COBRA Quiz & Flashcards - XCEL Chapter 11

Questions and Answers

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

Remain on their current coverage for 30 months

In the event of employment termination, group health insurance can be kept if the employer pays the premiums

Receive a tax credit to help offset the cost of health insurance

In the event of employment termination, group health insurance can be kept if the employee pays the premiums (correct)

Credit Accident and Health plans are designed to?

Provide permanent protection

Permit creditors the ability to require that coverage be purchased through insurers of their choice

Help pay off existing loans during periods of disability (correct)

Not permit free choice of coverage selection

Ron has a new employer and wishes to enroll in the company's group health plan. In determining whether his pre-existing health condition applies, Ron cannot have more than a ___ day gap without previous health insurance.

63 (correct)

Health insurance involves two perils, accident and ____.

Sickness 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

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

Responsible third party Signup and view all the answers

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

The election of COBRA for continuation of health coverage will?

Maintain the same coverage and increase premium 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

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

Preferred Provider Organization plan 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

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

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

Group 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

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 would be considered a possible applicant and contract policyholder for group health benefits?

Employer 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

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 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 is typically NOT eligible for coverage in a group health policy?

Temporary employee 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

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

Avoid overpayment of claims 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

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

A group Disability Income plan that pays tax-free benefits to covered employees is considered?

Fully contributory Signup and view all the answers

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

Terminated employee 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

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

A common exclusion with Vision plans is

Lasik surgery Signup and view all the answers

Which of the following does Coordination of Benefits allow?

Allows the secondary payor to reduce their benefit payments so no more than 100% of the claim is paid Signup and view all the answers

Study Notes

COBRA and Health Insurance Regulations

COBRA (Consolidated Omnibus Budget Reconciliation Act) allows employees to maintain group health insurance after termination by paying premiums.
Employers must have at least 20 employees for COBRA eligibility after a termination.
COBRA continuation of coverage maintains the same coverage but increases premiums.

Credit Accident and Health Plans

Designed to assist in paying off existing loans during periods of disability.

Pre-existing Conditions and Coverage

A gap of no more than 63 days in health insurance coverage is allowed for determining pre-existing conditions.

Health Insurance Perils

Health insurance primarily covers two perils: accident and sickness.

Ownership Evidence in Insurance Contracts

Policy ownership is required for evidence in participating health insurance contracts.

Subrogation Rights

The subrogation clause permits insurers to take legal action against a responsible third party for recovery of payments made to the insured.

Tax Deductions for Sole Proprietors

Sole proprietors can deduct 100% of health costs from taxable income.

Coordination of Benefits

The purpose of Coordination of Benefits is to prevent overpayment of claims in group plans and it applies to various plans, excluding Preferred Provider Organization plans.

HIPAA Regulations

HIPAA prevents denial of group health policy renewal unless participation or contribution rules have been violated.
Creditable coverage under HIPAA may reduce waiting periods for preexisting conditions in a new employer's health plan.

Group Health Benefits

A master policy and certificate of coverage are associated with group health insurance plans.
Employers are considered the policyholder for group health benefit plans.

Disability Income Policies

Accidental bodily injury provision pays benefits if an injury is unexpected and accidental.

Tax-Free Benefits in Disability Income

Disability benefits are tax-free if premiums are paid by the insured.

Eligibility Under Group Health Policies

Typically, temporary employees are not eligible for coverage under group health policies.

Conversion of Health Insurance

Transitioning from a group to an individual plan after employment termination is termed conversion.

Lasik Surgery Exclusion

Lasik surgery is commonly excluded from vision plan coverage.

Payments Coordination

Coordination of Benefits allows primary and secondary payers to ensure total claim payments do not exceed 100%.

Business Insurance Options

Business overhead expense policies cover costs of continuing business while the owner is disabled.

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Description

Test your knowledge with these flashcards from XCEL Chapter 11, focusing on the Consolidated Omnibus Budget Reconciliation Act (COBRA) of 1985. Learn about employee benefits related to health insurance continuation after employment termination. This quiz is designed to enhance your understanding of essential healthcare laws.

XCEL Chapter 11 Flashcards