Book 2 Pages 102 - End Flashcards
a federal law that eliminates previously detrimental aspects of changing jobs and enrolling in a new employer’s group health plan
HIPAA (health insurance portability and accountability act)
limits the application of preexisting condition exclusions when enrolling in a new employer health plan
HIPAA
provides additional opportunities to enroll in a group plan if an employee loses other coverage or experiences certain life events
HIPAA
guarantees that certain individuals will have access to and can renew individual health insurance policies
HIPAA
prohibits discrimination against employees and dependents based on health factors such as prior medical conditions and health history
HIPAA
what does HIPAA define as a pre existing condition?
any health event that caused the need for medical advice, treatment, or diagnosis within 6 months prior to enrollment in new plan
when does the catch up limit kick in for HSA?
age 55
can individuals who have medicare at age 65 still contribute to a HSA?
no
what is the last month rule under HSA’s?
states that if you are covered by a high deductible plan and have access to a HSA by on Decemeber 1st, you can make a full year contribution in December without penalty
what is the maximum monthly contribution allowed under HSA’s?
1/12 of the annual contribution limit
True or False?
Archer Medical Savings Accounts allow funding from the employee and employer in the same year
False
Do HSA’s allow funding from employee and employer in the same year?
Yes
True or False?
MSA’s were limited to self employed individuals or small employers with 50 or less employees
True
what was the maximum contribution under a MSA?
65% of the deductible for individuals and 75% of the deductible for families
penalty for excess contributions to a HSA
6% excise tax
True or False?
if moving funds from a FSA or HRA to a HSA the transfer can exceed the annual contribution limit to a HSA
True
Estimate the health care cost of a married couple who has a life expectancy of 20 years by using a needs analysis based off the below info:
estimated health insurance premiums = $6k annually
estimated out of pocket costs = $2k annually
retirement age = 62 years
life expectancy = 20 years
quality of health = good to excellent
inflation = 3%
pmt = 8k n= 20 i = 3 fv = 0 pv ?
pv = $119,019
medicare covers only a maximum of ____ days of skilled nursing care, and only the first ____ days are covered at 100%
100 ; 20
how long is the look back period for Medicaid?
60 months ( 5 years)
if an asset was transferred within 60 months of applying/receiving medicaid how do you determine the length of time the client remains ineligible?
take the amount of asset that was transferred and divide it by the average monthly cost of nursing home care for the region ( i.e. if the asset transferred was $10k and the nursing home cost for the region was $1k per month then the client would be ineligible for another 10 months)
long term care approach where coverage lasts for a set time period and the maximum period is usually 2 - 5 years
Defined period approach
long term care approach where coverage lasts until a specified dollar amount is reached
pool of money concept
what are the activities of daily living?
eating, bathing, dressing, transferring from bed to chair, using the toilet, and continence
how many of the activities of daily living does an insured need to be unable to perform to receive long term care benefits?
2 out of the 6
true or false?
long term care premiums paid by a self-employed individual are a deduction for AGI (above the line)
True
true or false?
long term care premiums paid by an individual are deductible as medical expenses for itemized deduction purposes
True
true or false?
employer payments for group long term care are tax deductible for the employer and are not included in taxable income for the employee
True
can long term care benefits be included in a cafeteria plan or flexible spending account?
no
type of long term care insurance that provides a specific dollar amount of assets which would be protected if the client used up all of the long-term care insurance benefit and had to apply for Medicaid
Partnership Long Term Care
what is the tax rate under social security for medicare hospital insurance?
2.9% split between the employee and employer evenly
people who have been receiving Social Security disability benefits for at least ____ months are also eligible for Medicare benefits
24
hospital care is covered under medicare part ___
A
skilled nursing care is covered under medicare part ___
A
hospice care is covered under medicare part __
A
home health care is covered under medicare part ___
A
physicians’ fees are covered under medicare part ___
B
outpatient services are covered under medicare part ___
B
if you are 65 and receiving Social Security are you automatically enrolled in medicare part A?
yes
true or false?
most people don’t pay a premium for medicare part A
True
how many quarters are needed of medicare covered employment to receive free medicare part A?
40
can you opt out of medicare part B coverage?
Yes
are there premiums associated with medicare part B coverage?
yes, change based on income
medicare pays for hospital services for up to ___ days in each benefit period
90
under medicare, a benefit period ends when the patient is out of the hospital for ____ consecutive days
60
in each benefit period under medicare, covered hospital expenses are paid in full for ___ days
60
in each benefit period under medicare, covered hospital expenses will have a coinsurance for days ___ through ___
61 ; 90
to receive skilled nursing care benefits, what must be proven?
the physician must certify that skilled nursing care or rehab services are needed for a condition that was treated in a hospital within the past 30 days
for days ___ through ___ there will be coinsurance under skilled nursing care benefits
21 ; 100
true or false?
no coverage is covered for custodial or long term care coverage under Medicare Part A
True
true or false?
a nursing home must be certified by Medicare for benefits to be payable
True
benefits that are designated for those who are terminally ill
hospice benefits
terminally ill means you have a life expectancy of ___ months or less
6
what is the maximum length of hospice care?
210 days, unless individual is re-certified as terminally ill
are oxygen tanks, hospital beds, dialysis machines covered under home health care benefits?
Yes
what is the coinsurance for oxygen tanks, dialysis machines, etc?
20%
does Medicare part A provide blood benefits (i.e. receiving new blood)? Does the insured have to pay any costs for this?
Yes and yes the insured is responsible for costs associated with first 3 pints of blood during a calendar year
is there a deductible you have to meet for Part B insurance?
yes
is there coinsurance after the deductible is met under Medicare Part B?
Yes, 80/20
Part B pays ___% of x-ray and pathology services
100
true or false?
medicare part C plans usually have lower premiums and lower coinsurance than the original medicare plans
true
does medicare part D cover generic and brand-name brands?
yes
can medicare part C plans include drug coverage?
yes
does medicare part D have a premium you have to pay?
yes
does medicare part D have a deductible you have to meet?
yes
service of physicians is covered under medicare part ___
B
service of surgeons is covered under medicare part __
B
to qualify for medicaid an individual may only have ___ to ___ liquid funds available
$2k to $3k
is your primary residence included when determining if you are eligible for medicaid?
no
how many motor vehicles can you exclude from medicaid qualification?
1
are household belongings included in medicaid qualification?
no
what is the maximum value of life insurance that can be excluded from medicaid?
$1,500
can an employee sue their employer if they are receiving workers’ comp
no
when an employee is unable to work because of an injury but will recover and return to work; benefits are a % of weekly earning
total temporary disability
when an employee cannot pursue his own occupation but can pursue other work ; benefits are a % of weekly earnings
Partially temporary disability
when in employee is unable to be gainfully employed because of an industrial injury ; benefits are payable for the entire period of disability
total permanent disability
an industrial injury resulting in the loss of a limb ; benefits are based on a schedule
partial permanent disability
is workers comp taxed at the federal level?
no
are unemployment benefits included in federal income for tax purposes?
yes
an insurance policy that combines two or more separate coverages into one policy (fire, theft, personal liability)
homeowners insurance
coverage designed to protect against all perils except those specifically excluded from coverage
opened perils coverage
true or false?
HO-3 policies contain open peril coverage for dwelling and other structures
true
true or false?
HO-5 policies contain open peril coverage for dwelling and other structures
True
how do you calculate actual cash value of a property?
replacement cost - depreciation
true or false?
opened perils coverage has lower premiums than other homeowners policies
false
