Maine Life Insurance Exam |148 Questions with
Solutions
Contributory Health Insurance - -If the employees share a portion of the premium.
Often require participation by 75% of eligible members.
- Noncontributory Health Insurance - -If the employer pays the entire premium. Most
require 100% participation by eligible members.
- (Funding of Group Insurance) Shared funding - -Allows employer to self-fund health
care expenses, select a deductible and pay covered expenses for any individual
incurring claims up to that max, insurer assumes risk
- (Funding of group insurance) Min. premium arrangement - -Employer self-insure the
normal and expected claims up to a given amount and the insurer funds only the excess
amounts
- (Funding of group insurance) retrospective premium arrangement - -Insurer agrees
to collect a provisional premium but may collect additional premium/make a premium
refund at the end of the year based on actual incurred losses.
- (Funding of group insurance) Self-funding arrangement - -Large employers may
elect to fully self-fund, or may self-fund a plan but contract for administrative services
only (ASO).
- Conversion privilege - -An employee can convert their group certificate to an
individual medical expense policy w/ same insurer, if/when they leave employer.
Employee must make an application for a converted policy within a given period of time
(usually 31 days) depending on the state.
- Health Insurance Portability and Accountability Act (HIPAA) - -Provides the ability to
transfer and continue health insurance when someone changes or loses their job
- HIPAA Requirements - -Employers with 20 or more employees have to allow former
employees to continue benefits. Rules apply to all types of group health plans except
disability income plans
- HIPAA pre-existing conditions - -Health issues that existed, were treated, diagnosed
within 6 months prior to employment
- COBRA - -Requires employers with 20+ employees to continue coverage for
terminated workers, (as well as dependents) for up to 18 months. Employee is required
to pay premiums (up to 102%)
, - Group Disability Income Plans - -Specify benefits based on a percentage of the
employees wages
- Blanket Health Plans - -Cover a group who may be exposed to the same risk, no
certificates issued
- Taxation of group health premiums - -Employers are entitled to take a tax deduction
for premium contributions made to group plans
- Taxation of group health benefits - -Any benefit received under a medical expense
plan are not considered taxable income.
- Accidental means - -Requires that both the cause and the result of an accident must
be unintentional
- accidental results - -only the injury resulting from the accident must be
unintentional.
- 3 basic categories of health insurances - -Medical Expense, Disability Income
Insurance, AD&D
- Health insurance premium factors - -Interest, expenses, types of benefits, morbidity,
age, sex, occupation
- Disability Buy-Sell (business income policy) - -Legal agreement that specifies how a
business will pass between owners when one of the owners dies or becomes disabled
- Business overhead expense (business income policy) - -Sold to small business
owners who must continue to meet overhead expenses such as rent, used if owner
becomes disabled. Covers fixed business expenses
- Disability Buy-Out (business income policy) - -Specifies who will purchase a disabled
partner's interest and legally obligates that person/party to purchase the business
interest of the disabled partner.
- Maternity Benefits - -Any policy of health insurance that provides maternity care
must also cover the services of nurses/midwives, and licensed birth centers.
- Coordination of Benefits provision - -Prevents an insured covered by two health plans
from making a profit on a covered loss
Solutions
Contributory Health Insurance - -If the employees share a portion of the premium.
Often require participation by 75% of eligible members.
- Noncontributory Health Insurance - -If the employer pays the entire premium. Most
require 100% participation by eligible members.
- (Funding of Group Insurance) Shared funding - -Allows employer to self-fund health
care expenses, select a deductible and pay covered expenses for any individual
incurring claims up to that max, insurer assumes risk
- (Funding of group insurance) Min. premium arrangement - -Employer self-insure the
normal and expected claims up to a given amount and the insurer funds only the excess
amounts
- (Funding of group insurance) retrospective premium arrangement - -Insurer agrees
to collect a provisional premium but may collect additional premium/make a premium
refund at the end of the year based on actual incurred losses.
- (Funding of group insurance) Self-funding arrangement - -Large employers may
elect to fully self-fund, or may self-fund a plan but contract for administrative services
only (ASO).
- Conversion privilege - -An employee can convert their group certificate to an
individual medical expense policy w/ same insurer, if/when they leave employer.
Employee must make an application for a converted policy within a given period of time
(usually 31 days) depending on the state.
- Health Insurance Portability and Accountability Act (HIPAA) - -Provides the ability to
transfer and continue health insurance when someone changes or loses their job
- HIPAA Requirements - -Employers with 20 or more employees have to allow former
employees to continue benefits. Rules apply to all types of group health plans except
disability income plans
- HIPAA pre-existing conditions - -Health issues that existed, were treated, diagnosed
within 6 months prior to employment
- COBRA - -Requires employers with 20+ employees to continue coverage for
terminated workers, (as well as dependents) for up to 18 months. Employee is required
to pay premiums (up to 102%)
, - Group Disability Income Plans - -Specify benefits based on a percentage of the
employees wages
- Blanket Health Plans - -Cover a group who may be exposed to the same risk, no
certificates issued
- Taxation of group health premiums - -Employers are entitled to take a tax deduction
for premium contributions made to group plans
- Taxation of group health benefits - -Any benefit received under a medical expense
plan are not considered taxable income.
- Accidental means - -Requires that both the cause and the result of an accident must
be unintentional
- accidental results - -only the injury resulting from the accident must be
unintentional.
- 3 basic categories of health insurances - -Medical Expense, Disability Income
Insurance, AD&D
- Health insurance premium factors - -Interest, expenses, types of benefits, morbidity,
age, sex, occupation
- Disability Buy-Sell (business income policy) - -Legal agreement that specifies how a
business will pass between owners when one of the owners dies or becomes disabled
- Business overhead expense (business income policy) - -Sold to small business
owners who must continue to meet overhead expenses such as rent, used if owner
becomes disabled. Covers fixed business expenses
- Disability Buy-Out (business income policy) - -Specifies who will purchase a disabled
partner's interest and legally obligates that person/party to purchase the business
interest of the disabled partner.
- Maternity Benefits - -Any policy of health insurance that provides maternity care
must also cover the services of nurses/midwives, and licensed birth centers.
- Coordination of Benefits provision - -Prevents an insured covered by two health plans
from making a profit on a covered loss
