Free Group Health Insurance Study Guide
Maine Life, Accident & Health exam — Group Health Insurance.
The national Group Health guide covers how group coverage works: eligible groups, the master policy and certificates, participation, coordination of benefits, COBRA and HIPAA. This guide covers Maine's group rules in 24-A M.R.S. chapter 35 and the small group law in 2808-B. Two points get tested most. One is Maine's own state continuation right, which isn't COBRA. The other is the small group rating limits.
Participation and enrollment
- A noncontributory employee group health policy, where the employer pays the whole premium, must cover all eligible employees except those who reject coverage in writing (2804(2)).
- Dependent special enrollment: at least 30 days (2834-B).
- Newborns and adopted children are covered from birth or from the signed placement agreement, with no pre-existing condition exclusion (2834).
- Group policies must let the insured assign benefits to the provider of care (2827-A).
- Domestic partner coverage must be made available on the same terms as for spouses (2832-A).
Small group plans (2808-B)
| Rule | Maine figure |
|---|---|
| Eligible small group | An employer with an average of 50 or fewer eligible employees during the previous calendar year |
| Eligible employee | Full-time, with a normal work week of 30 hours or more. An employer may choose to include part-timers working 10 or more hours. |
| Guaranteed availability | Plans must be offered to every eligible group that meets participation requirements. The minimum participation requirement may not exceed 75%, and employees with other coverage don't count. |
| Rating | Premiums may not vary by gender, health status, claims experience or policy duration. They may vary for family membership and wellness program participation. |
Renewal and market exit (2850-B)
- Group health coverage is guaranteed renewable. It may be ended only for:
- nonpayment
- fraud
- breaking participation or contribution rules
- moving out of a managed care plan's service area
- the carrier leaving the market
- A carrier leaving a market gives the Bureau 3 months' notice of its decision. It gives the Bureau and policyholders 6 months' notice before nonrenewing existing contracts.
- A carrier that leaves can't write new business in that market for 5 years.
Maine state continuation (2809-A(11))
Maine gives a continuation right of its own. It applies to group members who lose coverage because of:
- a temporary layoff
- certain permanent layoffs that qualify for federal premium assistance
- loss of employment because of a claimed work-related injury or disease
| Rule | Maine figure |
|---|---|
| Eligibility | Member or employee for at least 6 months |
| Election | Within 31 days after coverage ends, with the first payment |
| Cost | Up to 102% of the group rate, including the share the employer used to pay |
| Length | Up to 1 year from the last day of work, with listed exceptions |
Federal COBRA (employers with 20 or more employees) is covered in the national guide. The Maine right is narrower in who qualifies and shorter in length.
Group life cross-reference
Group life has a parallel rule: a noncontributory plan must cover all eligible employees except those who refuse in writing (2603). Conversion on leaving a group life plan is 31 days (2621). See the Maine Life Policy Provisions guide.
Common exam traps
- Small group: 50 or fewer employees. Full-time means 30+ hours. Participation can't be set above 75%.
- Small group rates can't use health status, claims or gender.
- State continuation is for layoffs and work-injury job loss. It requires 6 months of prior membership, 31 days to elect, 102% premium and 1 year of coverage.
- Market exit: 5-year bar on re-entry, and 6 months' notice to policyholders.
- Noncontributory plans must enroll everyone eligible unless they refuse in writing.
Practice Group Health Insurance questions All Life, 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.
