Free Group Health Insurance Study Guide
Iowa Accident & Health exam — Group Health Insurance.
The national guide covers the general group concepts:
- group underwriting, the master contract and certificates;
- contributory versus noncontributory plans and experience rating;
- federal COBRA and coordination of benefits.
Iowa's group health rules are in Iowa Code chapter 509 (group policies), chapter 509B (state continuation) and chapter 513B (small group). The tested Iowa point: Iowa repealed its group conversion statute in 2006. Departing employees get state continuation, not a state conversion right.
National concepts in brief
- The employer holds the master policy. Each covered person gets a certificate.
- Noncontributory plans are fully employer-paid. Contributory plans share the cost with employees.
- Federal COBRA applies to employers with 20 or more employees. State continuation fills gaps for insured plans.
Group policy requirements (chapter 509)
- Participation: a contributory group accident and health policy needs at least 75% of eligible employees to enroll. A noncontributory policy must cover all eligible employees (Iowa Code 509.1(1)(b)).
- Trust groups: a policy issued to a multiple-employer or union trust must cover at least 100 persons at issue (Iowa Code 509.1(5)).
- Application and certificates: a copy of the policyholder's application is attached at issue or furnished within 30 days. Each insured gets an individual certificate, and new eligible members are added from time to time (Iowa Code 509.3).
- Claims data: for groups of 51 or more, the insurer gives claims and premium data on request once a year, but not more than three months before renewal (Iowa Code 509.19).
State continuation (chapter 509B)
| Rule | Iowa |
|---|---|
| Who qualifies | An employee (or member) continuously insured for the three months before coverage ended. Layoffs and leaves count (Iowa Code 509B.2, 509B.3(1)) |
| Not available to | Anyone who is or could be covered by Medicare (Iowa Code 509B.3(2)) |
| Employer notice | Written notice of continuation rights within 10 days of termination (Iowa Code 509B.5) |
| Election deadline | No later than 31 days after termination, if properly notified (Iowa Code 509B.3(4)) |
| Cost | No more than the group rate (Iowa Code 509B.3(5)) |
| Benefits | May exclude dental, vision or prescription drug benefits (Iowa Code 509B.3(3)) |
| Length | Up to nine months. Ends earlier on Medicare or other group eligibility. A former spouse's continuation ends on remarriage (Iowa Code 509B.3(6)) |
| Conversion | The old conversion section (509B.4) was repealed in 2006 |
Small group (chapter 513B)
- A small employer has 1 to 50 full-time equivalent eligible employees (Iowa Code 513B.2).
- An eligible employee normally works 30 or more hours a week.
Related rules
- Employer and association benefit plans: an employer or association administering its own plan, without pay from the insurer, needs no producer license (Iowa Code 522B.3(2)(c)).
- Group life rules (31-day grace period and conversion) are in the Life Policy Provisions guide.
Common exam traps
- Iowa continuation lasts nine months, after three months of prior coverage. The employer notifies within 10 days, and the employee elects within 31 days.
- Iowa has no state group health conversion right today.
- Contributory plans need 75% participation. Noncontributory plans cover 100% of eligible employees.
- A small employer has 1–50 employees. Eligible employees work 30+ hours a week.
Practice Group Health Insurance questions All Accident & Health topics
Practice questions are study aids generated for exam preparation and are not actual exam questions. Content is provided for educational purposes and is not legal advice. Verify current statutes, rules, and exam specifications with the Insurance Department and the exam administrator before relying on it.
