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AZ Group Health Ins

AZ State Health Insurance Group Health Chapter

QuestionAnswer
In Group Insurance, who is the contract between? Insurer and Employer
Who is issued the Master Policy? Employer
What is given to employees in a Group Health Plan? Certificate of Coverage.
What is an Experience Rating? Used to determine premium rates by looking at the claims experience of the particular group as a whole.
What is a Community/Pool Rating? Determines the premium rate by looking at the claims of the entire company.
What is a MEWA? Multiple Employer Welfare Arrangement: establishes a benefit plan for the purpose of offering or providing insurance to the employees of AT LEAST 2 employers.
What is a MET? Multiple Employer Trust: two or more employers in a similar or related business who do not qualify for group insurance on their own.
How many people must an Association insure? at least 25 members but must have a member base of at least 100.
Who is the beneficiary in a Credit Insurance plan? The lender.
How is underwriting done on a group policy? As a whole instead of individually.
Medical information can not be included in the underwriting of groups of... 50 or more.
What are the eligibility requirements for Group Coverage? - full time employee (30+ hours per week) - employed 1 to 3 months.
How long is the Annual Open Enrollment period? 30 days.
What does the acronym PPACA stand for, and what does it entail? Patient Protection and Affordable Care Act requires employers to extend coverage to all employees working more than 30 hours per week.
What is the birthday rule? For dependents, the parent whos birthday is sooner is the Primary Insurance provider for the dependent.
What does COBRA provide for employees? The right to extend group coverage to employees and their families after a qualifying event.
What are the qualifying events under COBRA? - voluntary termination of employment - termination of employment for reasons other than gross misconduct - employment status change from full time to part time.
What is the coverage period for an employee under COBRA? 18 months.
If death or divorce were to happen, how long is coverage for dependants under COBRA? 36 months.
How long is the conversion period? 31 days.
If returning from Active Duty, how long do military members have to reinstate their coverage? 90 days of discharge, or 1 year after hospitalization continuing after discharge.
Define a small employer At least 2, but no more than 50 employees.
What is a pre-existing condition? A condition for which medical treatment was recommended no more than 6 months prior to enrollment.
How long may pre-existing conditions be excluded? No more than 12 months, or 18 months for a late enrollee.
What is HIPAA? Health Insurance Portability and Accountability Act.
How many people does HIPAA apply to? More than 2.
Created by: jgray2015
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