Maine Life Insurance Exam Practice
Questions and Answers
Contributory Health Insurance - Answer️️ -If the employees share a
portion of the premium. Often require participation by 75% of eligible
members.
Noncontributory Health Insurance - Answer️️ -If the employer pays the
entire prem...
Maine Life Insurance Exam Practice
Questions and Answers
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
Disability Buy-Sell (business income policy) - Answer✔️✔️-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) - Answer✔️✔️-Sold to
small business owners who must continue to meet overhead expenses such
as rent, used if owner becomes disabled. Covers fixed business expenses
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