Ch 7 Group Accident and Health Insurance Part II Flashcards
How many members must an association have to qualify for group insurance?
100 members
If a group health policy covers individuals that reside in more than one state which state has jurisdiction over a group policy?
The state in which the policy was delivered
What type of groups are eligible for group health insurance?
Employer sponsored and association sponsored groups
Does group health insurance require medical examinations?
No, the underwriter evaluates the group as a whole, rather than each individual member
What is a birthday rule in a coordination of benefits provision?
The coverage of the parent whose birthday is earlier in the year is considered primary
How do insurers determine the cost for a group health policy?
The main variables are the ratio of men and women in the group, and the average age of the group
If the insured’s share in the cost of health insurance premiums with the employer, this would be known as what type of group health plan?
Contributory
In group insurance, who is issued a certificate of insurance?
Individual insured
What is a probationary period in group health insurance?
The period of time that must lapse before an employee is eligible for group health coverage
In health insurance, when would an excess plan pay benefits?
After the primary plan has paid its full promised benefit, the excess plan will pay the balance
According to the coordination of benefits provision, if both parents have coverage for a child from their employers policies, which policy will pay first?
The order of payment will be determined by the birthday rule: the coverage of the parent whose birthday is earlier in the year will be considered primary
What do individual insureds receive as proof of the group health coverage?
Certificate of insurance
In group insurance, what is the name of the policy?
Master policy
Who are the parties in a group health contract?
The employer and insurer
What is the purpose of COBRA?
To allow continuation of health insurance coverage for terminated employees
