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Maine Life Insurance Exam Study Guide with complete solution
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Maine Life Insurance Exam 2023-2024Study Guide with complete solution
Contributory Health Insurance - If the employees share a portion of the premium. Often
require participation by 75% of eligible members.
Noncontributory Health Insurance - If the employer pays the entire premium. Most
require 100% participation by eligible members.
(Funding of Group Insurance) Shared funding - Allows employer to self-fund health
care expenses, select a deductible and pay covered expenses for any individual
incurring claims up to that max, insurer assumes risk
(Funding of group insurance) Min. premium arrangement - Employer self-insure the
normal and expected claims up to a given amount and the insurer funds only the excess
amounts
(Funding of group insurance) retrospective premium arrangement - Insurer agrees to
collect a provisional premium but may collect additional premium/make a premium
refund at the end of the year based on actual incurred losses.
(Funding of group insurance) Self-funding arrangement - Large employers may elect to
fully self-fund, or may self-fund a plan but contract for administrative services only
(ASO).
Conversion privilege - An employee can convert their group certificate to an individual
medical expense policy w/ same insurer, if/when they leave employer. Employee must
make an application for a converted policy within a given period of time (usually 31
days) depending on the state.
Health Insurance Portability and Accountability Act (HIPAA) - Provides the ability to
transfer and continue health insurance when someone changes or loses their job
HIPAA Requirements - Employers with 20 or more employees have to allow former
employees to continue benefits. Rules apply to all types of group health plans except
disability income plans
HIPAA pre-existing conditions - Health issues that existed, were treated, diagnosed
within 6 months prior to employment
COBRA - Requires employers with 20+ employees to continue coverage for
terminated workers, (as well as dependents) for up to 18 months. Employee is required
to pay premiums (up to 102%)
, Group Disability Income Plans - Specify benefits based on a percentage of the
employees wages
Blanket Health Plans - Cover a group who may be exposed to the same risk, no
certificates issued
Taxation of group health premiums - Employers are entitled to take a tax deduction for
premium contributions made to group plans
Taxation of group health benefits - Any benefit received under a medical expense plan
are not considered taxable income.
Accidental means - Requires that both the cause and the result of an accident must be
unintentional
accidental results - only the injury resulting from the accident must be unintentional.
3 basic categories of health insurances - Medical Expense, Disability Income
Insurance, AD&D
Health insurance premium factors - Interest, expenses, types of benefits, morbidity,
age, sex, occupation
Disability Buy-Sell (business income policy) - Legal agreement that specifies how a
business will pass between owners when one of the owners dies or becomes disabled
Business overhead expense (business income policy) - Sold to small business owners
who must continue to meet overhead expenses such as rent, used if owner becomes
disabled. Covers fixed business expenses
Disability Buy-Out (business income policy) - Specifies who will purchase a disabled
partner's interest and legally obligates that person/party to purchase the business
interest of the disabled partner.
Maternity Benefits - Any policy of health insurance that provides maternity care must
also cover the services of nurses/midwives, and licensed birth centers.
Coordination of Benefits provision - Prevents an insured covered by two health plans
from making a profit on a covered loss
Waiting period in a group health policy - gives insurance company the right to delay
coverage for a covered sickness for a specified number of days after the effective date
of the policy
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