BU - Insurance Flashcards
HDHP and HSA
Will be on tables
Remember to be a HDHP, must be between the minimum deductible and max out of pocket amounts
Max out of pocket included deductible
Last month rule: if eligible on Dec 1, then can fund HSA for entire year
20% tax penalty on distributions that are not qualifying
Qualifying events for COBRA
The death of the covered employee
The termination of employee (except gross misconduct)
A reduction in EE hours so that they or dependents is ineligible for coverage
The divorce or legal separation of the covered employee and spouse
For spouses and children, the EE becoming eligible for Medicare
A child ceasing to be an eligible dependent under the plan
Cost of COBRA cannot exceed
102% & must be paid monthly
Max period of COBRA coverage
Termination other than gross: 18 months
EE or beneficiary meets SS definition of disability: 29 months
All others: 36 months
COBRA applies to ERs with XX number of employees
20+ employees
LTC Facilities (2)
Nursing Home Care (Private/Semi)
- Residential, higher level than Assisted Living
- Personal care, health support, rehabilitation, medication, 24-hour
Assisted Living Facility (ALF)
-Residential, personal care, health support
LTC: Community
Adult Day Health Care
- Residential
- Socialization, structure, supervision
- May include medical management
LTC: Home
Home Health Aide Services
-Personal care, non-medical
Homemaker Services
- Household tasks & errand
- “hands-off” approach
What does Medicare pay for?
Skilled nursing care for a limited time following hospitalization
Days 1-20: $0 co-pay for each benefit period
Days 21-100: patient pays $194.5 coinsurance per day
Days 101+: Patient pays all costs
Long Term Care Insurance Features & Benefits
Benefit period - how long the policy will pay benefits
Elimination period - waiting period before benefits start
Daily benefit - max amount policy will reimburse for daily services
Riders - add-on features (inflation protection)
Waiver of premium - insured does not pay premiums while receiving benefits
Renewability - most are guaranteed renewable
Qualified LTCi Required Features
Benefits payable only for qualified LTC services
Contract must be guaranteed renewable
Contract does not pay or reimburse expenses reimbursed under Medicare
Contract does not provide for a cash surrender value
Policy dividends must be applied as a reduction in future premiums or increase future benefits
Limitations and exclusion are prohibited (except pre-existing within 6months of application)
Contract cannot provide for skilled nursing care only or require prior hospitalization
Contract must have 2 yr incontestable clause for misrepresentation
Qualified LTCi Tax benefits
Benefits are received tax-free
Premiums paid are a qualified medical expense for itemized deduction for medical expenses
Premiums can be paid from HSA
Premiums paid by ER are tax-free to EE and benefits remain tax-free
Qualified LTCi Benefit Triggers
2 of 6 ADLs 90+ days
Substantial cognitive impairment
ADLs
Bathing
Eating
Dressing
Continence
On/Off Toilet
Transferring
NOT: blindness or inability to walk
Partnership LTCi
Partnership between states and insurance companies for QLTCi
Provides add’l asset protection if LTCi benefit is exhausted and insured files for Medicaid
Total amount paid under LTCi is added to Medicaid spend-down limited and protected
Pooling Feature of LTCi
If the daily benefit is $300/day and the benefit period is 2 years, but the need is only $200/day, then the excess can be pooled and lengthen the benefit period
Disability Insurance Taxation
Who is paying the premium?
ER pays the premium & does not include as comp to EE > benefits are taxable
ER pays the premium & includes as comp to EE > benefits are tax-free
EE pays the premium with after-tax dollars > benefits are tax-free
EE pays the premium with pre-tax dollars > benefits are taxable
Types of Life Insurance
Term Life Insurance
Whole Life Insurance
Universal Life Insurance
Term Life Insurance
Lowest premium at issue
No cash value
May be participating (dividends)
May be renewable
May be convertible to permanent
Level Term: death benefit remains level over the guaranteed term, premiums increase upon expiration
Whole Life Insurance
Higher premium than term
Guaranteed death benefits
Builds cash value
Cash value accessible by loans or withdrawals
May be participating (dividends)
Universal Life
Most flexible
Option A- death benefit remains level
Option B- death benefit is face amount + cash value
Variable UL offers to pay random add’l amounts into the policy
Life Insurance Termination (non-forfeiture options)
Cash Surrender Value - ins company pays the cash value to the policy owner as a lump sum and end contract
Extended-term option - the policy owner uses the cash value to place the policy on extended term ins; serves as a single premium to pay for term life ins. The level of coverage is maintained, but maybe not for the life expectancy
Reduced paid-up Ins - cash value is used to buy a paid-up policy of the same type as the policy that lapsed. The new policy will have reduced death benefit but will retain a cash value that will grow at a reduced rate
Some ins company allow to convert the policy to an immediate single premium annuity that will pay out the rest of the life
An automatic premium loan allows the insurer to make a loan against the cash value for paying the overdue premiums, assuming the cash value is more than the amount due
Variable Life subaccounts
are not part of the insurance company’s general assets and are protected from the insurance company creditors
Modified Endowment Contracts
Curtails the use of single premium life insurance as a tax-free income investment
Policy becomes MEC if fails the 7-day test and changes the tax treatment of living distributions
7-pay test is applied at inception of policy and after any material changes
Fails 7-pay test if total premium paid exceeds the sum of the net level premium needed to result in a paid-up policy after 7 years
10% penalty will apply for any loans or distributions if taxpayer is under 59.5
Once a MEC, always a MEC
Viatical Settlements
Insured must be terminally or chronically ill
Viatical provider must provide 15 day cooling off period, which the viator can rescind policy
Payment to insured is not included in gross income if terminally ill or if used for long-term care for chronically ill
Viatical provider is taxed on the death benefit that exceeds basis. Basis= payment to insured + any premiums received