life ins exam chp 11

group health ins is also caleld

master policy

certificates of insurance r also called

certificate of coverage

T/F: individual health ins is less strict on rules and regulations than group health ins policy

false

t/f: participants in group health plan have to do physicals and answer medical questions.

false

group contributory health ins

ER & EE share in paying prem.s at least 75% of all EEs eligible must say they want to take coverage

noncontributory group health ins

ER pays 100% of prems, and must cover 100% of all eligible EEs

biggest eligibility part for group health ins

you have to be full time EE

t/f: to establish MET - multiple er trust, they all have to be in the same industry

true

how many ppl in group for group health insurance to make it so med info is nto required of participants?

50 or more

t/f: admin cost per capita is greater in group health ins than for ind coverage

false

greater for ind

usually, to be eligible for group plan, EE must be ___ time, usually ____ hours per week, and have been employed there from ____ to ___ months.

full, 30 hrs, 1-3 mo.s

ACA (2 things)

ER must cover to all EEs who work > 30hrs/week. all ERs r not denied coverage for not satisfying min participation/contrib. req.s

if EE is actively at work when date of coverage is transferred to diff carrier then

auto covered under new plan - no probationary period. otherwise, theyre included but benefits can be limited until back at work

coins/deductibles can be carried from old plan to new plan, T/F>

true

t/f: when changing health ins, benefits must be paid for ongoing claims no matter pre existing conditions

true

when group health policy discontinued, must provide reasonable extension of benefits to who:

any covered person who is totally disabled at that time

how many EEs for COBRA rule to apply

ER w >=20 EEs

COBRA: extend gr health coverage to terminated EE if (3):

Voluntary termination of employment;

Termination of employment for reasons other than gross misconduct (e.g. company downsizing); and Employment status change: from full time to part time

qualifying events, under COBRA, coverage extended up to ______

18 mo.s

events like death of EE, divorce, COBRA says that coverage extension is ______ for dependents

36 months

terminated EEs can convert group health to ind ins _______________

without evidence of insurability

the only time termination cant convert gr health to ind is

termination due to gross misconduct

small ER, EEs r at least ppl and not more than __

2, 50