AD Banker Chapter 13 Quiz Well answered

Which statement would be considered inaccurate regarding the underwriting of a group plan? - ANSWERSContributory plans require 100% employee participation When underwriting group life, the underwriter treats the group as if it were: - ANSWERSOne individual All of the following are true of the Coordination of Benefits Provision under a group plan, except: - ANSWERSIn the event children are covered under two group plans, the insurer for the parent who is the oldest is primary, and the other parent's plan is secondary Which action would not render a small employer's health benefit plan nonrenewable? - ANSWERSFrequent claims All of the following are correct regarding regulatory jurisdiction over group insurance, except: - ANSWERSThe policy only needs to provide benefits as required by the state in which the insurer is incorporated Hicks Corp. wants to install a contributory group plan. It employs 200 people. How many employees must participate in order to install the plan? - ANSWERS150 All of the following are requirements that insurers may place on a group plan to avoid adverse selection, except: - ANSWERSProof of insurability from each employee Generally, regulatory jurisdiction over a group insurance plan belongs to the insurance commissioner of: - ANSWERSThe state in which the group contract was delivered to the policyowner The XYZ Company, which employs 800 workers, provides group disability insurance for the 400 employees working 30 hours or more. How many workers must be covered if this group benefit is offered on a noncontributory basis? - ANSWERS400 An employer group health insurance sponsor does all of the following, except: - ANSWERSIssue the policy A small employer health benefit plan may be nonrenewed for all of the following reasons, except: - ANSWERSHigh number of claims All of the following are accurate statements, except: - ANSWERSGroup insurance normally covers occupational injury or disease How many employees would an employer require in order to be considered a small employer: - ANSWERS50 or less COBRA applies to employers with: - ANSWERS20 or more employees Which of the following types of policies would a sports team purchase to obtain coverage for a season? - ANSWERSBlanket Under COBRA, coverage for dependents of an employee may continue up to 36 months for any of the following events, except: - ANSWERSTermination of the employee What percentage of employee participation is required for a contributory employer group plan? - ANSWERS75% When an individual carries more accident and health insurance than he/she would need for a loss, it is called: - ANSWERSOverinsurance The pregnancy discrimination act applies to groups with ______ or more employees - ANSWERS15 An employee is considered full time and eligible for small employer medical expense insurance if he or she works a minimum of ________ hours per week. - ANSWERS30 Which statement is incorrect regarding COBRA? - ANSWERSThe employee or beneficiary must respond to the notification of his/her right to continue coverage within 90 days, if he/she wants to continue the coverage A third party administrator is utilized in which of the following plans? - ANSWERSSelf-funded plans When a group is covered by a MET, who is issued the Master Policy? - ANSWERSThe trust An employer may require a former employee who has COBRA coverage to pay up to _____% of the premium. - ANSWERS102 HIPAA defines a pre-existing condition as one for which the insured received medical advice, diagnosis, care, or treatment within the past _____ months. - ANSWERS6 Under HIPAA, coverage may be nonrenewed for all of the following reasons, except: - ANSWERSFrequency of claims Under Small Employer Medical Expense Insurance, the insurer can nonrenew the health benefit plan for all of the following, except: - ANSWERSHigh claim frequency Which of the following is not used to reduce adverse selection? - ANSWERSEstablishing a maximum number of participants that can be covered under the plan Which provision of group health plans is used to determine primary and secondary coverage when an insured is covered by more than one insurance plan? - ANSWERSCoordination of Benefits A firm with 50 employees replaces its existing group health plan. With regard to ongoing existing claims, the replacing insurer will be: - ANSWERSRequired to continue paying them under the No Loss-No Gain law For an employee to be eligible to participate in an employer's group health insurance plan, he/she must be considered full-time and work a minimum of _____ hours as established by the Affordable Care Act. - ANSWERS30 If a plan offers coverage to dependents, eligible dependents include all children, natural and adopted, married and unmarried, up to age ______. - ANSWERS26 A third party administrator is utilized in which of the following plans? - ANSWERSSelf Funded Plans All of the following are correct regarding regulatory jurisdiction over group insurance, except: - ANSWERSThe policy only needs to provide benefits as required by the state in which the insurer is incorporated When group health insurance is being replaced, ongoing claims under the former policy must continue under the new policy, overriding any preexisting condition exclusion. This is a requirement under which of the following? - ANSWERSNo Loss - No Gain Statutes A carrier replacing employer group coverage is not required to cover all employees and dependents covered by, or eligible for, coverage under the previous policy if the replacement takes place more than _____ days after of the previous policy's termination. - ANSWERS60 Which event does not cause termination of continuing coverage by COBRA? - ANSWERSPremium payments are made in a timely manner Which of the following is incorrect regarding the group underwriting process? - ANSWERSAdverse selection is not a concern for group contracts Which is not a qualifying event for the continuation of dependent coverage under the Consolidated Omnibus Budget Reconciliation Act? - ANSWERSTermination of the employee for theft Until yesterday, J. J. worked for his father's company and was covered by the company's large group health plan. He stopped working to go to college. He is 26 years of age and wants to keep the same coverage until he earns his degree in approximately 24 months. Which of the following statements is true? - ANSWERSA good option for J.J. is to exercise the COBRA option under his father's group plan A replacing insurer must assume liability for paying ongoing existing claims under which law? - ANSWERSNo-Loss, No-Gain - ANSWERS