Chapter 12: Group Health Insurance, Social Insurance, and Other State and Federal Plans

I. Group Health Insurance Characteristics of Group Health Insurance Eligible Groups – Legal Requirements Contributory vs. Noncontributory Plan Standard Provisions of Group Policy Handicapped Children New Employees Certificates Cost Containment Provisions Non-duplication and Coordination of Benefits Mandated Provisions for Individual & Group Health Policies Funding Alternatives Self-Insured Plans Third-Party Administrators & Administrative Services Only Federal Laws Affecting Group Insurance - Age Discrimination in Employment Act - The Americans with Disabilities Act - Pregnancy Discrimination Small Employers COBRA Dental Expense Insurance - Expenses Covered - Coinsurance and Deductible Provisions - Exclusions Health Maintenance Organizations (HMOs) Types of Health Maintenance Organizations Preferred Provider Organizations (PPO) Print Section 1* II. Social Insurance Medicare Medicaid The PACE Program Social Security III. Other Federal & State Regulated Plans Health Insurance Portability & Accountability Act (HIPPA) HIPPA Mandated Benefits The Omnibus Budget Reconciliation Act of 1989 The Tax Equity and Fiscal Responsibility Act of 1982 The Employee Retirement Income Security Act of 1974 Cafeteria Plans Tricare VA Health Medical Savings Accounts Workers Compensation Print Section 3* IV. Take Chapter 12 Test

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