Exam (elaborations)
Maine Life Insurance Exam Study Guide with complete solution
- Course
- Institution
Maine Life Insurance Exam Study Guide with complete solution
[Show more]
Seller
Follow
Wiseman
Reviews received
Content preview
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
The benefits of buying summaries with Stuvia:
Guaranteed quality through customer reviews
Stuvia customers have reviewed more than 700,000 summaries. This how you know that you are buying the best documents.
Quick and easy check-out
You can quickly pay through credit card or Stuvia-credit for the summaries. There is no membership needed.
Focus on what matters
Your fellow students write the study notes themselves, which is why the documents are always reliable and up-to-date. This ensures you quickly get to the core!
Frequently asked questions
What do I get when I buy this document?
You get a PDF, available immediately after your purchase. The purchased document is accessible anytime, anywhere and indefinitely through your profile.
Satisfaction guarantee: how does it work?
Our satisfaction guarantee ensures that you always find a study document that suits you well. You fill out a form, and our customer service team takes care of the rest.
Who am I buying these notes from?
Stuvia is a marketplace, so you are not buying this document from us, but from seller Wiseman. Stuvia facilitates payment to the seller.
Will I be stuck with a subscription?
No, you only buy these notes for $12.99. You're not tied to anything after your purchase.
Can Stuvia be trusted?
4.6 stars on Google & Trustpilot (+1000 reviews)
82871 documents were sold in the last 30 days
Founded in 2010, the go-to place to buy study notes for 14 years now