#1
What is the primary function of group health insurance?
To cover a group of people under a single policy
ExplanationProvides coverage for a collective group under one insurance policy.
#2
Which of the following is typically responsible for paying the premium in group health insurance?
Both employers and employees
ExplanationPremium payment responsibility shared between employers and employees.
#3
What is the Affordable Care Act (ACA) also known as?
Obamacare
ExplanationCommonly referred to as Obamacare, the ACA is a healthcare reform law.
#4
Which of the following is NOT typically covered under a group health insurance plan?
Cosmetic surgery
ExplanationExclusion of cosmetic surgery from standard coverage.
#5
What is 'COBRA' in the context of group health insurance?
A federal law that allows employees to continue their health insurance coverage for a limited time after leaving their job
ExplanationLegislation enabling continued coverage post-employment.
#6
What does the term 'deductible' mean in group health insurance?
The amount an individual pays for healthcare services before the insurance covers any expenses
ExplanationInitial amount paid by the individual before insurance coverage begins.
#7
What is 'coinsurance' in the context of group health insurance?
The percentage of costs an insured person must pay for covered services after the deductible is met
ExplanationInsured's share of costs post-deductible, expressed as a percentage.
#8
In group health insurance, what does 'open enrollment' refer to?
A period during which employees can sign up for or make changes to their health insurance coverage
ExplanationDesignated time for employees to enroll or modify health insurance coverage.
#9
What is the purpose of a Health Maintenance Organization (HMO) in group health insurance?
To coordinate and provide healthcare services to members for a fixed fee
ExplanationHMOs manage and deliver healthcare services for a set fee.
#10
What is the main difference between Preferred Provider Organizations (PPOs) and Health Maintenance Organizations (HMOs)?
PPOs have a network of preferred providers, but HMOs do not
ExplanationPPOs utilize a network of preferred providers, unlike HMOs.
#11
Which of the following is NOT a factor that influences group health insurance premiums?
Gender of employees
ExplanationEmployee gender does not typically affect insurance premiums.
#12
What is the purpose of 'coordination of benefits' in group health insurance?
To prevent duplication of benefits when an individual is covered by multiple health insurance plans
ExplanationAvoiding overlap of benefits in cases of multiple insurance coverage.
#13
What is 'stop-loss insurance' in the context of group health insurance?
Insurance that protects the employer against high claims by reimbursing them for claims that exceed a certain threshold
ExplanationCoverage shielding employers from excessive claims costs.
#14
What is 'medical underwriting' in the context of group health insurance?
A process of evaluating an individual's health status to determine eligibility and premiums
ExplanationAssessing health status to determine eligibility and premiums.
#15
What is the significance of 'HIPAA' in the context of group health insurance?
It sets standards to protect sensitive patient information
ExplanationEstablishes standards for safeguarding sensitive health information.
#16
What is 'cost-sharing' in the context of group health insurance?
The practice of dividing healthcare expenses between the insurance company and the insured individual
ExplanationSharing healthcare expenses between insurer and insured.
#17
What is the role of a 'benefit administrator' in group health insurance?
To manage the financial aspects of the insurance policy
ExplanationResponsible for overseeing financial aspects of the insurance policy.