At the end of any eligibility period under the new employer plans. HIPAA recognizes time served under group plans to determine pre-existing condition restrictions.
If a person is not covered, what is the maximum period they are allowed to go without coverage before the HIPAA requirements become void?
6 months
5 months
90 days
63 days
John is over 65 and has been enrolled in Medicare Part A. He remains enrolled on his employer’s group plan. If he has a claim, which plan pays first?
Medicare will be primary and his employer’s plan will function as a supplement.
The employer plan will be primary and Medicare will be secondary as long as he is actively at work.
Sally and James are married and they work for the same employer. Both have family coverage under the employer group plan, since the employer pays the full premium for all employees. What will the reimbursement be in the event that Sally or James has a claim?
Both Sally and James will receive full reimbursement from the plan, even if that results in a higher payment than the claim.
The spouse who has the sickness or accident will receive reimbursement up to the benefit maximum under the contract, and coverage for the well spouse will make up the difference up to 100% of the bill, but there will be no excess payment.
To qualify as an association group benefit program, an
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