Group Health Insurance

Question 1

Eligible Groups:

Answer 1

Qualification: Natural groups formed for reasons other than insurance.
Includes: Employer-based groups, labor unions, fraternal benefit societies, associations, blanket policies for specific activities (e.g., students, campers, sports teams).
Minimum Association Members: Association policies must cover at least 15 individual members, excluding officers

Question 2

Continuation:

Answer 2

Coverage Extension: Terminated employees may continue coverage if the policy remains active for active employees.
Duration: Coverage can continue for 18 months after loss of employment or until becoming eligible for other group coverage, with a potential extension for disabled individuals up to 29 months.
Notice Requirements: Employers must notify employees of their continuation rights; beneficiaries must notify insurers within 63 days of termination.

Question 3

Conversion:

Answer 3

Conversion Option: Allows transitioning from group coverage to individual policy without evidence of insurability.
Election Period: Insured must notify the insurer within 31 days of termination; premiums must be paid within the same timeframe.

Question 4

Coordination of Benefits:

Answer 4

Purpose: Controls overinsurance by specifying the order in which plans pay claims.
Primary and Secondary Plans: Primary plan pays first, secondary plan compensates after; total benefits from all plans cannot exceed 100% of the allowable expense.
Medicare Coverage: Benefits under Medicare are paid after primary and secondary plans.