Group Medical Expense Insurance — practice questions

5.3% of the exam ≈8 real questions 6 free questions here

Small and large groups, coverage forms, dependents and domestic partners, ERISA, COBRA, Cal-COBRA, HIPAA, FMLA and small business options: about 8 of the 150 combined questions.

Where people lose points

• Small groups are 2 to 100 employees under CDI's objectives.
• Cal-COBRA covers employers with 2 to 19 employees, where federal COBRA does not reach.
• Registered domestic partners get the same coverage as spouses.
• Self-insured association health plans are prohibited by regulation.

Questions and answers, explained

All 2 questions above, with the correct answer and why it is correct. Everything here is on group medical expense insurance.

1. Which characteristic distinguishes blanket health insurance from group health insurance?

   • ABlanket coverage insures a constantly changing body of persons who are not individually named and who normally receive no certificatesCorrect
   • BBlanket coverage requires each covered person to sign an individual application and to receive a certificate of coverage
   • CBlanket coverage is available only to employer-employee groups that have at least 25 eligible lives
   • DBlanket coverage must always include a conversion privilege exercisable within 31 days of a loss of eligibility

   Why: Blanket policies cover an undefined, shifting group defined by a common activity or exposure — passengers of a common carrier, students on a field trip, volunteers at an event — so no individual enrollment, certificates, or conversion rights are involved. Choice B contradicts the essential feature of blanket coverage, which is that members are identified only by their membership in the class at the moment of loss.

   Reference CA A&H objectives III.B (Group medical expense insurance)

2. An employer's group health plan costs $780 per month for single coverage; the employer pays $600 and the employee pays $180. A terminated employee elects COBRA. What is the MOST the plan may charge her per month, and how long does she have to elect coverage?

   • A$183.60 per month, with 30 days to elect
   • B$612 per month, with 60 days to elect
   • C$795.60 per month, with 60 days to electCorrect
   • D$1,170 per month, with 45 days to elect

   Why: COBRA lets the plan charge up to 102% of the TOTAL applicable premium — the employer share plus the employee share — so $780 x 1.02 = $795.60, and the election period is 60 days from the later of the loss of coverage or the election notice. Choice A applies the 102% only to the employee's former payroll share ($180 x 1.02), which is the most common error; the 45 days in choice D is the separate deadline for paying the first premium after electing.

   Reference CA A&H objectives III.B (Group medical expense insurance)

Topics inside this domain

• California licensing, appointments and continuing education
• California group health insurance, COBRA and Cal-COBRA

Drill other domains

• Basic Insurance Concepts and Contract Law (17.3%)
• The Insurance Marketplace, Licensing and Ethics (9.3%)
• Life Insurance Basics, Underwriting and Claims (7.3%)
• Types of Life Policies and Group Life (8%)
• Annuities (5.3%)
• The Life Insurance Contract and Riders (9.3%)

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