Chapter 14/1: Group Health Insurance – Flashcards

Maternity benefits must be covered by employer groups that insure 15 or more employees. The correct answer is: Maternity does not need to be covered.

Certificates of coverage detail the policy, its coverage and term, claim procedures, and the right of conversion. The correct answer is: All of the above

Some lenders obtain creditor group insurance, which provides specialized life and health insurance coverage to its borrowers to protect the lender for losses resulting from the disability or death of the borrower. Usually, premiums for creditor group insurance are paid by the borrower, and the lender is the policy's beneficiary. The correct answer is: Premiums are typically paid by the lender.

Groups must have at least two employees to be eligible for group insurance coverage. The correct answer is: Maggie's Piano Studio with 1 employee

Group health insurance policy rates are usually based on experience rating in which premiums are based on the claims experience of the entire group. The correct answer is: Experience rating

Advertising for health insurance policies must be truthful, not misleading, and avoid using insurance jargon. The words and phrases must be clear and accurately describe the policy features. Illustrations must be accurate and relevant with regards to the policy advertised. Testimonials must be genuine and current. Advertisements may not make unfair, incomplete, or unsubstantiated comparison of other insurers_ policies or benefits. The correct answer is: All of the above

With community rating, premiums are based on the actual or projected costs of insureds in a particular geographic location with reference to insureds_ age, gender, occupation and health. When community rating is used to underwrite a group health plan, each member pays the same premium. The correct answer is: Community rating

The master contract is issued to the group entity, which is often an employer providing group health insurance for the employees_ benefit. The correct answer is: Employer

An association may obtain group health coverage for its members if the association consists of at least 100 people, has been organized for at least two years, has a constitution and by-laws, and holds at least annual meetings. The correct answer is: 100 members

All of Blain's eligible employees must participate in the plan since he is paying the entire cost of coverage. The correct answer is: The plan is noncontributory and all eligible employees must participate in the plan.

Group health plans may include or offer several types of coverage including medical, hospital, and surgical expenses, accidental death and dismemberment, and disability income. Often, disability income and accidental death and dismemberment polices are offered separately. The correct answer is: All of the above

Group insurance policies are governed by state insurance laws. Jurisdiction over the policy is in the state the policy was delivered. Many states allow delivery of a group policy issued in another state if the policy was approved by the state in which it was issued, complies with the insurance laws of the state in which it was delivered, and the insurance laws of the two states are essentially the same. The correct answer is: State insurance laws

A multiple employer trust (MET) allows several small businesses to work together to provide health insurance to their employees. The correct answer is: MET

Each member or employee covered under the policy is issued a certificate of coverage. Certificates of coverage detail the policy, its coverage and term, claim procedures, and the right of conversion. The correct answer is: Certificate of coverage

An association may obtain group health coverage for its members if the association consists of at least 100 people, has been organized for at least two years, has a constitution and by-laws, and holds at least annual meetings. The correct answer is: Have been organized for at least 4 years

Group health plans must state the eligibility requirements including: who is eligible; when individuals are eligible to enroll; and minimum plan participation requirements. The correct answer is: All of the above

Workers' Compensation covers occupational accidental injuries and sicknesses. The correct answer is: Occupational injuries

To be eligible for group coverage, a group must exist naturally, for reasons other than to acquire group insurance. The most common group health insurance is for a company and its employees. Other groups include labor or trade unions, credit unions and banks, alumni and professional associations. The correct answer is: ABC group, which banded together to obtain insurance coverage

Some companies may choose to offer health coverage to their employees through noninsured plans by establishing a trust that pays the employees' health benefits directly to the medical provider or to the employee. The trust is funded by employer contributions and employee premiums. Usually, an insurer or other financial or medical-related corporation acts as the administrator of the plan. The correct answer is: Self-funded plan

Multiple employer trusts (METs) and multiple employer welfare arrangements (MEWAs) consist of two or more employers or labor unions seeking group health insurance coverage. The correct answer is: MET and MEWA