CLAHS California Life, Accident and Health or Sickness Examination - Set 3 - Part 1

Test your knowledge of technical writing concepts with these practice questions. Each question includes detailed explanations to help you understand the correct answers.

Question 1: In group health insurance, the single contract issued to the sponsoring employer that covers many individuals is known as which of the following?

The certificate of coverage

The individual application

The master policy

The summary annual report

Question 2: Under a group health plan, which party owns and controls the master policy and makes plan decisions?

The sponsoring employer

Each covered employee

The Insurance Commissioner

The claims adjuster

Question 3: Because individual members do not hold the group contract, each covered member receives which document as evidence of coverage?

The master policy

A binder of insurance

An outline of underwriting

A certificate of coverage

Question 4: A method of setting a large group's premium based on that group's own prior claims experience is known as which of the following?

Community rating

Experience rating

Manual rating only

Capitation rating

Question 5: Charging all subscribers of a plan the same rate structure, regardless of any single group's loss history, is known as which rating method?

Experience rating

Retrospective rating

Community rating

Schedule rating

Question 6: To be eligible for group insurance, a group generally must satisfy which overriding requirement?

It must exist for an independent purpose

It must be formed only for insurance

It must have a thousand members

It must be in one city

Question 7: In a contributory group plan, where employees pay part of the premium, what minimum level of eligible employees must generally participate?

Twenty-five percent

Fifty percent

One hundred percent

Seventy-five percent

Question 8: A group plan in which the employer pays the entire premium and every eligible employee must be covered is known as which type of plan?

A contributory plan

A blanket plan

A noncontributory plan

A self-funded plan

Question 9: In a self-funded, or self-insured, group health plan, who pays the employees' health claims?

A licensed insurer from premiums

The employer from its own funds

The state guarantee association

Each employee individually

Question 10: A self-funded employer typically purchases which type of coverage to protect against catastrophic years when claims exceed a set threshold?

Credit disability insurance

Title insurance

Surety coverage

Stop-loss insurance

Question 11: In California, what is the status of newly created self-funded multiple employer welfare arrangements that pool unrelated small employers?

They are prohibited

They are encouraged by the state

They are tax-exempt by default

They require no oversight

Question 12: Under federal law, a group health plan that offers dependent-child coverage must make it available to an employee's children up to what age?

Age eighteen

Age twenty-one

Age twenty-six

Age thirty

Question 13: Under California law, a group health policy that covers spouses must provide coverage to a registered domestic partner in what manner?

At a higher premium than spouses

Equal to a spouse's coverage

Only after a waiting period

Only for same-sex partners

Question 14: A policy that covers all persons within a defined class, such as all passengers of a common carrier, by description rather than by name, is known as which of the following?

Individual insurance

Credit insurance

Key person insurance

Blanket insurance

Question 15: When an eligible employee enrolls in a group health plan during the normal enrollment period, what is generally true about evidence of insurability?

No evidence of insurability is required

A full medical exam is always required

Each member is individually underwritten

A two-year waiting period applies

Question 16: The federal law that sets fiduciary standards and reporting and disclosure requirements for most private-sector employee benefit plans, including group health plans, is known as which of the following?

COBRA

HIPAA

ERISA

FMLA

Question 17: Federal COBRA continuation rights generally apply to group health plans of employers with how many employees?

One or more employees

Five or more employees

One hundred or more employees

Twenty or more employees

Question 18: Under federal COBRA, an employee who loses coverage because of termination of employment or a reduction in hours may continue coverage for a maximum of how long?

Thirty-six months

Eighteen months

Six months

Sixty months

Question 19: Under federal COBRA, a dependent child who ages out of a group health plan may continue coverage for a maximum of how long?

Thirty-six months

Eighteen months

Twelve months

Three months

Question 20: Under federal COBRA, an employee terminated for which reason is NOT entitled to elect continuation coverage?

A company layoff

Voluntary resignation

Poor job performance

Gross misconduct

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