Health Insurance Regulations Quiz

Questions and Answers

Under the Consolidated Omnibus Budget Reconciliation Act (COBRA), a terminated employee's benefits must?

Be less extensive and premium cannot exceed 102%

Be more extensive and the premium cannot exceed 102%

Be the same and the premium cannot exceed 102% (correct)

Be the same as well as the premium

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

Enrollment period (correct)

Probationary period

Sign-up period

Enlistment period

Which of the following does Coordination of Benefits allow?

Allows each health provider to pay 100% of the claim

Allows the deductible to be spread out between all the health providers

Allows the secondary payor to reduce their benefit payments so no more than 100% of the claim is paid (correct)

Allows both a group health plan and individual health plan to coordinate their benefit payments

Sole proprietors are permitted tax deductions for health costs paid from their earnings in the amount of?

100% of costs 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?

May 30 Signup and view all the answers

A group disability income plan that pays tax-free benefits to covered employees is considered?

Fully contributory Signup and view all the answers

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

Certificate 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?

Employee's waiting period for coverage of a preexisting condition can be reduced under the new employer's health plan Signup and view all the answers

Health insurance will typically cover which of the following perils?

Injury due to accident Signup and view all the answers

A common exclusion with Vision plans is?

Lasik surgery 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?

Medicare is the secondary payer Signup and view all the answers

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

In the event of employment termination, group health insurance can be kept if the employee pays the premiums Signup and view all the answers

Under which criteria may a group health plan exclude participation?

Member's part-time employment status 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

Justin is receiving disability income benefits from a group policy paid for by his employer. How are these benefits treated for tax purposes?

Taxable income 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?

It would be considered taxable income to the employee 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

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?

$500 Signup and view all the answers

Continued coverage under COBRA would be provided to a(n)?

Terminated employee Signup and view all the answers

The purpose of the Coordination of Benefits provision in group accident and health plan is to?

Avoid overpayment of claims 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 contract called that is issued to an employer for a Group Medical Insurance plan?

Master policy Signup and view all the answers

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

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

Group Signup and view all the answers

Credit Accident and Health plans are designed to?

Help pay off existing loans during periods of disability 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?

Business overhead expense policy Signup and view all the answers

Which of the following would be considered a possible applicant and contract policyholder for group health benefits?

Employer Signup and view all the answers

The policyholder for a group health benefit plan is considered to be the?

Employer Signup and view all the answers

The election of COBRA for continuation of health coverage will?

Maintain the same coverage and increase premium Signup and view all the answers

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

Employer Signup and view all the answers

Health insurance involves two perils, accident and __________.

Sickness Signup and view all the answers

An employer is issued a group medical insurance policy. The single contract is known as a(n)?

Master Policy 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?

Is eligible for coverage upon hire Signup and view all the answers

Which of the following is INELIGIBLE to participate in a Section 125 plan?

An S-Corp owner with a greater than 2% share 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?

60% of the benefit 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

According to the Health Insurance Portability and Accountability Act (HIPAA), when can a group health policy renewal be denied?

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

Which of the following would evidence ownership in a participating health insurance contract?

Policy ownership 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?

Subrogation 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)?

Conversion Signup and view all the answers

A person covered with an individual health plan?

Is issued a policy 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

When are group disability benefits considered to be tax-free to the insured?

When the recipient pays the premiums 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.

63 Signup and view all the answers

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

Responsible third party 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

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.

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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.

Health Insurance Regulations Quiz

Questions and Answers

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?

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?

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?

A group disability income plan that pays tax-free benefits to covered employees is considered?

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

Under the Health Insurance Portability and Accountability Act (HIPAA), the employee's new Group Health Plan will verify Creditable Coverage so that the?

Health insurance will typically cover which of the following perils?

A common exclusion with Vision plans is?

Mark continues working after the age 65 and is covered through his employer's group health plan. Which of the following statements is TRUE?

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

Under which criteria may a group health plan exclude participation?

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

Justin is receiving disability income benefits from a group policy paid for by his employer. How are these benefits treated for tax purposes?

Without a section 125 plan in place, what would happen to an employee's payroll contribution to an HSA?

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

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?

Continued coverage under COBRA would be provided to a(n)?

The purpose of the Coordination of Benefits provision in group accident and health plan is to?

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

What is the contract called that is issued to an employer for a Group Medical Insurance plan?

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

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

Credit Accident and Health plans are designed to?

Which type of business insurance is meant to cover the costs of continuing to do business while the owner is disabled?

Which of the following would be considered a possible applicant and contract policyholder for group health benefits?

The policyholder for a group health benefit plan is considered to be the?

The election of COBRA for continuation of health coverage will?

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

Health insurance involves two perils, accident and __________.

An employer is issued a group medical insurance policy. The single contract is known as a(n)?

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?

Which of the following is INELIGIBLE to participate in a Section 125 plan?

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?

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

According to the Health Insurance Portability and Accountability Act (HIPAA), when can a group health policy renewal be denied?

Which of the following would evidence ownership in a participating health insurance contract?

An insurer has the right to recover payment made to the insured from the negligent party. These rights are called?

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)?

A person covered with an individual health plan?

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

When are group disability benefits considered to be tax-free to the insured?

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.

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

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

Study Notes

COBRA and Health Insurance Regulations

Coordination of Benefits

Tax Deductions and Coverage

Coverage Effective Dates

Group Health Plan Certificates

Health Insurance Portability and Accountability Act (HIPAA)

Exclusions and Eligibility

Group Disability Insurance

Employment and Insurance Eligibility

Coverage and Continuation Plans

Health Savings Accounts (HSA)

Subrogation Rights

Master Policy and Coverage Terms

Important Numbers

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