Group Accident & Health Insurance and Dental Care Plans (CH 10) Flashcards Preview

Ohio Life and Health Insurance > Group Accident & Health Insurance and Dental Care Plans (CH 10) > Flashcards

Flashcards in Group Accident & Health Insurance and Dental Care Plans (CH 10) Deck (22)
Loading flashcards...
1
Q

Adverse Selection

A

Selection against the insurance company. The tendency of poorer risks to want insurance more often than standard risks.

2
Q

COBRA

A

Consolidated Omnibus Budget Reconciliation Act (COBRA) passed by Congress in 1986. The law enables a former employee to continue with his or her health coverage at the former employee’s own expense.

3
Q

Community Rating

A

A method of HIC rate calculation where the rate charged to a group or individual for the HIC coverage is based on the profit or loss experience of the HIC’s entire population.

4
Q

Contributory Group Policy

A

Group insurance for which the employees pay part of the premium. A minimum of 75% of eligible employees must participate.

5
Q

Credible Coverage

A

Any previous health insurance coverage a person had before buying a Medi-gap policy, as long as there was no break in coverage of more than 63 days.

6
Q

Experience Rating

A

The loss record of an insured, a class of coverage, or an insurance company.

7
Q

Non-contributory Policy

A

Any plan or program of insurance (usually group) for which the employer pays the entire premium and the employee contributes no part of the premium. Participation must be 100%.

8
Q

Persistency

A

The length of time that a group case stays on the books of the insuring company; impacts the group rate.

9
Q

Pre-existing Condition

A

A condition of health or physical condition that existed before the policy was issued.

10
Q

Individual Employer Plans

A

Self employed or partnerships in which the individual owner may have an individual policy or a group plan. Partner considered to be owners of the business and in some cases these individuals could be set up as employees of their business.

11
Q

Multiple Employer Trust (MET)

A

A trust consisting of multiple small employers in the same industry, formed for the purpose of purchasing Group Health Insurance or establishing a self-funded plan at a lower cost than what is available to the employers individually. MET’s are managed by an attorney-in-fact/

12
Q

Multiple Employer Welfare Arrangement (MEWA)

A

Any plan established or maintained by an employer or by an employee organization. Its purpose is to provide for its participants or their beneficiaries often on a self-insured basis, medial, surgical, or hospital care or benefits, or benefits in the event of sickness, accident, disability, and death.

13
Q

Preventative and diagnostic care

A

office visits, examinations, cleaning, X-rays, and diagnostics

14
Q

Restorative Care

A

fillings, inlays, and crowns

15
Q

Prosthodontics

A

Bridgework- artificial teeth as a prosthesis

16
Q

Oral Surgery

A

such as removal of wisdom teeth

17
Q

Periodontics

A

treatments of gum problems

18
Q

Endodontics

A

procedures such as root canals

19
Q

Orthodontics

A

braces

20
Q

When a corporation established a non-contributory group medical insurance contract, what percentage of eligible employees must enroll for the insurance to be issued?

A

100% of eligible employees

21
Q

Being defined as a “true group” means

A

the employees who enroll in the insurance plan do not have to answer any medical questions.

22
Q

Who has regulatory control over the group insurance contract?

A

State where the master policy is delivered.