Health Insurance Chapter 4 Flashcards

Questions and Answers

Under the Health Insurance Portability and Accountability Act (HIPAA), what does the employee's new Group Health Plan verify?

Policy Exclusions

Creditable Coverage (correct)

Benefit Limits

Claim Denials

What is issued to a person covered with an individual health plan?

Policy

Under the subrogation clause, legal action can be taken by the insurer against whom?

Responsible third party

Which of the following decisions would a Health Savings Account (HSA) owner NOT be able to make?

The amount contributed by the employer Signup and view all the answers

What is issued to each employee of an employer health plan?

Certificate Signup and view all the answers

A common exclusion with Vision plans is?

Lasik surgery Signup and view all the answers

A master contract and certificate of coverage can be found in which type of policy?

Group Signup and view all the answers

Which of the following is typically NOT eligible for coverage in a group health policy?

Temporary employee Signup and view all the answers

On which date would Sonya have coverage after applying for a health insurance policy?

May 30 Signup and view all the answers

What is the purpose of the Coordination of Benefits provision in group accident and health plans?

Reduce adverse selection Signup and view all the answers

Who would continued coverage under COBRA be provided to?

Terminated employee Signup and view all the answers

HIPAA considers which of the following as 'individually identifiable health information'?

A person's health claim information Signup and view all the answers

Credit Accident and Health plans are designed to help pay off what?

Existing loans during periods of disability Signup and view all the answers

What does the Consolidated Omnibus Budget Reconciliation Act (COBRA) of 1985 allow an employee to do?

Keep group health insurance if the employee pays the premiums after termination Signup and view all the answers

In an employer-sponsored group accident and health plan, who is the master contract issued to?

Employer Signup and view all the answers

What does Coordination of Benefits allow?

Allows the secondary payor to reduce their benefit payments so no more than 100% of the claim is paid Signup and view all the answers

If an employee contributes 50% toward the disability plan premium provided by an employer, what is the taxable income of a $1,000 monthly disability benefit?

$500 Signup and view all the answers

What rights does an insurer have to recover payment made to the insured from the negligent party?

Subrogation Signup and view all the answers

When can a group health policy renewal be denied according to HIPAA?

When contribution or participation rules have been violated Signup and view all the answers

What is the limited period of time given to all members to sign up for a group health plan called?

Enrollment period Signup and view all the answers

Mark continues working after the age of 65 and is covered through his employer's group health plan. Medicare is the secondary payer.

True Signup and view all the answers

How many employees must an employer have for a terminated employee to be eligible for COBRA?

20 Signup and view all the answers

Under a disability income policy, which provision would be payable if the cause of an injury is unexpected and accidental?

Accidental bodily injury provision Signup and view all the answers

How are disability income benefits received from a group policy paid for by the employer treated for tax purposes?

Taxable income Signup and view all the answers

Coordination of Benefits regulation applies to all of the following plans EXCEPT?

Preferred Provider Organization plan Signup and view all the answers

How much tax deduction are sole proprietors permitted for health costs paid from their earnings?

100% of costs Signup and view all the answers

What is issued to each employee of an employer health plan?

Certificate Signup and view all the answers

What change occurs when Susan changes her coverage from a Group Health Insurance plan to an individual plan after her employment was terminated?

Conversion Signup and view all the answers

Study Notes

Health Insurance Terms and Concepts

Health Insurance Portability and Accountability Act (HIPAA): Ensures that an employee's waiting period for coverage of a preexisting condition can be reduced based on previous credible coverage.
Individual Health Plan: When a person subscribes to a health plan, they receive an issued policy.
Subrogation Clause: Enables insurers to take legal action against a third party responsible for a loss.
Health Savings Account (HSA): Owners cannot decide the amount contributed by the employer to their HSA.

Coverage and Policies

Employer Health Plans: Each employee receives a policy under an employer-sponsored health plan.
Vision Plans Exclusion: Common exclusions include LASIK surgery.
Group Policy Features: Contains a master contract and certificate of coverage.
Temporary Employees: Typically not eligible for coverage in a group health policy.

Important Dates and Coverage Terms

Effective Coverage Date: Example given: Sonya's health insurance coverage starts on May 30 after relevant actions taken.
Coordination of Benefits: Aims to reduce adverse selection by ensuring correct payment distribution between insurers.
COBRA Coverage: Ensures terminated employees can retain group health insurance if they pay premiums.
Individually Identifiable Health Information: Defined by HIPAA to include health claim information.

Financial Considerations and Tax Implications

Credit Accident and Health Plans: Designed to cover existing loans during disability periods.
Taxable Income from Disability Benefits: If an employee pays 50% of a disability plan premium, only the employer’s portion is considered taxable.
Subrogation Rights: Insurers may recover payments from negligent parties.
Tax Deductions for Sole Proprietors: Allowed to deduct 100% of health costs paid from earnings.

Regulatory Requirements

COBRA Eligibility: Requires employers to have at least 20 employees for terminated employees to access COBRA benefits.
Policy Renewal Denial: Can occur if contribution or participation rules are violated as per HIPAA.
Enrollment Period: Designated timeframe for members to sign up for a group health plan.

Medicare and Group Health Plans

Medicare as Secondary Payer: For individuals over 65 working and covered by employer health plans, Medicare acts as the secondary payer.

Coverage Changes

Conversion from Group to Individual Plan: The transition when an employee switches to an individual plan after termination is termed "conversion."

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Test your knowledge on key concepts from Chapter 4 of health insurance. This set includes definitions related to HIPAA, individual health plans, and more. Perfect for students preparing for exams in health insurance topics.

Health Insurance Chapter 4 Flashcards

Questions and Answers

Under the Health Insurance Portability and Accountability Act (HIPAA), what does the employee's new Group Health Plan verify?

What is issued to a person covered with an individual health plan?

Under the subrogation clause, legal action can be taken by the insurer against whom?

Which of the following decisions would a Health Savings Account (HSA) owner NOT be able to make?

What is issued to each employee of an employer health plan?

A common exclusion with Vision plans is?

A master contract and certificate of coverage can be found in which type of policy?

Which of the following is typically NOT eligible for coverage in a group health policy?

On which date would Sonya have coverage after applying for a health insurance policy?

What is the purpose of the Coordination of Benefits provision in group accident and health plans?

Who would continued coverage under COBRA be provided to?

HIPAA considers which of the following as 'individually identifiable health information'?

Credit Accident and Health plans are designed to help pay off what?

What does the Consolidated Omnibus Budget Reconciliation Act (COBRA) of 1985 allow an employee to do?

In an employer-sponsored group accident and health plan, who is the master contract issued to?

What does Coordination of Benefits allow?

If an employee contributes 50% toward the disability plan premium provided by an employer, what is the taxable income of a $1,000 monthly disability benefit?

What rights does an insurer have to recover payment made to the insured from the negligent party?

When can a group health policy renewal be denied according to HIPAA?

What is the limited period of time given to all members to sign up for a group health plan called?

Mark continues working after the age of 65 and is covered through his employer's group health plan. Medicare is the secondary payer.

How many employees must an employer have for a terminated employee to be eligible for COBRA?

Under a disability income policy, which provision would be payable if the cause of an injury is unexpected and accidental?

How are disability income benefits received from a group policy paid for by the employer treated for tax purposes?

Coordination of Benefits regulation applies to all of the following plans EXCEPT?

How much tax deduction are sole proprietors permitted for health costs paid from their earnings?

What is issued to each employee of an employer health plan?

What change occurs when Susan changes her coverage from a Group Health Insurance plan to an individual plan after her employment was terminated?

Study Notes

Health Insurance Terms and Concepts

Coverage and Policies

Important Dates and Coverage Terms

Financial Considerations and Tax Implications

Regulatory Requirements

Medicare and Group Health Plans

Coverage Changes

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