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Maine Life Insurance Exam 2024 Review
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Maine Life Insurance Exam 2024 Review
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Maine Life Insurance Exam2024 Review
Contributory Health Insurance - Answer>> If the
employees share a portion of the premium. Often require
participation by 75% of eligible members.
Noncontributory Health Insurance - Answer>> If the
employer pays the entire premium. Most require 100%
participation by eligible members.
(Funding of Group Insurance) Shared funding -
Answer>> 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 -
Answer>> 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 - Answer>> 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 -
Answer>> Large employers may elect to fully self-fund,
or may self-fund a plan but contract for administrative
services only (ASO).
Conversion privilege - Answer>> 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) - Answer>> Provides the ability to transfer and
continue health insurance when someone changes or
loses their job
HIPAA Requirements - Answer>> 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 - Answer>> Health issues
that existed, were treated, diagnosed within 6 months prior
to employment
COBRA - Answer>> 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 - Answer>> Specify
benefits based on a percentage of the employees wages
Blanket Health Plans - Answer>> Cover a group who
may be exposed to the same risk, no certificates issued
Taxation of group health premiums - Answer>>
Employers are entitled to take a tax deduction for premium
contributions made to group plans
Taxation of group health benefits - Answer>> Any
benefit received under a medical expense plan are not
considered taxable income.
Accidental means - Answer>> Requires that both the
cause and the result of an accident must be unintentional
accidental results - Answer>> only the injury resulting
from the accident must be unintentional.
3 basic categories of health insurances - Answer>>
Medical Expense, Disability Income Insurance, AD&D
Health insurance premium factors - Answer>> Interest,
expenses, types of benefits, morbidity, age, sex,
occupation
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