Health Insurance

Front 1

Which of the following concepts is founded on the ability to predict the approximate number of deaths or frequency of disabilities within a certain group during a specific time?

A. Principle of Large Loss
B. Quantum Insurance Principle
C. Indemnity Law
D. Law of Large Numbers

Back 1

D. Law of Large Numbers

Front 2

The owner of a camera store is worried that her new employees may help themselves to items from inventory without paying for them. What kind of hazard is described?

A. Physical Hazard
B. Ethical Hazard
C. Morale Hazard
D. Moral Hazard

Back 2

D. Moral Hazard

Front 3

All of the following actions are examples of risk avoidance EXCEPT?

A. Bill won't fly in an airplane
B. Wemdu keeps her money out of the stock market
C. Pat pays his insurance premium
D. John never drives a car

Back 3

C. Pat pays his insurance premium

Front 4

Risk Avoidance

Back 4

One method of dealing with risk is risk avoidance, which is simply avoiding as many risks possible. By choosing not to drive or own an automobile, one could avoid the risk associated with driving. By never flying one could eliminate the risk of being in an airplane crash. By never investing in stock, one could avoid the risk of a market crash. Clearly risk avoidance is effective, but it is not always practical. Few risks can be handled in this manner

Front 5

Eligible employees or their dependents may not be denied coverage under a group health plan or insurance policy due to

Back 5

Health status; Medical condition; Claims and experience; Receipt of health care; Medical history; Genetic information; Evidence of insurability-including arising from acts of domestic violence; Disability

Front 6

Under the law group health plans, insurers can only apply preexisting exclusions to

Back 6

Late entrants; Person who has never had health coverage; Person who previously has had health coverage for less than 63 days; A person who has been without coverage for more than 63 days

Front 7

A late entrant is a plan member or a dependant who does not enroll during

Back 7

The first period in which she/he is eligible to enroll, or a special enrollment period when there is a change in family status or loss of group coverage under another plan

Front 8

Preexisting exclusiions are not allowed for

Back 8

Newborns; Adopted children placed for adoption; Pregnancy (including late term)

Front 9

Standard and Alternative Methods of Counting Credible Coverage

Back 9

Mental health; Substance abuse treatment; Prescription drugs; Dental care; Vision care

Front 10

Cobra-Consolidated Omnibus ou Budget Reconcilation Act

Back 10

Terminated employees or those that lose medical coverage because of reduced work hours may be able to buy group coverage for themselves and their families for limited periods of time. If you are entitled to Cobra benefits, your health plan must give you notice stating your rights to choose to continue benefits provided by the plan. You have 60 days to accept the coverage or lose all rights to benefits. Once Cobra coverage is chosen, you are required to pay for coverage. Replaces ERISA - the Internal Revenue Code and Public Health Service Act

Front 11

Group health plans and insurers must offer special enrollment periods during which eligible persons are allowed on the plan without being considered late entrants. Eligible employees or dependents are allowed to enroll within 30 days following:

Back 11

Separation; Divorce; Death; Termination of employment; Reduction in work hours; Employers contributions toward coverage have terminated; Exhaustion of Cobra continuation or state continuation;
A change in family status due to: marriage, birth of a child, adoption or placement for adoption of a child

Front 12

Can an employee or a dependent spouse enroll in a plan during special enrollment period?

Back 12

Yes: Employees and dependent spouses who are otherwise eligible but not enrolled in the plan can also enroll during the special enrollment period when a change in family status occurs. Persons enrolling under these special enrollment conditions cannot be treated as late entrants

Front 13

If someone loses other coverage, when are they eligible to enroll?

Back 13

For persons losing other group coverage, special enrollement requests can be made only after losing eligibility for the other coverage. Special enrollment is not available in the previous coverage loss resulted from fraudulent activity, or because the person did not pay premiums

Front 14

An insurer my renew insured group policies at the employers options except for

Back 14

non payment of premiums; fraud; violations of participation or contribution rules and insurance carrier may set its own participation or contribution rules so long as they comply with state law; Termination of coverage the carrier ceases to offer coverage in a particular market; Movement outside the service area (applies to networks); For association plans of an employer's membership in the association ends. Under certain circumstances, however, an insurer may modify coverage. An insurer may also discontinue some or all of coverage's in certain markets. If this is done, group health plans and state insurance departments must be notified in advance

Front 15

Guranteed renewable clause

Back 15

prohibits the cancelation of a policy as long as the premiums are paid properly and no false information has been supplied in order to obtain coverage. Providing false information can have much more serious consequences that just losing insurance coverage it is a crime