In a group health insurance arrangement, the employer is the master policyholder, and each covered employee receives:
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Answer & full 3-part explanation (select an option above, or peek)
Why A is correct
Group insurance is written under a single master policy issued to the group policyholder, such as the employer, union, or trustee. Each covered employee is not issued a separate insurance contract but instead receives a certificate of coverage that summarizes the benefits, limitations, exceptions, and terms of the master policy. Under CIC §10270.5(c), an individual certificate setting forth the benefits and exceptions and referring to the master policy must be issued to each covered person. The certificate documents the employee's participation in the group plan, making A the correct answer.
Why the other options are wrong
- B) Group coverage is issued on a wholesale basis to qualifying classes of employees without individual medical underwriting or individual risk classification for each member. Group underwriting applies to the class as a whole, never to individual employee risk.
- C) The master policy is issued to the employer, trustee, or other group policyholder, never to each employee; employees receive certificates referencing that single master contract. Only one master contract is issued, and it belongs to the group policyholder rather than to employees.
- D) Medigap policies supplement Original Medicare for beneficiaries age 65 and older and are unrelated to employer group health coverage for employees. Medigap is designed for the Medicare market and has no role in employer group coverage.
Memory hook
One master policy up top, a stack of certificates below. The employer owns the contract; you carry the proof.