Q: What types of groups are eligible for group health insurance?
A: Employer-sponsored and association-sponsored groups
A: Employer-sponsored and association-sponsored groups
Q: According to the Coordination of Benefits provision, if both parents have coverage for a child from their employers' policies, which policy will pay first?
A: The order of payment will be determined by the birthday rule: the coverage of the parent whose birthday is earlier in the year will be considered primary
A: The order of payment will be determined by the birthday rule: the coverage of the parent whose birthday is earlier in the year will be considered primary
Q: Who are the parties in a group health contract?
A: The employer and the insurer
A: The employer and the insurer
Q: What is a birthday rule in a coordination of benefits provision?
A: The coverage of the parent whose birthday is earlier in the year is considered primary
A: The coverage of the parent whose birthday is earlier in the year is considered primary
Q: What is the purpose of COBRA?
A: To allow continuation of health insurance coverage for terminated employees
A: To allow continuation of health insurance coverage for terminated employees
Q: In health insurance, when would an excess plan pay benefits?
A: After the primary plan has paid its full promised benefit, the excess plan will pay the balance
A: After the primary plan has paid its full promised benefit, the excess plan will pay the balance
Q: If a group health policy covers individuals that reside in more than one state, which state has jurisdiction over the group policy?
A: The state in which the policy was delivered
A: The state in which the policy was delivered
Q: How many members must an association have to qualify for group insurance?
A: 100 members
A: 100 members
Q: How do insurers determine the cost for a group health policy?
A: The main variables are the ratio of men and women in the group, and the average age of the group
A: The main variables are the ratio of men and women in the group, and the average age of the group
Q: What is a probationary period in group health insurance?
A: The period of time that must lapse before an employee is eligible for group health coverage
A: The period of time that must lapse before an employee is eligible for group health coverage
Q: Does group health insurance require medical examinations?
A: No, the underwriter evaluates the group as a whole, rather than each individual member
A: No, the underwriter evaluates the group as a whole, rather than each individual member
Q: In group insurance, who is issued a certificate of insurance?
A: Individual insured
A: Individual insured
Q: What do individual insureds receive as proof of their group health coverage?
A: Certificate of Insurance
A: Certificate of Insurance
Q: In group insurance, what is the name of the policy?
A: Master policy
A: Master policy
Q: If the insureds share in the cost of health insurance premiums with the employer, this would be known as what type of group health plan?
A: Contributory
ERISA—The Employee Retirement Income Security Act of 1974 (ERISA) is a federal law that sets minimum standards for most voluntarily established retirement and health plans in private industry to provide protection for individuals in these plans.
A: Contributory
ERISA—The Employee Retirement Income Security Act of 1974 (ERISA) is a federal law that sets minimum standards for most voluntarily established retirement and health plans in private industry to provide protection for individuals in these plans.