This podcast is made by Ran Chen, who holds an EA license, Insurance and Securities licenses (Series 6, 63, 65), and the CFP® designation. He is passionate about opening access to high-quality exam preparation resources and helping learners prepare more effectively for professional certification exams.

In this episode you will learn:

- That a fiduciary's primary duty under ERISA is to act solely in the interest of plan participants and beneficiaries.

- Key details about the Summary Plan Description (SPD), including that it must be provided automatically to new participants within 90 days of coverage.

- The distinction between fully insured and self-insured plans regarding ERISA's preemption of state insurance laws.

- The required timelines for deciding claim appeals, such as within 72 hours for urgent care claims.

- That ERISA establishes a formal grievance and appeals process that must be exhausted before legal action can be taken in federal court.

This podcast is made by Ran Chen, who holds an EA license, Insurance and Securities licenses (Series 6, 63, 65), and the CFP® designation. He is passionate about opening access to high-quality exam preparation resources and helping learners prepare more effectively for professional certification exams.

In this episode you will learn:

- How HIPAA limits pre-existing condition exclusions using a 6-month look-back period and a maximum 12-month exclusion.

- The role of creditable coverage in reducing or eliminating pre-existing condition exclusion periods.

- What qualifying life events trigger a special enrollment period outside of open enrollment.

- The key components of the HIPAA Privacy Rule and its protection of Protected Health Information (PHI).

- The differences between the Privacy Rule and the Security Rule, which safeguards electronic PHI (ePHI).

For more free exam prep tools, practice questions, and AI-powered explanations, visit https://open-exam-prep.com/ or YouTube Channel: https://www.youtube.com/@Open-exam-prep

This podcast is made by Ran Chen, who holds an EA license, Insurance and Securities licenses (Series 6, 63, 65), and the CFP® designation. He is passionate about opening access to high-quality exam preparation resources and helping learners prepare more effectively for professional certification exams.

In this episode you will learn:

- The employer has 30 days to notify the plan administrator of qualifying events like termination or reduction in hours.

- The employee or beneficiary has 60 days to notify the plan administrator of qualifying events like divorce or a child losing dependent status.

- A qualified beneficiary has a 60-day period to elect to continue their COBRA coverage after receiving the election notice.

- The initial COBRA premium payment is due within 45 days of electing coverage.

- Subsequent monthly premium payments have a 30-day grace period.

For more free exam prep tools, practice questions, and AI-powered explanations, visit https://open-exam-prep.com/ or YouTube Channel: https://www.youtube.com/@Open-exam-prep

This podcast is made by Ran Chen, who holds an EA license, Insurance and Securities licenses (Series 6, 63, 65), and the CFP® designation. He is passionate about opening access to high-quality exam preparation resources and helping learners prepare more effectively for professional certification exams.

In this episode you will learn:

- That COBRA is a federal law applying to employers with 20 or more employees.

- The difference in qualifying events for employees (termination, reduced hours) versus dependents (death, divorce, Medicare eligibility).

- The standard continuation period is 18 months for termination or reduction in hours.

- Dependents are eligible for a longer, 36-month continuation period for events like death of the employee or divorce.

- Beneficiaries must pay up to 102% of the premium, which includes the full cost plus a 2% administrative fee.

For more free exam prep tools, practice questions, and AI-powered explanations, visit https://open-exam-prep.com/ or YouTube Channel: https://www.youtube.com/@Open-exam-prep

This podcast is made by Ran Chen, who holds an EA license, Insurance and Securities licenses (Series 6, 63, 65), and the CFP® designation. He is passionate about opening access to high-quality exam preparation resources and helping learners prepare more effectively for professional certification exams.

In this episode you will learn:

- The distinction between the master contract held by the employer and the certificate of insurance provided to employees.

- Common eligibility requirements for group coverage, including waiting periods for new hires.

- The key differences between contributory and noncontributory plans, including their required participation percentages.

- The function and importance of the annual open enrollment period for making coverage changes.

- How experience rating is used for large groups to determine premiums based on their specific claims history.

For more free exam prep tools, practice questions, and AI-powered explanations, visit https://open-exam-prep.com/ or YouTube Channel: https://www.youtube.com/@Open-exam-prep

This podcast is made by Ran Chen, who holds an EA license, Insurance and Securities licenses (Series 6, 63, 65), and the CFP® designation. He is passionate about opening access to high-quality exam preparation resources and helping learners prepare more effectively for professional certification exams.

In this episode you will learn:

- That the ACA's guaranteed issue and renewability rules prohibit insurers from denying coverage based on health status.

- Why health plans can no longer impose lifetime or annual dollar limits on essential health benefits.

- How the Medical Loss Ratio (MLR) requires insurers to spend at least 80% (individual/small group) or 85% (large group) of premiums on healthcare, or else issue rebates.

- How the No Surprises Act protects consumers from unexpected bills for emergency care and from out-of-network providers at in-network facilities.

- The critical exception to the No Surprises Act that is often tested: it does not apply to ground ambulance services.

For more free exam prep tools, practice questions, and AI-powered explanations, visit https://open-exam-prep.com/ or YouTube Channel: https://www.youtube.com/@Open-exam-prep

This podcast is made by Ran Chen, who holds an EA license, Insurance and Securities licenses (Series 6, 63, 65), and the CFP® designation. He is passionate about opening access to high-quality exam preparation resources and helping learners prepare more effectively for professional certification exams.

In this episode you will learn:

- The four metal tier plans (Bronze, Silver, Gold, Platinum) and their specific actuarial values.

- Eligibility requirements for Catastrophic health plans.

- The 2026 update making Bronze and Catastrophic plans automatically eligible for Health Savings Accounts (HSAs).

- The difference between Premium Tax Credits and Cost-Sharing Reductions, and why Silver plans are key.

- A mnemonic to easily remember the metal tiers and their corresponding cost-sharing percentages.

For more free exam prep tools, practice questions, and AI-powered explanations, visit https://open-exam-prep.com/ or YouTube Channel: https://www.youtube.com/@Open-exam-prep

This podcast is made by Ran Chen, who holds an EA license, Insurance and Securities licenses (Series 6, 63, 65), and the CFP® designation. He is passionate about opening access to high-quality exam preparation resources and helping learners prepare more effectively for professional certification exams.

In this episode you will learn:

- The ten Essential Health Benefits (EHBs) are mandatory for all new individual and small group health plans under the ACA.

- EHBs do not automatically apply to large group plans, self-funded plans, or grandfathered plans.

- While EHBs must be covered, cost-sharing still applies, with the major exception of certain preventive services which have no cost-sharing.

- States define the specific services required within each of the ten EHB categories by selecting a state-specific "benchmark plan".

- Exam questions focus on applying EHB rules, such as identifying if a denied service falls into a mandatory category or understanding the limits of the requirements.

For more free exam prep tools, practice questions, and AI-powered explanations, visit https://open-exam-prep.com/ or YouTube Channel: https://www.youtube.com/@Open-exam-prep

This podcast is made by Ran Chen, who holds an EA license, Insurance and Securities licenses (Series 6, 63, 65), and the CFP® designation. He is passionate about opening access to high-quality exam preparation resources and helping learners prepare more effectively for professional certification exams.

In this episode you will learn:

- That insurers must offer coverage to all applicants regardless of health status under the guaranteed issue provision.

- That premiums can only be rated based on age, location, family size, and tobacco use, not health history.

- That dependents can remain on a parent's plan until age 26, irrespective of marital, student, or financial status.

- Key 2026 updates, including the expiration of enhanced premium tax credits on Dec 31, 2025, and the new 9.96% employer affordability threshold.

- That all compliant plans must cover ten Essential Health Benefits, such as hospitalization and prescription drugs.

For more free exam prep tools, practice questions, and AI-powered explanations, visit https://open-exam-prep.com/ or YouTube Channel: https://www.youtube.com/@Open-exam-prep

This podcast is made by Ran Chen, who holds an EA license, Insurance and Securities licenses (Series 6, 63, 65), and the CFP® designation. He is passionate about opening access to high-quality exam preparation resources and helping learners prepare more effectively for professional certification exams.

In this episode you will learn:

- That Workers' Compensation is always the primary payer for work-related injuries and illnesses.

- How health insurance policies exclude coverage for occupational injuries covered by Workers' Comp.

- The four main types of Workers' Compensation benefits: medical, disability income, rehabilitation, and death.

- That Workers' Compensation is a no-fault system, meaning an employee's negligence usually does not affect their benefits.

- A mnemonic to remember the key benefits: 'MR. DD lives at work' (Medical, Rehabilitation, Disability, Death).

For more free exam prep tools, practice questions, and AI-powered explanations, visit https://open-exam-prep.com/ or YouTube Channel: https://www.youtube.com/@Open-exam-prep