Podcast
Questions and Answers
What federal law regulates companies that set up employee health and pension plans?
What federal law regulates companies that set up employee health and pension plans?
ERISA
What health insurance program is available for federal government employees?
What health insurance program is available for federal government employees?
FEHB
What may be used to modify the terms of an insurance contract?
What may be used to modify the terms of an insurance contract?
Rider
What type of contract involves a third-party claim administrator for a self-funded health plan?
What type of contract involves a third-party claim administrator for a self-funded health plan?
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What is a common reason why people elect to enroll in individual health plans?
What is a common reason why people elect to enroll in individual health plans?
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Who is not a common purchaser of individual health plans?
Who is not a common purchaser of individual health plans?
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How often do open enrollment periods usually occur?
How often do open enrollment periods usually occur?
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What is one way that an employer can reduce prices for their group health plans?
What is one way that an employer can reduce prices for their group health plans?
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What type of plan do employers or employee organizations typically offer to their employees?
What type of plan do employers or employee organizations typically offer to their employees?
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Who may be covered under a group health plan?
Who may be covered under a group health plan?
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How can employees customize their group health plan policies?
How can employees customize their group health plan policies?
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What document do self-funded plan members receive that outlines their benefits and legal rights?
What document do self-funded plan members receive that outlines their benefits and legal rights?
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How can third-party administrators help self-funded health plans?
How can third-party administrators help self-funded health plans?
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Third-party claims administrators are classified as what?
Third-party claims administrators are classified as what?
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What type of contract binds a third-party administrator to provide services for a fixed fee per employee?
What type of contract binds a third-party administrator to provide services for a fixed fee per employee?
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If a state law is more restrictive than federal law, what law is followed?
If a state law is more restrictive than federal law, what law is followed?
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What advantage do employers gain by offering group health plans?
What advantage do employers gain by offering group health plans?
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Which organization runs ERISA?
Which organization runs ERISA?
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Self-funded health plans pay premiums to whom?
Self-funded health plans pay premiums to whom?
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Approximately what percent of the population is covered under individual health plans?
Approximately what percent of the population is covered under individual health plans?
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What is the term for the time that must pass before an employee can enroll in a health plan?
What is the term for the time that must pass before an employee can enroll in a health plan?
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What term refers to an individual who enrolls in a health plan after the original enrollment date?
What term refers to an individual who enrolls in a health plan after the original enrollment date?
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What type of deductible must be met for each separate enrollee?
What type of deductible must be met for each separate enrollee?
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What type of deductible can be met by combining payments?
What type of deductible can be met by combining payments?
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The term maximum benefit limit applies to what?
The term maximum benefit limit applies to what?
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What name is given to the time between the date of an employee's hire and the earliest effective date of insurance coverage?
What name is given to the time between the date of an employee's hire and the earliest effective date of insurance coverage?
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What is a list of drugs covered under an insurance plan called?
What is a list of drugs covered under an insurance plan called?
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What type of provider performance would be reimbursed at the highest level in a tiered network?
What type of provider performance would be reimbursed at the highest level in a tiered network?
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What type of plan permits the funding of premiums with pretax payroll deductions?
What type of plan permits the funding of premiums with pretax payroll deductions?
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Define parity as it relates to medical insurance.
Define parity as it relates to medical insurance.
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What benefit does COBRA offer to employees leaving a job?
What benefit does COBRA offer to employees leaving a job?
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In conjunction with COBRA, what must be considered when an employee joins a new plan?
In conjunction with COBRA, what must be considered when an employee joins a new plan?
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Study Notes
Key Federal Laws and Programs
- ERISA regulates employee health and pension plans.
- FEHB is the health insurance program for federal government employees.
Insurance Contract Modifications
- A rider modifies the terms of an insurance contract.
Insurance Administration
- An Administrative Services Only (ASO) contract involves a third-party administrator managing self-funded health plans.
- TPAs help self-funded plans by handling premium collections, processing claims, and maintaining member lists.
Health Insurance Plans
- Individual Health Plans (IHPs) are often chosen to continue coverage between jobs, mainly by individuals and not typically by employers.
- Group Health Plans (GHPs) are offered by employers or employee organizations and can cover employees, their families, and former employees.
Enrollment and Deductibles
- Open enrollment periods occur annually.
- Employees can customize GHP policies by selecting various premium and deductible levels.
- Waiting period defines the time before employee enrollment in a health plan is permissible.
- Late enrollees join health plans after the original enrollment period.
Deductibles
- Individual deductibles must be met separately for each enrollee, while family deductibles are cumulative across family members.
Coverage Limits and Formularies
- Maximum benefit limit refers to a specified monetary cap under an insurance plan.
- A formulary is a list of drugs covered by an insurance policy.
Cost Management and Provider Performance
- Employers can reduce costs for GHPs by negotiating benefit carve-outs.
- In tiered networks, providers that deliver high-quality care at lower costs receive higher reimbursement.
Plan Features and Benefits
- Section 125 cafeteria plans allow premium funding using pretax payroll deductions.
- Parity in medical insurance signifies equality in benefits for medical and surgical services.
Employee Benefits and COBRA
- COBRA provides employees the right to continue health insurance after leaving a job for a limited time, at their own expense.
- When joining a new plan post-COBRA, employees must consider their past creditable coverage.
Organizations and Regulatory Bodies
- EBSA oversees the implementation of ERISA.
- Self-funded health plans do not pay premiums as they assume the risk directly, covering costs as they arise.
Population Coverage
- Approximately 10% of the population is covered under Individual Health Plans.
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Description
This quiz covers essential federal laws related to health and pension plans, including ERISA and FEHB. It also explores modifications to insurance contracts and the role of third-party administrators in managing health plans. Test your knowledge on individual and group health plans, enrollment periods, and deductibles.
