Explore the essentials of Group Health Insurance in Chapter 6, focusing on eligibility, policyholder roles, and legal jurisdictions. This quiz assesses understanding of employment-based health coverage dynamics, making it vital for professionals in insurance and human resources.
Take out a personal plan of coverage
Exercise the COBRA option under his father's group
Sign up for the educatioal group activity plan
As a student, he is still covered with his father's group.
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To insure that the insured receives all necessary treatment needed
To determine what is paid by primary and secondary insurance companies, in case of a claim
To allow the parent to choose which plan covers a dependent child
To protect a second insurance company from paying a claim
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A grace period
A deductible
A waiting period (probationary period)
An elimination period
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20, 36
25, 45
15, 36
20, 18
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The state that has the most coverage
The state in which the policy was delivered
The state in which the majority of individuals live
The employer has a choice as to which state has jurisdiction over the policy
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75%
100%
25%
50%
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Only the employer receives a Certificate of Insurance
The employer is the policyholder
Each employee receives a policy
Under Group insurance, the insurer may reject certain individuals from coverage
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A Master policy
An Employer Certificate policy
A Certificate policy
A Conglomerate policy
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Deductible
Elimination Period
Policy Period
Waiting Period
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Enroll the business owner first
Include all dependents to make the groups larger
Require a minimum percentage of the group to enroll
None of these
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Group insurance normally covers occupational injury or disease
In group insurance, the employer receives a Master Policy and each employee receives a Certificate of Insurance
The Coordination of Benefits provision is designed to help reduce over insurance.
In group insurance, the contract is between the employer and the insurer.
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Claim underwriting
Waiting period
Medical underwriting
Deductible
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Waiting Period
Exclusion
Probationay Period
Morbidity table
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Misrepresentation by the emploer on the application
Claims processing is very frequent
The employer does not comply with the plan provisions
Premiums are not paid
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By conditions of employment
By the physical conditions of the applicants at the time of employment.
In such a manner as to establish individual selection as to the amounts of insurance
Eligibility is not determined, but simply accepted
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Multiple Employer Welfare Arrangements
Multiple Employer Trusts
Labor Unions
Alumni groups
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The Labor Union must have a minimum of 50 people
An insurer may exclude or limit the coverage on any person who provides unsatisfactory evidence of insurability to the insurer
The premiums for the policy must be paid either from funds of the union, or from funds contributed by the insured members specifically for their insurance, or from both
The members eligible for insurance must be all the members of the union or organization
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Replacement of Group Policies
Preexisting Conditions
Level Of Benefits
No Loss-No Gain
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Identifies the employee, employer relationship.
Provides an extension of benefits if an employee is disabled while covered by a terminated plan.
Provides the employee a 60-day period to convert the group coverage to an individual policy without proof of insurability upon termination of group plan eligibility,
Provides that both incapacity and dependency be proven, for coverage to continue for a dependent of the employee, who is physically or mentally handicapped beyond a specified age.
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