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Life Insurance Exam > Group Health Plans > Flashcards

Group Health Plans Flashcards

1
Q

All of the following are requirements which were enacted as a result of HIPPA EXCEPT

  • ensuring the portability of group insurance coverage
  • enforcing the privacy of individual’s health information
  • creating various mandated benefits for pregnant women
  • eliminating pre-existing conditions for all eligible individuals
A
  • eliminating pre-existing conditions for all eligible individuals

The Affordable Care Act eliminated pre-existing conditions

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2
Q

Emily is 3 months pregnant and receiving prenatal health care from her employer group health plan. When her employer switches plans with a new insurer, Emily’s claim with the original insurer

  • will be terminated, and she will have to seek coverage from the new plan
  • will be terminated, and she will not be insurable under the new plan because her condition is pre-existing
  • will be transferred to the new insurer plan under the no loss/no gain rule
  • will be continued for the balance of her pregnancy under the no loss/no gain rule
A
  • will be continued for the balance of her pregnancy under the no loss/no gain rule
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3
Q

Eric works for J&G Corporation and is recently divorces. His 56-year old ex-spouse, Sophie, wants to know if she can maintain coverage under Eric’s group medical insurance plan. Which of the following statements best describes how this situation might be treated?

  • Sophie would no longer qualify for coverage under Eric’s group medical plan because she no longer is a dependent
  • Sophie would be able to continue coverage for up to 3 years by paying up to 102% of the premium requires for the group coverage
  • Sophie would be able to continue coverage until age 65 by paying up to 102% of the premium required for the group coverage
  • Sophie would be able to qualify for coverage under an individual policy, provided she submits to individual underwriting and pays a premium commensurate with her risk
A
  • Sophie would be able to continue coverage for up to 3 years by paying up to 102% of the premium requires for the group coverage
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4
Q

Which of the following criteria used in group health insurance underwriting reduces the risk of adverse selection?

  • persistency
  • size of the group
  • flow of members through the group
  • administrative capability
A
  • flow of members through the group
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5
Q

A single plan that covers the employees of 2 or more unrelated employers is called

  • a combined risk plan (CRP)
  • a multiple administrative plan (MAP)
  • a multiple employer trust (MET)
  • a multiple employer welfare arrangement (MEWA)
A

a multiple employer welfare arrangement (MEWA)

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6
Q

Under a group health insurance plan, a terminated employee may have which of the following options?

  • to continue identical coverage at the same premium
  • to continue reduced-benefit coverage under the group plan at an adjusted premium
  • to convert the coverage to an individual plan at the same premium
  • to convert the coverage to an individual plan at an adjusted premium
A
  • to convert the coverage to an individual plan at an adjusted premium
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7
Q

Which of the following statements regardiung multiple employer trusts (METs) is not covered?

  • METs provide only a self funded basis
  • an employer desiring coverage for its employees from a MET must subscribe by becoming a member of the trust
  • METs are most typically used by smaller employers
  • METs are established to provide group benefits to employers within a specific industry, such as construction
A
  • METs provide only a self funded basis
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8
Q

Which of the following populations may an employer legally exclude from group health benefits?

  • married women between the ages of 25 and 40
  • employees over the age of 62
  • union workers as a class
  • handicapped employees
A
  • union workers as a class
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9
Q

Which of the following situations regarding covered employees is not considered a qualifying event?

  • Doreen becomes legally separated from her spouse
  • Santino’s son who no longer meets the dependent status
  • Dmitri’s hours are reduced
  • Laurie becomes eligible for Medicaid
A
  • Laurie becomes eligible for Medicaid
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10
Q

Which of the following criteria used in group health insurance underwriting reduces the risk of adverse selection?

  • persistency
  • flow of members through the group * size of the group
  • administrative capability
A
  • flow of members through the group * size of the group
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11
Q

Eric works for j&G coporation and is recently, divorced. His 56 year old ex spouse, Sophie, wants to know if she can maintain coverage under Eric’s group medical insurance plan. Which of the following statements best describes how this situation might be treated?

  • Sophie would no longer qualify under Eric’s group medical plan because she is no longer a dependent
  • Sophie would be able to qualify for coverage under an individual policy provided she submits to individual underwriting and pays a premium commensurate with her risk
  • Sophie would be able to continue until age 65 by paying up to 102% of the premium required for the group insurance
  • Sophie would be able to continue coverage for up to 3 years by paying up to 102% of the premium required for group coverage
A
  • Sophie would be able to continue coverage for up to 3 years by paying up to 102% of the premium required for group coverage
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12
Q

Emily is 3 monthly is ps pregnant and receiving prenatal health care from her employer group health plan. When her employer switches plans with a new insurer, Emily’s claim with the original insurer

  • will be terminated, and she will not be insuraunded the new plan because her condition is pre-existing
  • will be terminated, and she will have to seek coverage from the new plan
  • will be continued for the balance of her pregnancy under the no loss/no gain rule
  • will be transferred to the new insurer plan under the no loss/no gain rule
A
  • will be continued to the new insurer plan under the no loss/no gain rule
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13
Q

Which of the following statements reagarding mutiple employer trusts (METs) is NOT correct?

  • METs are established to provide group benefits to employers with specific industry, such as construction
  • METs provide coverage only on a self-funded basis
  • METs are most typically used by smaller employ
  • An employer desiring coverage for its employees from a MET must subscribe by becoming a member of the trust
A
  • METs provide coverage only on a self-funded basis
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14
Q

All of the following are requirements which were enacted as a result of HIPAA EXCEPT?

  • ensuring the portability of group insurance coverage
  • enforcing the privacy of individuals’ health information
  • creating various mandated benefits for pregnant women
  • eliminating pre-existing conditions for all eligible individuals
A
  • eliminating pre-existing conditions for all eligible individuals
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15
Q

Employers must provide notification statements to individuals eligible for COBRA continuation within

  • 21 days
  • 14 day
  • 30 days
  • 31 days
A
  • 14 day
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16
Q

Under Liz’s group employer disability insurance, she is eligible to receive $1500 every month. When she becomes disabled, she is also eligible to receive $850 each month from Social Secuirty. How much will she receive each month form her group disability plan?

  • 2350
  • 1500
  • 650
  • 850
A
  • 650
17
Q

Which of the following would NOT be a criterion for group underwriting?

  • ages of the group members
  • education level of the group members
  • income level of the group members
  • sex of the group members
A
  • education level of the group members
18
Q

Uner CA regulations, which of the following statements regarding coverage of a spouse after divorce from an insured employee is CORRECT?

  • the ex-spouse’s coverage can be converted to an individual policy
  • the ex-spouse’s coverage can be continued with identical benefits for a specified period
  • the ex-spouse’s coverage can be continued with an increase in coinsurance and deductible
  • all coverage ends at the time of deivorce
A
  • the ex-spouse’s coverage can be continued with identical benefits for a specified period
19
Q

When an employee’s coverage terminates under a group health policy, the employee has the option to elect continuation within

  • 10 days
  • 60 days
  • 45 days
  • 30 days
A
  • 60 days
20
Q

Natasha has $200 of her annual deductible through her employer’s group health insurance policy. She recently went to the dermatologist and received a billing statement for $2,000. A week after her appointment, her employer replaces the group health plan with a different insurer, what will Natasha owe the dermatologist?

  • $0
  • $1,500
  • $2,000
  • $1,800
A
  • $1,800
21
Q

All of the following are underwriting criteria for group health insurance EXCEPT

  • composition of the group
  • size of the group
  • geographic location of the group
  • persistency
A
  • geographic location of the group

Life Insurance Exam (13 decks)

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