Podcast
Questions and Answers
Under the Health Insurance Portability and Accountability Act (HIPAA), what does the employee's new Group Health Plan verify?
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?
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?
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?
Which of the following decisions would a Health Savings Account (HSA) owner NOT be able to make?
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What is issued to each employee of an employer health plan?
What is issued to each employee of an employer health plan?
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A common exclusion with Vision plans is?
A common exclusion with Vision plans is?
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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?
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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?
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On which date would Sonya have coverage after applying for a health insurance policy?
On which date would Sonya have coverage after applying for a health insurance policy?
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What is the purpose of the Coordination of Benefits provision in group accident and health plans?
What is the purpose of the Coordination of Benefits provision in group accident and health plans?
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Who would continued coverage under COBRA be provided to?
Who would continued coverage under COBRA be provided to?
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HIPAA considers which of the following as 'individually identifiable health information'?
HIPAA considers which of the following as 'individually identifiable health information'?
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Credit Accident and Health plans are designed to help pay off what?
Credit Accident and Health plans are designed to help pay off what?
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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?
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In an employer-sponsored group accident and health plan, who is the master contract issued to?
In an employer-sponsored group accident and health plan, who is the master contract issued to?
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What does Coordination of Benefits allow?
What does Coordination of Benefits allow?
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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?
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?
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What rights does an insurer have to recover payment made to the insured from the negligent party?
What rights does an insurer have to recover payment made to the insured from the negligent party?
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When can a group health policy renewal be denied according to HIPAA?
When can a group health policy renewal be denied according to HIPAA?
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What is the limited period of time given to all members to sign up for a group health plan called?
What is the limited period of time given to all members to sign up for a group health plan called?
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Mark continues working after the age of 65 and is covered through his employer's group health plan. Medicare is the secondary payer.
Mark continues working after the age of 65 and is covered through his employer's group health plan. Medicare is the secondary payer.
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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?
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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?
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How are disability income benefits received from a group policy paid for by the employer treated for tax purposes?
How are disability income benefits received from a group policy paid for by the employer treated for tax purposes?
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Coordination of Benefits regulation applies to all of the following plans EXCEPT?
Coordination of Benefits regulation applies to all of the following plans EXCEPT?
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How much tax deduction are sole proprietors permitted for health costs paid from their earnings?
How much tax deduction are sole proprietors permitted for health costs paid from their earnings?
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What is issued to each employee of an employer health plan?
What is issued to each employee of an employer health plan?
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What change occurs when Susan changes her coverage from a Group Health Insurance plan to an individual plan after her employment was terminated?
What change occurs when Susan changes her coverage from a Group Health Insurance plan to an individual plan after her employment was terminated?
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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."
Studying That Suits You
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Description
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.
