Podcast
Questions and Answers
Which of the following does Coordination of Benefits allow?
Which of the following does Coordination of Benefits allow?
- Allows the primary payor to pay 100% of the claim
- Allows double payment of claims
- Allows coordination only with Medicare
- Allows the secondary payor to reduce their benefit payments (correct)
A common exclusion with Vision plans is?
A common exclusion with Vision plans is?
- Lasik surgery (correct)
- Eye exams
- Prescription sunglasses
- Contact lenses
According to the Health Insurance Portability and Accountability Act (HIPAA), a group health policy renewal can be denied if participation or contribution rules have been violated.
According to the Health Insurance Portability and Accountability Act (HIPAA), a group health policy renewal can be denied if participation or contribution rules have been violated.
True (A)
Health insurance involves two perils, accident and _____
Health insurance involves two perils, accident and _____
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.
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 election of COBRA for continuation of health coverage will?
The election of COBRA for continuation of health coverage will?
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?
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?
Ron cannot have more than a _____ day gap without previous health insurance to enroll in his new employer's group health plan.
Ron cannot have more than a _____ day gap without previous health insurance to enroll in his new employer's group health plan.
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?
What is issued to each employee of an employer health plan?
What is issued to each employee of an employer health plan?
How are disability income benefits from a group policy paid for by the employer treated for tax purposes?
How are disability income benefits 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?
Coordination of Benefits regulation applies to all of the following plans EXCEPT?
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?
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?
Sonya would have coverage beginning on _____ after applying for a health insurance policy.
Sonya would have coverage beginning on _____ after applying for a health insurance policy.
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 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?
If an employee contributes 50% toward the disability plan premium, what would be considered the taxable income of a $1,000 monthly disability benefit?
If an employee contributes 50% toward the disability plan premium, what would be considered the taxable income of a $1,000 monthly disability benefit?
Study Notes
Coordination of Benefits
- Coordination of Benefits permits secondary payors to adjust benefit payments, ensuring no more than 100% of the claim is compensated.
Vision Plan Exclusions
- A common exclusion in Vision plans is Lasik surgery, which typically isn't covered.
Health Insurance Portability and Accountability Act (HIPAA)
- Group health policy renewals can be denied if participation or contribution rules have been violated.
Health Insurance Perils
- Health insurance addresses two main perils: accidents and sickness.
Medicare and Group Health Plans
- For individuals over 65 who continue working, Medicare acts as the secondary payer when they are covered under an employer's group plan.
Disability Income Plans
- Group Disability Income plans that provide tax-free benefits to employees are classified as fully contributory.
COBRA Continuation Coverage
- Under COBRA, continuation of health coverage maintains the same benefits but leads to an increase in premium costs.
Tax-Free Group Disability Benefits
- Group disability benefits are tax-free to the insured if they personally pay the premiums.
Subrogation Rights
- Insurers hold the right of subrogation, allowing them to recover payments made to the insured from liable third parties.
Pre-Existing Conditions and Enrollment
- For new group health plan enrollment, a gap of no more than 63 days in previous health insurance is acceptable for pre-existing condition coverage.
Enrollment Period
- The designated timeframe in which all members can register for a group health plan is termed the enrollment period.
Certificate of Coverage
- A certificate is issued to each employee enrolled in an employer health plan.
Disability Income Taxation
- Disability income benefits received from an employer-funded group policy are classified as taxable income.
Coordination of Benefits Applicability
- Coordination of Benefits regulations do not apply to Preferred Provider Organizations (PPOs).
Issuance of Master Contracts
- In employer-sponsored group accident and health plans, a master contract is provided to the employer.
Group Medical Insurance Master Policy
- The agreement issued to an employer for Group Medical Insurance is known as the master policy.
Effective Date of Coverage
- In the case of Sonya’s application timeline, coverage begins on May 30th, the stated effective date.
Creditable Coverage Verification
- Under HIPAA, a new group health plan must verify an employee's Creditable Coverage to potentially reduce waiting periods for pre-existing conditions.
COBRA Requirements
- COBRA mandates that benefits for terminated employees must remain unchanged, with premiums capped at 102% of the original cost.
Tax Implications of Disability Benefits
- If an employee pays 50% of the disability plan premium, the taxable income derived from a $1,000 monthly benefit is $500.
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Description
Test your knowledge on health and accident insurance terms and concepts with this quiz. Explore topics such as coordination of benefits, excluding coverage, and HIPAA regulations. Perfect for students in health insurance studies or professionals looking to refresh their knowledge.
