Health Insurance Answer Book, Ninth Edition

Health Insurance Answer Book, Ninth Edition

by John C. Garner

Hardcover(Ninth Edition)

$290.00

Product Details

ISBN-13: 9780735582187
Publisher: Wolters Kluwer Law & Business
Publication date: 03/30/2010
Edition description: Ninth Edition
Product dimensions: 7.10(w) x 10.20(h) x 2.40(d)

Table of Contents

1. An Overview of Group Insurance


• Group Health Insurance
• The Uninsured
• Group Insurance
• Types of Insurance Professionals
• Intermediaries
• Blue Cross/Blue Shield Plans

2. State and Federal Laws


• Legal Factors Affecting Design
• State Law
• Federal Law
• Pregnancy Discrimination Act
• Family and Medical Leave Act
• Americans with Disabilities Act
• Taxation of Group Health Plans
• Reservists' Benefits

3. Eligibility


• Employees
• Dependents

4. Types of Medical Plans


• Traditional Plans
• Managed Care
• Health Maintenance Organizations
• Adverse Selection
• Legal Standards
• Evaluating HMOs
• Preferred Provider Organizations
• POS
• Managed Care Backlash

5. Factors Influencing Plan Design


• Strategies
• Contributions
• Types of Plans
• Covered Expenses
• Restrictions on Coverage
• Deductibles, Copayments, and Reimbursement
• Cost Containment
• Managed Competition

6. Flexible Benefits


• Tax Advantages
• Cost Control
• Types of Plans
• Flexible Spending Accounts
• Mid-Year Plan Changes
• Flexible Benefit Options
• Implementation

7. Consumer-Driven Health Plans


• Health Savings Accounts
• Health Reimbursement Accounts
• Medical Savings Accounts
• Consumer-Driven Dental Care
• Defined Contribution Health Care

8. Plan Implementation and Administration


• Setting Up the Plan
• Reporting and Disclosure
• Enrollment
• Billing
• Claims
• Coordination of Benefits
• Coverage, Renewal, and Changes
• Termination of Coverage
• Computerized Administration
• Billing Codes
• Third-Party Administrators

9. Health Insurance Portability and Accountability Act (HIPAA)


• Portability
• Electronic Data Interchange
• Privacy
• Security

10. COBRA


• The Basics
• Covered Employers
• Covered Plans
• General Requirements
• Notification Requirements
• Premiums
• Election and Grace Periods
• Qualified Beneficiaries
• Retiree Medical Coverage
• Miscellaneous

11. Form 5500


• Plan Years
• Administration
• Completing the Form
• Electronic Filing
• Summary Annual Report

12. Nondiscrimination Rules


• Accident and Health Plans
• Cafeteria Plans
• Voluntary Employees' Beneficiary Associations
• Nondiscriminatory Classification
• Nondiscrimination Rules for Archer MSAs
• Comparability Rules for health savings accounts (HSAs)
• Controlled Group Rules
• Tax-Exempt Organizations
• Comparisons

13. Plan Rating and Funding


• Plan Funding
• Fully Insured Plans
• Alternatives to Fully Insured Plans
• Deferred Premium Arrangements
• Shared Funding Arrangements
• Retrospective Premium Arrangements
• Reserve Reduction Agreements
• Minimum Premium Plans
• Captives

14. Self-Funding


• Reasons for Self-Funding
• Decision to Self-Fund
• Administration
• Marketplace
• Effect of Self-Funding on Regulations
• Stop-Loss Insurance
• Volunta

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