Health Insurance Flashcards

Under HIPAA, a pre-existing condition exclusion period for a new group health plan is limited to a maximum of how many months?

Answer: 12 months

HIPAA limits pre-existing condition exclusion periods to 12 months (18 months for late enrollees) for group health plans.

A health insurance policy that pays a fixed dollar amount per day of hospitalization, regardless of actual expenses, is called a:

Answer: Hospital indemnity policy

A hospital indemnity policy pays a predetermined flat daily benefit regardless of actual hospital charges.

Which provision in a health insurance policy allows the insured to continue coverage after leaving a group plan by converting to an individual policy without proving insurability?

Answer: Conversion privilege

The conversion privilege allows a departing group member to obtain individual coverage without a medical exam or evidence of insurability.

An HMO that employs physicians directly and provides services at HMO-owned facilities uses which model?

Answer: Staff model

The staff model HMO employs physicians as salaried staff who work exclusively at HMO-owned facilities.

The 'free-look' period required for individual health insurance policies in most states is typically:

Answer: 10 days

Most states require a 10-day free-look period allowing the insured to return the policy for a full premium refund.

A UCR (Usual, Customary, and Reasonable) charge limit in a health insurance plan is used to:

Answer: Cap the benefit paid for a service based on prevailing area rates

UCR limits restrict reimbursement to the standard charge for a service in a geographic area, and the insured pays any amount above that.

Under a group health plan, the COBRA continuation period for a covered employee who is laid off is generally:

Answer: 18 months

Involuntary termination of employment or reduction in hours triggers an 18-month COBRA continuation period.