ch 12 group hlth insurance txtbook
what types of groups are eligible to sponsor group insurance plans - correct answer ✔✔cannot be
formed for the sole purpose of purchasing insurance, must be a "natural" group
what is the minimum participation requirement for contributory plans - correct answer ✔✔at least 75%
eligible employees must participate
under wht circumstances would a dependent lose coverage in a group insurance plan - correct answer
✔✔if the parent loses coverage, the child is no longer considered a dependent, the parent stops paying
premiums, or the master contract terminates
what are the rules for association groups to offer group insurance plans - correct answer ✔✔if it is a
natural group and has at least 100 members, has been in active existence at least a yr, has a constitution
and by laws, elects officers, and holds annual meetings
if more than one group plan covers an individual, how is it determined which plan is primary - correct
answer ✔✔under coordination of benefits, the individual's plan is always primary for individual and the
spouse's plan is secondary
does the birthday rule apply in a divorced or separation - correct answer ✔✔the custodial parent's plan
is generally primary, unless a court order states otherwise, regardless of birthday
COBRA rules apply to what size group - correct answer ✔✔groups of 20 or more
who owns the HSA? health savings account - correct answer ✔✔owned by the employee
under the sc small employer medical plans law, when can an insurance carrier terminate a group plan -
correct answer ✔✔the insurer is usually required to renew coverages unless one of these apply:
the employer does not pay premiums
emploer or employees commit fraud
what types of groups are eligible to sponsor group insurance plans - correct answer ✔✔cannot be
formed for the sole purpose of purchasing insurance, must be a "natural" group
what is the minimum participation requirement for contributory plans - correct answer ✔✔at least 75%
eligible employees must participate
under wht circumstances would a dependent lose coverage in a group insurance plan - correct answer
✔✔if the parent loses coverage, the child is no longer considered a dependent, the parent stops paying
premiums, or the master contract terminates
what are the rules for association groups to offer group insurance plans - correct answer ✔✔if it is a
natural group and has at least 100 members, has been in active existence at least a yr, has a constitution
and by laws, elects officers, and holds annual meetings
if more than one group plan covers an individual, how is it determined which plan is primary - correct
answer ✔✔under coordination of benefits, the individual's plan is always primary for individual and the
spouse's plan is secondary
does the birthday rule apply in a divorced or separation - correct answer ✔✔the custodial parent's plan
is generally primary, unless a court order states otherwise, regardless of birthday
COBRA rules apply to what size group - correct answer ✔✔groups of 20 or more
who owns the HSA? health savings account - correct answer ✔✔owned by the employee
under the sc small employer medical plans law, when can an insurance carrier terminate a group plan -
correct answer ✔✔the insurer is usually required to renew coverages unless one of these apply:
the employer does not pay premiums
emploer or employees commit fraud
