CFP 512 - MODULE 4 QUESTIONS AND ANSWERS WITH
COMPLETE SOLUTIONS VERIFIED
Events Causing a Change in Coverage
- Marriage
- Divorce
- Death
- Disability
- Losing or changing jobs
- Reducing the number of hours worked
- Moving (even within the same state)
- Birth: 30 days old
- Age 26
- Age 65
Heath Insurance Portability and Accountability Act of 1996 (HIPAA)
Eliminated the previously detrimental aspects of changing jobs and enrolling in a new
employer group health insurance plan that included a pre-existing conditions clause.
Consolidated Omnibus Reconciliation Act of 1985 (COBRA)
Provides for continuation of health care benefits when an employee leaves work
(whether voluntary or involuntary).
Patient Protection and Affordable Care Act of 2010 (PPACA)
, law aims to eliminate barriers on individuals' ability to acquire coverage throughout their
lifetime.
Small Business Health Options Program (SHOP)
Open to employers (including nonprofit organizations) with fewer than 50 full-time
equivalent employees.
Medicaid
a government insurance program for persons of all ages whose income and resources
are insufficient to pay for health care.
Children's Health Insurance Program (CHIP)
A program that provides medical insurance for minimal premiums to children from low-
income families.
Internal Limits
excluded treatments or controls that limit the extent to which certain benefits may be
used and paid for by the plan.
Case Management
another form of utilization review that is used to control costs and ptimize patient
benefits in the treatment of expensive illness such as diabetes, hypertension, AIDS,
cancer, or heart disease.
Deductible
the initial amount of covered expenses the insured must pay before the health plan
begins to pay.
Coinsurance
a splitting of the costs of medical care between the insurance company and the insured.
COMPLETE SOLUTIONS VERIFIED
Events Causing a Change in Coverage
- Marriage
- Divorce
- Death
- Disability
- Losing or changing jobs
- Reducing the number of hours worked
- Moving (even within the same state)
- Birth: 30 days old
- Age 26
- Age 65
Heath Insurance Portability and Accountability Act of 1996 (HIPAA)
Eliminated the previously detrimental aspects of changing jobs and enrolling in a new
employer group health insurance plan that included a pre-existing conditions clause.
Consolidated Omnibus Reconciliation Act of 1985 (COBRA)
Provides for continuation of health care benefits when an employee leaves work
(whether voluntary or involuntary).
Patient Protection and Affordable Care Act of 2010 (PPACA)
, law aims to eliminate barriers on individuals' ability to acquire coverage throughout their
lifetime.
Small Business Health Options Program (SHOP)
Open to employers (including nonprofit organizations) with fewer than 50 full-time
equivalent employees.
Medicaid
a government insurance program for persons of all ages whose income and resources
are insufficient to pay for health care.
Children's Health Insurance Program (CHIP)
A program that provides medical insurance for minimal premiums to children from low-
income families.
Internal Limits
excluded treatments or controls that limit the extent to which certain benefits may be
used and paid for by the plan.
Case Management
another form of utilization review that is used to control costs and ptimize patient
benefits in the treatment of expensive illness such as diabetes, hypertension, AIDS,
cancer, or heart disease.
Deductible
the initial amount of covered expenses the insured must pay before the health plan
begins to pay.
Coinsurance
a splitting of the costs of medical care between the insurance company and the insured.
