Podcast
Questions and Answers
What is the minimum benefit level provided by a succeeding policy when replacing a prior group insurance policy?
What is the minimum benefit level provided by a succeeding policy when replacing a prior group insurance policy?
- Determined by the insurance administrator.
- Higher than the prior policy's benefit level.
- The same as the former plan's benefit level minus any benefits already paid. (correct)
- Equal to the prior policy's benefit level.
Under what condition can a legally separated spouse continue coverage under COBRA?
Under what condition can a legally separated spouse continue coverage under COBRA?
- If they notify the administrator within 30 days of separation.
- Only if they were the primary certificate holder.
- If written notice is given within 60 days of legal separation. (correct)
- Coverage cannot continue under COBRA for legally separated spouses.
What must occur for a new insurance policy's coverage to terminate?
What must occur for a new insurance policy's coverage to terminate?
- The insurance company decides to stop the coverage.
- The individual does not pay the premium on time.
- The individual becomes eligible under the new plan. (correct)
- The individual's health condition worsens.
What happens to the ongoing claims under a new policy when replacing an old insurance policy?
What happens to the ongoing claims under a new policy when replacing an old insurance policy?
At what age must a surviving spouse be to continue coverage after the death of the certificate holder?
At what age must a surviving spouse be to continue coverage after the death of the certificate holder?
Under what condition can a group health insurance policy not be converted to an individual policy?
Under what condition can a group health insurance policy not be converted to an individual policy?
What is the maximum time allowed for a long-term care policy to have an effective date before coverage starts due to prior conditions?
What is the maximum time allowed for a long-term care policy to have an effective date before coverage starts due to prior conditions?
What must LTC insurance associations provide to the Director regarding their organization?
What must LTC insurance associations provide to the Director regarding their organization?
What is the maximum duration that non-institutional benefits can require prior institutional care under long-term care policies?
What is the maximum duration that non-institutional benefits can require prior institutional care under long-term care policies?
What happens if a claim is denied under a long-term care policy?
What happens if a claim is denied under a long-term care policy?
What requirement must be met for an insurer to be considered a long-term care provider?
What requirement must be met for an insurer to be considered a long-term care provider?
What conduct is explicitly prohibited under state law regarding insurance practices?
What conduct is explicitly prohibited under state law regarding insurance practices?
How long does the Director have to decide on the acceptance of evidence filed by LTC insurance associations?
How long does the Director have to decide on the acceptance of evidence filed by LTC insurance associations?
What is a key characteristic of a blanket policy?
What is a key characteristic of a blanket policy?
Which of the following is true regarding small employer group health plans?
Which of the following is true regarding small employer group health plans?
What is the maximum employee count for an entity to be classified as a small employer?
What is the maximum employee count for an entity to be classified as a small employer?
What requirement must health benefits plans for small employers comply with?
What requirement must health benefits plans for small employers comply with?
Which group is NOT an eligible entity for group health insurance policies in Missouri?
Which group is NOT an eligible entity for group health insurance policies in Missouri?
Flashcards
Pre-existing conditions under replacement policies
Pre-existing conditions under replacement policies
Prior claims are covered by the new policy, regardless of pre-existing conditions limitations.
Minimum benefit level for replacement policies
Minimum benefit level for replacement policies
The new policy's minimum benefit level must be at least as high as the old policy's level, subtracting any benefits already paid.
Coverage continuation under replacement policies
Coverage continuation under replacement policies
Coverage under the new policy continues until the individual is eligible for the succeeding plan, their coverage would normally end, or any extension period ends.
Spousal continuation after policyholder's death
Spousal continuation after policyholder's death
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Coverage for divorced/legally separated spouses
Coverage for divorced/legally separated spouses
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Loss of Group Health Insurance Coverage
Loss of Group Health Insurance Coverage
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Effective Date of LTC Policies
Effective Date of LTC Policies
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LTC Benefits and Institutional Care
LTC Benefits and Institutional Care
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LTC Insurance Association Requirements
LTC Insurance Association Requirements
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LTC Coverage Duration
LTC Coverage Duration
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Prohibited Insurance Practices
Prohibited Insurance Practices
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Prohibiting High-Pressure Tactics
Prohibiting High-Pressure Tactics
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Unfair or Deceptive Trade Practices
Unfair or Deceptive Trade Practices
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What is a blanket policy?
What is a blanket policy?
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Who qualifies as a small employer in Missouri?
Who qualifies as a small employer in Missouri?
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What are the requirements for small employer health plans in Missouri?
What are the requirements for small employer health plans in Missouri?
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What is required for group health insurance policies in Missouri?
What is required for group health insurance policies in Missouri?
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What is the minimum participation level for small employer health plans?
What is the minimum participation level for small employer health plans?
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Study Notes
Group Policy Replacement
- Individuals not continuously covered under a group policy for months before termination can be covered under a similar policy.
- The new policy must begin within 31 days of termination, with first month's premium and application within 31 days.
- Replacement policies must provide at least the same benefits as the old policy, reduced by any benefits covered under the previous policy.
- Coverage in a replacement policy continues until the earliest of these dates: individual's new eligibility date, original policy termination date, or disability ending date.
- The minimum level of benefits is the applicable level payable by the carrier.
Spousal Coverage
- Surviving spouses aged 55 or older at the policy's expiration can continue coverage (hospital, medical, expenses).
- Legal separations or divorces are eligible for similar continuation options.
- Dental, vision, and prescription drug coverage can also be continued for legal separations or divorces and surviving children as previously offered.
- COBRA (Consolidated Omnibus Budget Reconciliation Act) applicable for legal separation or divorce continuation coverage; written notice within 60 days is required.
- If the individual is legally separated or divorced, the policy must specify how such coverage will be handled under COBRA.
Blanket Policies
- This section discusses blanket policies, but more detail is needed to summarize it fully.
- A group health policy does not need to be available to an individual if the individual's group coverage failed to make timely payments.
- If the former group policy is terminated under the COBRA (Consolidated Omnibus Budget Reconciliation Act) provision, the former group policy benefits under the new policy that replaces the former group policy are not affected, and the new policy continues to the same terms as the former policy until the expiration of the former policy coverage period.
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Description
This quiz covers the essentials of group policy replacements and spousal coverage under insurance plans. Understand the requirements for continuous coverage, the process of applying for replacement policies, and the options available for surviving spouses and separated individuals. Test your knowledge on these important insurance concepts.
