Questions
Questions
2: Which of the following statements is NOT correct concerning the COBRA Act of 1985?
A It requires all employers, regardless of the number or age of employees, to provide extended group health coverage.
B It covers terminated employees and/or their dependents for up to 36 months after a qualifying event.
C It applies only to employers with 20 or more employees that maintain group health insurance plans for employees.
D COBRA stands for Consolidated Omnibus Budget Reconciliation Act.
COBRA Act applies to only employers with 20 or more employees.
3: What type of health insurance would be used to cover children at a Girl Scout Camp?
A Term insurance
B Blanket insurance
C Children’s rider
D Short-term disability
Blanket health insurance operates on the same principles as group health insurance. The only difference is that the insured members are not named. The policy is designed for groups where the membership changes frequently.
4: Which renewal provision(s) must be included in a long-term care policy issued to an individual?
A Renewable at the option of the insurer
B Noncancellable and guaranteed renewable
C Renewable and convertible
D Cancellable and conditionally renewable
No long-term care policy issued to an individual may contain renewal provisions other than guaranteed renewable or noncancellable.
7: Which of the following groups seeking group health insurance would represent a bad risk for underwriters?
A A group that changes insurance annually
B A group that pays a low premium
C A group that has a noncontributory plan
D A group that has a large number of members
The underwriter takes persistency into consideration because groups that change insurance companies every year do not represent a good risk.
13: What is the benefit of experience rating?
A It helps employers with high claims experience to get group coverage.
B It helps employees with low claims experience to become exempt from group premiums.
C It allows employers with high claims experience to obtain insurance.
D It allows employers with low claims experience to get lower premiums.
Group health insurance is usually subject to experience rating where the premiums are determined by the experience of this particular group as a whole. Experience rating helps employers with low claims experience because they get lower premiums.
3: How many eligible employees must be included in a contributory health insurance plan?
A 75%
B 90%
C 100%
D 50%
At least 50% percent of eligible employees can be included in a contributory health insurance plan. Both the employees and the employer contribute to premium payments.
8: Which of the following is monitored by ERISA?
A Cash profit-sharing plans
B Severance pay of less than 2 years
C Stock profit-sharing plans
D Cash bonus plans
Cash bonus plans, cash profit-sharing plans, and severance pay of less than two years are considered compensation and are not regulated by ERISA.
13: When compared with the administrative cost found in individual coverage, the per capita administrative cost in group health insurance is
A Higher.
B Comparable.
C Equal.
D Lower.
The per capita administrative cost in group health insurance is less than the administrative cost found in individual coverage.
14: What type of benefit plan is a managed plan that is developed in conjunction with the Health Benefit plan committee?
A Catastrophic Coverage Benefit Plan
B Small Employee Carrier Plan
C Open Care Plan
D Basic Coverage Benefit Plan
Basic Coverage Benefit Plan is a managed plan developed in conjunction with the Health Benefit plan committee. The Basic Coverage Benefit Plan is lower in cost than the Standard Benefit Plan.
7: According to the Coordination of Benefits (COB) provision in health insurance in this state, if insurer overpaid on a claim, the insurer may recover the excess from all of the following EXCEPT
A Another organization involved in the claim.
B The person to whom the benefit has been paid.
C The Insurance Guaranty Association.
D The other insurer.
If the amount of the payment made by an insurer is more than it should have paid under its COB provision, the insurer may recover the excess from any or all of the following: the person to whom the benefit has been paid, insurance companies, or other organizations.
10: One of the differences between group underwriting and individual underwriting is that there is little or no medical information required regarding plan participants in groups of
A 100 or more.
B 25 or more.
C Fewer than 50.
D 50 or more.
In groups of 50 or more, medical information cannot be required of plan participants.
14: Welfare benefits include all of the following EXCEPT
A Holiday pay.
B Day care benefits.
C Health care benefits.
D Workers compensation.
All forms of health care, life insurance, prepaid legal services, and disability insurance (both long- and short-term) are considered "employee welfare benefit" plans. Unfunded benefits or payroll practices, such as vacation, holidays, overtime premiums, holiday gifts, and compensation paid for time not worked are not included.
14: Welfare benefits include all of the following EXCEPT
A Day care benefits.
B Health care benefits.
C Workers compensation.
D Holiday pay.
All forms of health care, life insurance, prepaid legal services, and disability insurance (both long- and short-term) are considered "employee welfare benefit" plans. Unfunded benefits or payroll practices, such as vacation, holidays, overtime premiums, holiday gifts, and compensation paid for time not worked are not included.
15: Who guarantees a conventional fully-insured group plan?
A The insured
B The annuitant
C The employer
D The insurer
A conventional fully-insured plan is administered and guaranteed by an insurance company. In return for the premium collected from the insured by the insurer, the insurer assumes the risk of paying the cost of medical expenses that may or may not occur during the policy period.
1: In group insurance, what is the policy called?
A Master policy
B Entire contract
C Certificate of authority
D Certificate of insurance
In group insurance the policy is called the master policy and is issued to the policyowner, which could be the employer, an association, a union, or a trust.
4: Who guarantees a conventional fully-insured group plan?
A The annuitant
B The employer
C The insurer
D The insured
A conventional fully-insured plan is administered and guaranteed by an insurance company. In return for the premium collected from the insured by the insurer, the insurer assumes the risk of paying the cost of medical expenses that may or may not occur during the policy period.
6: Which of the following statements concerning group health insurance is CORRECT?
A Under group insurance, the insurer may reject certain individuals from coverage.
B The employer is the policyholder.
C Only the employer receives a certificate of insurance.
D Each employee receives a policy.
The employer receives the master policy; each employee receives a certificate of insurance. All employees have the same coverage under the master contract.
10: The minimum number of persons to be insured under a group health insurance plan is established by
A Federal law.
B State law.
C The employer.
D The NAIC.
State law specifies the minimum number of persons to be covered under a group insurance policy.
12: According to the Coordination of Benefits (COB) provision in health insurance in this state, if insurer overpaid on a claim, the insurer may recover the excess from all of the following EXCEPT
A The person to whom the benefit has been paid.
B The Insurance Guaranty Association.
C The other insurer.
D Another organization involved in the claim.
If the amount of the payment made by an insurer is more than it should have paid under its COB provision, the insurer may recover the excess from any or all of the following: the person to whom the benefit has been paid, insurance companies, or other organizations.
15: COBRA applies to employers with at least
A 20 employees.
B 80 employees.
C 60 employees.
D 50 employees.
Under the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA), any employer with 20 or more employees must extend group health coverage to terminated employees and their families.