Module 10 Flashcards
(30 cards)
Another term for
“other employee
benefit plans” under
ERISA
Welfare plans
This regulation requires
minimum standards for
health plan: providing plan
information, exercising
fiduciary responsibilities in
plan administration,
establishing a grievance
and appeal process, and
allowing participants the
right to sue
ERISA
A law requiring
parity with respect
to aggregate
lifetime and annual
dollar limits for
mental health
benefits
Mental Health Parity
and Addiction Equity
Act of 2008
A law requiring
health plans to
provide
mastectomy,
prosthetic device,
and reconstructive
surgery coverage
Women’s Health and
Cancer Rights Act of
1998
A law requiring most
group health plans to
provide temporary
continuation of group
health coverage that
may otherwise be
terminated
COBRA
The maximum %
amount that an
employer may
require a COBRA
participant to pay
for coverage
102%
Entities that do not
have to offer
COBRA
Federal government,
churches, ERs with
less than 20 EEs
A common benefit
not subject to
being offered in
COBRA
continuation
Life or disability
insurance
The maximum period
of COBRA
continuation
coverage offered
based on employee
termination or
reduction in hours
18 months
Upon the employee
divorcing, dying, or
qualifying for
Medicare, the spouse
and dependent child
may obtain COBRA for
up to how many
months?
36 months
This legal provision
allows additional
opportunities to enroll
in a group health plan
when coverage is lost,
the participant gets
married, or a new
dependent is added
HIPAA
HIPAA nondiscrimination rules
stipulate that
employees and their
family members
cannot be denied
eligibility or benefits
based on what?
Health factors
Starting in 2010, the
ACA prohibited
plans from imposing
this exclusion.
Pre-existing
condition exclusions
The decision in
National Federation
of Independent
Business v. Sebelius
Supreme Court
precluded the
federal government
from ________.
Withholding all
Medicaid federal
funding if the state
fails to
accept/comply with
ACA Medicaid
expansion
requirements
Under the ACA, the 10
core benefits that
must be covered such
as ambulatory patient
services, prescription
drugs, and laboratory
services are
considered what?
____________.
Essential health
benefits
The ACA designation
for the types of
coverage that qualify
for satisfying the
shared responsibility
provision for individuals
and employers.
Minimum essential
coverage
Under the ACA,
tax credits are
offered to those
with incomes of
________________.
100% to 400% of the
poverty line
Another name
for the shared
responsibility
mandate
under the ACA
Employer mandate or
the “play or pay
provision”
An IRC section
requiring applicable
large employers to
offer health
coverage to fulltime employees or
pay a penalty
4980H
For employers to avoid
having to make a
shared responsibility
payment to the IRS,
the minimum essential
coverage must be
both “affordable” and
_______.
Provide minimum
value
The # of hours an
employee must work to be
considered a full-time
employee under employer
shared responsibility
provisions
30 hours per week or
130 hours per month
Those who don’t have
employer-sponsored
insurance or who don’t
qualify for government
programs such as
Medicare or Medicaid
can purchase insurance
through a __________.
Health Insurance
Marketplace
The threshold for FTEs that
makes an employer be
considered an ALE
(applicable large
employer)
50
Employers with 50 or
fewer employees can
purchase health
insurance coverage
for their employees
through the
_____________.
Small Business
Health Options
(SHOP) Marketplace
