H2: Health Insurance Basics (Section II)

Franchise Health

Association

Self-Insured (Self-Funded) Plan

Self Insured= Self-Funded

Self-Insured plans CANNOT be used for DEATH BENEFITS (Life Insurance)

the following may opt for a SELF-INSURED medical and disability plan:

Stop-Loss Coverage AKA Retention Limit

Multiple Employer Trust

Individual Health UW Factors

Health Underwriter

Group Health UW Factors

Accidental Death (AD)

AD&D

Principal Sum

Capital Sum

The DOI has jurisdiction over entities that provide coverage designed to pay for health care provider's services and expenses UNLESS health care providers are appropriately licensed or certified by other governmental agencies

COBRA

COBRA

COBRA applies to only Group Health NOT Group Life

Cal-COBRA

COBRA=Federal

Cal COBRA= Cal State

Qualifying Events to Qualify for COBRA/ CAL COBRA

ERISA

ERISA

Right to Terminate

Americans with Disabilities Act (ADA)

FMLA

Covered FMLA events

CFRA= State Law

FMLA= Federal Law

CFRA provides employees up to 12 weeks for maternity leave

Maternity/Pregnancy

Pregnancy Discrimination Act

Women's Health & Cancel Rights Act