events that can result in termination of COBRA coverage:

Back 25

1. first day for which timely payment is not made

2. date the employer ceases to maintain any group health plan

3. first date on which the individual is covered by another group plan (even if coverage is less)

4. date the individual becomes eligible for medicare

Front 26

To cover administrative expense an employer may incur, the terminated individual to pay an additional amount each month not to exceed:

Back 26

2% of the premium

Front 27

OBRA

Back 27

Omnibus Budget Reconciliation Act - an extension of the minimum COBRA continuation of coverage period from 18-29 for qualified beneficiaries disabled at the time of termination or reduction in hours.

Front 28

TEFRA

Back 28

Tax Equity and Fiscal Responsibility Act - is intended to prevent group term life insurance plans from discriminating in favor of key employees.

Front 29

ERISA

Back 29

Employee Retirement Income Security Act - stringent reporting and disclosure requirements for establishing and maintaining group health insurance and other qualified plans.

Front 30

ADEA

Back 30

Age Discrimination in Employment Act - applies to employers with 20+ employees and is directed toward employees who are age 40 or older. This act prohibits compulsory retirement, and while benefits can be reduced they cannot be terminated.

Front 31

ADA

Back 31

The American with Disabilities Act - unlawful for employers with 15+ employees to discriminate on the basis of disability. Employees with disabilities must also be given equal access to whatever health insurance coverage the employers provides to other employees.