Business Management /PA Health Insurance - VII. Group Health Insurance
PA Health Insurance - VII. Group Health Insurance
This deck covers key concepts related to group health insurance, including eligibility, coverage, and specific provisions like COBRA and Coordination of Benefits.
In group health insurance, what does the employee receive which shows the amount of coverage?
Certificates of insurance
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Key Terms
Term
Definition
In group health insurance, what does the employee receive which shows the amount of coverage?
Certificates of insurance
What types of groups are eligible for group insurances?
2 types: employers sponsored and association sponsored.
With group health insurance, who provides coverage?
employer
What is a multiple employer trust? describe the general circumstances of the people/groups who tend to comprise the METs
Individuals or small groups in the same or similar fields that join together to get enough members to qualify for group rates.
According to the Coordination of Benefits (cob) provision, if both parents have coverage where they are employed, under who are the dependents covered and for how long?
If both parents have the children listed under their plans, that which ever parent is born earlier in the year is considered the primary.
Under Cobra, when are dependents covered and for how long?
extended up to 18 months. For events such as death, divorce or legal separation the period is 36 months for dependents.
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| Term | Definition |
|---|---|
In group health insurance, what does the employee receive which shows the amount of coverage? | Certificates of insurance |
What types of groups are eligible for group insurances? | 2 types: employers sponsored and association sponsored. |
With group health insurance, who provides coverage? | employer |
What is a multiple employer trust? describe the general circumstances of the people/groups who tend to comprise the METs | Individuals or small groups in the same or similar fields that join together to get enough members to qualify for group rates. |
According to the Coordination of Benefits (cob) provision, if both parents have coverage where they are employed, under who are the dependents covered and for how long? | If both parents have the children listed under their plans, that which ever parent is born earlier in the year is considered the primary. |
Under Cobra, when are dependents covered and for how long? | extended up to 18 months. For events such as death, divorce or legal separation the period is 36 months for dependents. |
What are the requirements for terminated employees to convert the group health insurance to an individual plan without evidence of insurability? | Have to sign up within 31 days (the conversion period), Insurer can determine standard or substandard but may not deny coverage, It will have lesser benefits and a higher premium. |
When a group health plan is terminated, how long is an extension of benefits provided for any totally disabled employee or dependent? | 12 months |
When ees are actively at work on the date coverage can be transferred to another insurance carrier, what happens to coinsurance and deductibles? | They carry over from the old plan to the new |