Free Group Health Insurance Study Guide
Minnesota Accident & Health exam — Group Health Insurance.
The national Group Health guide covers group underwriting, COBRA, HIPAA and coordination of benefits. Minnesota adds state continuation and conversion rights (Minn. Stat. 62A.16–62A.21). These apply to all insured group health plans covering Minnesota residents employed in Minnesota, including employer HMO plans. Minnesota also has a small employer law in chapter 62L. This guide covers both.
Continuation for employees (62A.17)
| Rule | Minnesota requirement |
|---|---|
| Who qualifies | Employees whose coverage would end because of voluntary or involuntary termination or layoff, including reduced hours. Discharge for gross misconduct doesn't qualify. |
| Length | Until the person gets other group coverage, or 18 months, whichever comes first |
| Cost | Up to 102% of the plan's cost for similarly situated employees |
| Employer notice | Within 14 days, covering the right to continue, the cost and how to pay |
| Election | 60 days, starting on the later of the date coverage would end or the date notice is received |
| Liability | An employer that fails to comply is liable for the coverage as the insurer would have been |
Spouses, dependents and survivors
- Dependents of a terminated employee may continue for up to 36 months, or until other group coverage or the date coverage would otherwise end (62A.20).
- Former spouses: coverage can't end just because of divorce. The former spouse gets a continuation right until he or she gets other group coverage or coverage would otherwise end (62A.21).
- Surviving spouses and dependents may continue until the surviving spouse gets other group coverage or coverage would have ended had the employee lived. Coverage may end if the survivor doesn't pay within 90 days after notice (62A.146).
- Totally disabled employees: benefits can't be ended just because of absence due to the disability (62A.148). The disability test is own occupation for 2 years, then any suitable occupation (62A.147).
Other group rules
- Disabled dependents: groups with dependent coverage must cover disabled dependents without pre-existing limits or underwriting (62A.141).
- Maternity: group policies (other than specified disease policies) cover maternity like any other illness. Unmarried women and minor dependents get the same coverage as married women (62A.041).
- Associations must exist in good faith for purposes other than buying insurance (60A.02).
- No fee beyond premium may be charged for conversion policies (72A.20, subd. 28).
Small employer plans (chapter 62L)
| Rule | Minnesota figure |
|---|---|
| Small employer | An average of at least 1 (not counting a sole proprietor) and no more than 50 current employees (62L.02) |
| Guaranteed issue | Carriers can't decline a small employer or any eligible employee or dependent (62L.02, 62L.03) |
| Conditions | At least 75% participation of eligible employees who don't waive coverage, and at least a 50% employer contribution (62L.03) |
| Shrinking groups | An employer reduced to one employee stays a small employer for 12 months |
Common exam traps
- State continuation: 18 months, 102%, a 14-day employer notice, 60 days to elect. It doesn't apply after gross misconduct.
- Dependents may continue up to 36 months. Divorce alone can't end a spouse's coverage.
- Group disability definition: own occupation for 2 years, then any suitable occupation.
- Small group: 1–50 employees, with 75% participation and a 50% employer contribution for guaranteed issue.
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.
