4 - Other A&H Topics Flashcards
Group participation percentage requirements
- Contributory 75% of eligible members
- Non-contributory 100% of eligible members
Notice of Non Renewal of Group Plan by Fiduciary to Members
-45 days prior to non renewal of policy
Eligibility for employer - employee group health plan
-work at least a minimum of 30 hours weekly
Member coverage start date for Group Health
-no later than 90 days after employment date
Notice of premium increase to members
-45 days notice prior to increase
State Continuation benefit period
-18 month maximum coverage period
Eligibility for State Continuation
-employment for at least the previous 90 days prior to application for continuation
Premiums for State Continuation paid by former employee
-Full group premium plus 2%
Tax deductibility of health expenses AGI
- under age 65 - 10%
- 65 and older - 7.5%
Social Security Disability trigger
-disability is expected to last 12 months or more
Social Security Disability benefits waiting period
-5 months
Group Health Premium Contribution
- contributory plan the employer will pay at least 50% of the premium
- non-contributory plans require the employer pay the full premium
Multiple Employer Welfare Arrangement (MEWA)
- must have been in existence for at least 5 years
- provides benefits to employees
Fully-insured Multiple Employer Trusts (MET)
-benefits are insured and the MET is administered by an insurance company
Insured, third-party administered MEWA
-benefits are insured and the MEWA is administered by a third-party
Self-funded MEWA
-benefits are self-funded and is administered by a third party
Social Security Earnings Test
- minimum of 40 quarters of SS covered work
- 1 quarter = 3 months
AD&D
-agrees to pay at death/dismemberment a sum of money as specified in the Declarations Page if occurs from accident within a specified period of days of the accident and before a specified age
A&H Premiums Tax Deduction
- amount in allowable deductions (annual premium [itemized tax return] + non-reimbursed medical expenses)
- % of AGI (10% or 7.5%)
- allowable deductions - % of AGI = actual deduction
Misrepresentation
-knowingly making a false statement
Concealment
-failure to disclose relevant information
APS
-Attending Physician’s Statement
MIB
-Medical Information Bureau
Conditional Receipt
-once application has been completed and initial premium is collected it provides evidence of temporary contract as long as the application is acceptable
