Podcast
Questions and Answers
Which policy covers business expenses when the owner is disabled?
Which policy covers business expenses when the owner is disabled?
- Business overhead expense policy (correct)
- Disability overhead policy
- Business continuation policy
- Disability buy-sell policy
Health insurance will typically cover which of the following perils? (Select one)
Health insurance will typically cover which of the following perils? (Select one)
- Death due to accident
- Dismemberment
- Death due to illness
- Injury due to accident (correct)
The limited period of time given to all members to sign up for a group health plan is called the?
The limited period of time given to all members to sign up for a group health plan is called the?
- Sign-up period
- Enlistment period
- Probationary period
- Enrollment period (correct)
When can a group health policy renewal be denied according to HIPAA? (Select one)
When can a group health policy renewal be denied according to HIPAA? (Select one)
What is issued to each employee of an employer health plan?
What is issued to each employee of an employer health plan?
The Consolidated Omnibus Budget Reconciliation Act (COBRA) applies to employers who employ at least:
The Consolidated Omnibus Budget Reconciliation Act (COBRA) applies to employers who employ at least:
An employer is issued a group medical insurance policy. This single contract is known as a(n):
An employer is issued a group medical insurance policy. This single contract is known as a(n):
A master contract and certificate of coverage can be found in which type of policy?
A master contract and certificate of coverage can be found in which type of policy?
The election of COBRA for continuation of health coverage will:
The election of COBRA for continuation of health coverage will:
An insurer has the right to recover payment made to the insured from the negligent party. These rights are called:
An insurer has the right to recover payment made to the insured from the negligent party. These rights are called:
Without a Section 125 Plan in place, what would happen to an employee's payroll contribution to an HSA?
Without a Section 125 Plan in place, what would happen to an employee's payroll contribution to an HSA?
According to the Health Insurance Portability and Accountability Act (HIPAA), when can a group health policy renewal be denied?
According to the Health Insurance Portability and Accountability Act (HIPAA), when can a group health policy renewal be denied?
A group Disability Income plan that pays tax-free benefits to covered employees is considered:
A group Disability Income plan that pays tax-free benefits to covered employees is considered:
The purpose of the Coordination of Benefits provision in group accident and health plans is to:
The purpose of the Coordination of Benefits provision in group accident and health plans is to:
Continued coverage under COBRA would be provided to all of the following EXCEPT:
Continued coverage under COBRA would be provided to all of the following EXCEPT:
Buy-sell plans are typically funded by which two types of insurance?
Buy-sell plans are typically funded by which two types of insurance?
How many employees must an employer have for a terminated employee to be eligible for COBRA?
How many employees must an employer have for a terminated employee to be eligible for COBRA?
Mark continues working after the age of 65 and is covered through his employer's group health plan. Which of the following statements is TRUE?
Mark continues working after the age of 65 and is covered through his employer's group health plan. Which of the following statements is TRUE?
Susan is insured through her Group Health Insurance plan and changed her coverage to an individual plan with the same insurer after her employment was terminated. This change is called a(n):
Susan is insured through her Group Health Insurance plan and changed her coverage to an individual plan with the same insurer after her employment was terminated. This change is called a(n):
Which of the following is INELIGIBLE to participate in a Section 125 Plan?
Which of the following is INELIGIBLE to participate in a Section 125 Plan?
Under a disability income policy, which provision would be payable if the cause of an injury is unexpected and accidental?
Under a disability income policy, which provision would be payable if the cause of an injury is unexpected and accidental?
What does the Consolidated Omnibus Budget Reconciliation Act (COBRA) of 1985 allow an employee to do?
What does the Consolidated Omnibus Budget Reconciliation Act (COBRA) of 1985 allow an employee to do?
The policyholder for a group health benefit plan is considered to be the:
The policyholder for a group health benefit plan is considered to be the:
In regards to a group health insurance plan, which statement is CORRECT?
In regards to a group health insurance plan, which statement is CORRECT?
Under the subrogation clause, legal action can be taken by the insurer against the:
Under the subrogation clause, legal action can be taken by the insurer against the:
The problem of overinsurance is addressed in which health insurance provision?
The problem of overinsurance is addressed in which health insurance provision?
Sole proprietors are permitted tax deductions for health costs paid from their earnings in the amount of:
Sole proprietors are permitted tax deductions for health costs paid from their earnings in the amount of:
Key Person Disability Insurance pays benefits to the:
Key Person Disability Insurance pays benefits to the:
Who is financially liable for the payment of covered claims in a fully insured group health plan?
Who is financially liable for the payment of covered claims in a fully insured group health plan?
A person covered with an individual health plan:
A person covered with an individual health plan:
Which of the following is typically NOT eligible for coverage in a group health policy?
Which of the following is typically NOT eligible for coverage in a group health policy?
When are group disability benefits considered to be tax-free to the insured?
When are group disability benefits considered to be tax-free to the insured?
Which of the following decisions would a Health Savings Account (HSA) owner NOT be able to make?
Which of the following decisions would a Health Savings Account (HSA) owner NOT be able to make?
Coordination of Benefits regulation applies to all of the following plans EXCEPT:
Coordination of Benefits regulation applies to all of the following plans EXCEPT:
Ron has a new employer and wishes to enroll in the company's group health plan. In determining whether his pre-existing health condition applies, Ron cannot have more than a ___ day gap without previous health insurance.
Ron has a new employer and wishes to enroll in the company's group health plan. In determining whether his pre-existing health condition applies, Ron cannot have more than a ___ day gap without previous health insurance.
In an employer-sponsored contributory group Disability Income plan, the employer pays 60% of the premium and each employee pays 40% of the premium. Any income benefits paid are taxed to the employee at:
In an employer-sponsored contributory group Disability Income plan, the employer pays 60% of the premium and each employee pays 40% of the premium. Any income benefits paid are taxed to the employee at:
Under the Consolidated Omnibus Budget Reconciliation Act (COBRA), a terminated employee's benefits must:
Under the Consolidated Omnibus Budget Reconciliation Act (COBRA), a terminated employee's benefits must:
A common exclusion with Vision plans is:
A common exclusion with Vision plans is:
Credit Accident and Health plans are designed to:
Credit Accident and Health plans are designed to:
Group health plans may deny participation based upon the:
Group health plans may deny participation based upon the:
Which of the following would be considered a possible applicant and contract policyholder for group health benefits?
Which of the following would be considered a possible applicant and contract policyholder for group health benefits?
During the underwriting process for a group health policy, it was discovered that 15 out of 50 members of the group have major health issues. How would the insurer handle this?
During the underwriting process for a group health policy, it was discovered that 15 out of 50 members of the group have major health issues. How would the insurer handle this?
Business Overhead Expense Insurance pays for:
Business Overhead Expense Insurance pays for:
Under the Health Insurance Portability and Accountability Act (HIPAA), the employee's new group health plan will verify Creditable Coverage so that the:
Under the Health Insurance Portability and Accountability Act (HIPAA), the employee's new group health plan will verify Creditable Coverage so that the:
Under group health insurance, a certificate of coverage is issued to the:
Under group health insurance, a certificate of coverage is issued to the:
Which of the following does Coordination of Benefits allow?
Which of the following does Coordination of Benefits allow?
HIPAA considers which of the following as 'individually identifiable health information'?
HIPAA considers which of the following as 'individually identifiable health information'?
An eligible individual who would like to obtain group health insurance without providing evidence of insurability must:
An eligible individual who would like to obtain group health insurance without providing evidence of insurability must:
When a claimant has coverage under more than one health plan, which group medical plan provision applies?
When a claimant has coverage under more than one health plan, which group medical plan provision applies?
Health insurance involves two perils, accident and ____.
Health insurance involves two perils, accident and ____.
What percentage of eligible employees must participate in a noncontributory group health plan before it can be put in effect?
What percentage of eligible employees must participate in a noncontributory group health plan before it can be put in effect?
In an employer-sponsored group accident and health plan, a master contract is issued to the:
In an employer-sponsored group accident and health plan, a master contract is issued to the:
According to HIPAA, when an insured individual leaves an employer and immediately begins working for a new company that offers group health insurance, the individual:
According to HIPAA, when an insured individual leaves an employer and immediately begins working for a new company that offers group health insurance, the individual:
If an employee contributes 50% toward the disability plan premium provided by an employer, what would be considered the taxable income of a $1,000 monthly disability benefit?
If an employee contributes 50% toward the disability plan premium provided by an employer, what would be considered the taxable income of a $1,000 monthly disability benefit?
Minimum participation standards exist for group health insurance plans in order to:
Minimum participation standards exist for group health insurance plans in order to:
Which of the following would evidence ownership in a participating health insurance contract?
Which of the following would evidence ownership in a participating health insurance contract?
Justin is receiving disability income benefits from a group policy paid for by his employer. How are these benefits treated for tax purposes?
Justin is receiving disability income benefits from a group policy paid for by his employer. How are these benefits treated for tax purposes?
Sonya applied for a health insurance policy on April 1. Her agent submitted the information to the insurance company on April 6. She paid the premium on May 15 with the policy indicating the effective date being May 30. On which date would Sonya have coverage?
Sonya applied for a health insurance policy on April 1. Her agent submitted the information to the insurance company on April 6. She paid the premium on May 15 with the policy indicating the effective date being May 30. On which date would Sonya have coverage?
What is the contract called that is issued to an employer for a Group Medical Insurance plan?
What is the contract called that is issued to an employer for a Group Medical Insurance plan?
Which of the following is NOT typically covered under vision care insurance?
Which of the following is NOT typically covered under vision care insurance?
Coverage is limited for vision and dental insurance in all of the following ways, EXCEPT:
Coverage is limited for vision and dental insurance in all of the following ways, EXCEPT:
Which type of business insurance is meant to cover the costs of continuing to do business while the owner is disabled?
Which type of business insurance is meant to cover the costs of continuing to do business while the owner is disabled?
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Study Notes
Certificates and Policies
- Each employee under a group health plan receives a certificate confirming their coverage.
- Employers must have at least 20 employees for COBRA (Consolidated Omnibus Budget Reconciliation Act) provisions to apply.
- A master policy is a single contract issued to the employer for group medical insurance.
Group Insurance Characteristics
- Group policies, such as health plans, include both a master contract for the employer and a certificate of coverage for employees.
- COBRA allows employees to maintain their health coverage after leaving a job, but premiums may increase.
- Subrogation rights allow insurers to recover costs from a negligent third party after they have paid out claims.
Tax Implications and Coverage Participation
- Without a Section 125 Plan, payroll contributions to a Health Savings Account (HSA) are taxable income for employees.
- Under HIPAA, group health policy renewal can be denied if participation or contribution rules have been violated.
- A fully contributory group disability income plan offers tax-free benefits when the employee pays the premiums.
Impact of Coverage and Claims
- Coordination of Benefits prevents overpayment of claims across multiple insurance plans.
- COBRA coverage is extended to former employees, divorced spouses, but not to employees terminated for gross misconduct.
- Key Person Disability Insurance provides benefits directly to the employer in the event of an insured key person's disability.
Eligibility and Enrollment
- To qualify for a non-contributory group health plan, 100% of eligible employees must participate.
- Temporary employees are generally ineligible for group health insurance plans.
- Members cannot have more than a 63-day gap in insurance to be eligible for new group coverage under HIPAA.
Different Insurances and Provisions
- Business Overhead Expense Insurance pays business expenses if the owner becomes disabled.
- Vision care insurance often excludes lasik surgery, but covers exams and certain types of corrective lenses.
- An employee is the policyholder for their individual health plan, which issues a policy directly to them.
Miscellaneous
- Health Savings Accounts (HSAs) allow account owners to control their contributions, but not the amounts contributed by employers.
- Coordination of Benefits applies to plans like group health and not typically to Preferred Provider Organization (PPO) plans.
- Creditable Coverage under HIPAA helps reduce waiting periods for pre-existing condition coverage in new group plans.
Insurance Policies and Ownership
- Evidence of ownership in participating health insurance is established through policy ownership.
- In Group Disability Income plans, benefits are taxed when the employer contributes towards the premiums.
- Enrollment periods specify the limited time for all members to sign up for a group health plan.
Regulations and Compliance
- Minimum participation standards exist in group health plans to prevent adverse selection.
- The Insurer carries the financial liability for covered claims in fully insured group health plans.
- Claims made under coordination of benefits ensure that no more than 100% of the claim is paid across all plans involved.
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