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AZ Group Health Ins
AZ State Health Insurance Group Health Chapter
Question | Answer |
---|---|
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. |