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Exam 16: Employee Benefits: Group Life and Health Insurance

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Question 1

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What is the purpose of stop-loss insurance that is used with self-insured group medical expense plans?

A) to require employees to buy insurance for losses in excess of some specified amount
B) to have a commercial insurer pay claims that exceed a specified limit
C) to obtain administrative services from a commercial insurer
D) to exempt self-insured plans from state insurance laws that require mandated benefits

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Question 2

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Maria is covered under a group medical expense plan as an employee.She is also covered under her husband's plan as a dependent.If Maria is hospitalized,how will each plan respond to her medical bills if both plans have the typical coordination-of-benefits provision?

A) Maria's plan is primary,and her husband's plan is excess.
B) Her husband's plan is primary,and Maria's plan is excess.
C) Her husband's plan will pay its benefits,and Maria's plan will deny coverage.
D) Both plans will pay benefits on a pro rata basis.

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Question 3

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Which of the following statements is (are) true concerning high deductible health plans? I.An employee can withdraw money tax-free from a health savings account or health reimbursement account to pay covered medical costs. II.There is a cap on an employee's out-of-pocket expenses under the plan.

Which of the following statements about Blue Cross Plans is (are) true? I.They typically provide service benefits rather than cash benefits to members. II.They usually provide very limited benefits for hospital charges.

Med Profs is a group of 18 doctors.These doctors work out of their own offices and treat patients on a fee-for-service basis.In addition,Med Profs doctors also agree to treat HMO members at reduced fees.The type of HMO that uses organizations like Med Profs is called a(n)

John and Jane Smith were just divorced.Jane was awarded custody of the couple's child,Maggie.John was born on March 18,1979.Jane was born on January 24,1980.John and Jane are each covered under generous employee benefit plans at work.The plans also cover the spouse and children of the worker.Assuming there is no court decree specifying responsibility for Maggie's health care expenses,which of the following is true regarding coverage of Maggie's health care expenses?

Which of the following statements about group insurance underwriting principles is (are) true? I.If a plan is contributory,100 percent of the eligible employees must be covered. II.Employees should be allowed to determine their own level of benefits.

Tracy had continuous group health insurance coverage at her previous employer for 6 years.Tracy decided to change jobs.Under federal law,if Tracy changes jobs,the new employer or group health plan must give her credit for previous and continuous health insurance coverage.This characteristic is called

Under the Health Insurance Portability and Accountability Act,what is the maximum length of a preexisting conditions exclusion if an employee enrolls when initially eligible?

Which of the following statements about group short-term disability income plans is true?

Some employers offer employees a choice of health care plans which are designed to make employees more sensitive to health care costs,to provide an incentive to avoid unneeded care,and to seek low-cost health care providers.Such plans are called

Reasons for having a minimum participation requirement before a group is eligible for insurance include which of the following? I.To lower the expense rate per unit of insurance. II.To minimize the possibility of insuring a group which consists largely of unhealthy individuals.

All of the following are criticisms of managed care plans EXCEPT

All of the following statements about HMOs are true EXCEPT

All of the following statements about group universal life insurance are true EXCEPT

Marv is covered by a group health insurance plan at work.His employer funds the entire cost of the group health insurance.Because of this characteristic,the group health insurance plan can be described as

All of the following statements about group basic medical expense insurance are true EXCEPT

Nancy's employer provides an interesting employee benefit plan.Each employee is given 250 employee benefit credits to spend.A wide array of benefits are available,and the employee uses benefit credits to select the benefits that he or she wants.This type of employee benefit plan is called a(n)

Which of the following statements is (are) true with regard to group life insurance? I.Most group life insurance is whole life coverage. II.Most group life insurance plans allow a modest amount of life insurance on the employee's spouse and dependent children.

Which of the following statements about group accidental death and dismemberment (AD&D) insurance is (are) true? I.The principal sum is paid if the employee dies in an accident. II.The employer usually pays at least 50 percent of the cost of voluntary AD&D coverage.