Podcast
Questions and Answers
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?
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?
Which of the following does Coordination of Benefits allow?
Which of the following does Coordination of Benefits allow?
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?
Signup and view all the answers
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?
Signup and view all the answers
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?
Signup and view all the answers
What is issued to each employee of an employer health plan?
What is issued to each employee of an employer health plan?
Signup and view all the answers
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?
Signup and view all the answers
Health insurance will typically cover which of the following perils?
Health insurance will typically cover which of the following perils?
Signup and view all the answers
A common exclusion with Vision plans is?
A common exclusion with Vision plans is?
Signup and view all the answers
Mark continues working after the age 65 and is covered through his employer's group health plan. Which of the following statements is TRUE?
Mark continues working after the age 65 and is covered through his employer's group health plan. Which of the following statements is TRUE?
Signup and view all the answers
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?
Signup and view all the answers
Under which criteria may a group health plan exclude participation?
Under which criteria may a group health plan exclude participation?
Signup and view all the answers
HIPAA considers which of the following as "individually identifiable health information?"
HIPAA considers which of the following as "individually identifiable health information?"
Signup and view all the answers
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?
Signup and view all the answers
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?
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?
Under a disability income policy, which provision would be payable if the cause of an injury is unexpected and accidental?
Signup and view all the answers
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?
Signup and view all the answers
Continued coverage under COBRA would be provided to a(n)?
Continued coverage under COBRA would be provided to a(n)?
Signup and view all the answers
The purpose of the Coordination of Benefits provision in group accident and health plan is to?
The purpose of the Coordination of Benefits provision in group accident and health plan is to?
Signup and view all the answers
When can a group health policy renewal be denied according to HIPAA?
When can a group health policy renewal be denied according to HIPAA?
Signup and view all the answers
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?
Signup and view all the answers
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?
Signup and view all the answers
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?
Signup and view all the answers
Credit Accident and Health plans are designed to?
Credit Accident and Health plans are designed to?
Signup and view all the answers
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?
Signup and view all the answers
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?
Signup and view all the answers
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?
Signup and view all the answers
The election of COBRA for continuation of health coverage will?
The election of COBRA for continuation of health coverage will?
Signup and view all the answers
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?
Signup and view all the answers
Health insurance involves two perils, accident and __________.
Health insurance involves two perils, accident and __________.
Signup and view all the answers
An employer is issued a group medical insurance policy. The single contract is known as a(n)?
An employer is issued a group medical insurance policy. The single contract is known as a(n)?
Signup and view all the answers
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?
Signup and view all the answers
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?
Signup and view all the answers
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 at 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 at the employee at?
Signup and view all the answers
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?
Signup and view all the answers
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?
Signup and view all the answers
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?
Signup and view all the answers
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?
Signup and view all the answers
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)?
Signup and view all the answers
A person covered with an individual health plan?
A person covered with an individual health plan?
Signup and view all the answers
Coordination of Benefits regulation applies to all of the following plans EXCEPT?
Coordination of Benefits regulation applies to all of the following plans EXCEPT?
Signup and view all the answers
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?
Signup and view all the answers
Ron has a new employer and wishes to enroll in the company's group health plan. In determining whether his preexisting 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 preexisting health condition applies, Ron cannot have more than a ______ day gap without previous health insurance.
Signup and view all the answers
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?
Signup and view all the answers
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?
Signup and view all the answers
Study Notes
COBRA and Health Insurance Regulations
- Under COBRA, a terminated employee can maintain the same health insurance coverage by paying premiums, which cannot exceed 102% of the original cost.
- Group health plans must allow for an enrollment period for all members to sign up for coverage after job changes.
Coordination of Benefits
- Coordination of Benefits allows secondary payors to limit benefits paid to no more than the total claim amount, avoiding overpayment.
- It's designed to reduce the financial burden of claims for insured individuals who have multiple health plans.
Tax Deductions and Coverage
- Sole proprietors can deduct 100% of health costs from their taxable income.
- Disability income benefits received from employer-paid policies are considered taxable income for the recipient.
Coverage Effective Dates
- Insurance coverage typically begins on the effective date indicated in the policy; for example, if a policy's effective date is May 30, that is when coverage starts despite other actions taken prior.
Group Health Plan Certificates
- Employees covered under an employer's group health plan receive a certificate that outlines their coverage details, while the master policy is held by the employer.
Health Insurance Portability and Accountability Act (HIPAA)
- HIPAA ensures employees transferring to a new employer can have their waiting periods for preexisting conditions shortened based on previous coverage.
- Individually identifiable health information is defined under HIPAA, emphasizing the confidentiality of personal health claims.
Exclusions and Eligibility
- Vision plans often exclude certain procedures such as Lasik surgery from coverage.
- Temporary employees generally cannot participate in group health policies, whereas full-time employees and business owners are typically eligible.
Group Disability Insurance
- In contributory plans where employees share premium costs, the benefits are taxed based on the portion of the premium paid by the employer.
Employment and Insurance Eligibility
- Employees must have prior continuous insurance coverage without a gap exceeding 63 days to avoid having preexisting conditions applied in the new health plan.
- The employer serves as the policyholder for group health benefit plans, indicating that they are responsible for the master policy.
Coverage and Continuation Plans
- COBRA allows terminated employees to continue their health insurance coverage at the same levels, although typically at a higher premium.
- In a group plan, benefits are intended to be paid tax-free only when premiums are paid by the employee.
Health Savings Accounts (HSA)
- Individuals cannot control the employer's contributions to their Health Savings Account (HSA) but can manage their own contributions and expenses covered by the HSA.
Subrogation Rights
- An insurer retains the right to pursue recovery from a negligent third party for payments made to an insured individual, highlighting the principle of subrogation.
Master Policy and Coverage Terms
- In group health policies, a master policy is issued to the employer, whereas individual policies are directly issued to the insured individuals.
- Each employee receives a certificate detailing their specific coverage terms and benefits as part of the group policy.
Important Numbers
- Employers must have at least 20 employees for a terminated employee to qualify for COBRA continuation coverage.
Studying That Suits You
Use AI to generate personalized quizzes and flashcards to suit your learning preferences.
Description
Test your knowledge on COBRA, Coordination of Benefits, and tax deductions related to health insurance. This quiz covers essential regulations that affect health plan enrollment and coverage effective dates. Perfect for anyone studying health insurance policies and regulations.
