CFP - Health Insurance Flashcards
For health plans issued after September 2010, what has been eliminated?
The lifetime limits cap on new health policies
What does 80/20 coinsurance mean?
Insurer pays 80% of the expenses above the deductible and the insured pays 20% of expenses above the deductible
*typically a maximum of 3 deductibles per family
*Coinsurance portion applies to each family member
Patient Protection and Affordable Care Act (PPACA) did what?
Requires most U.S. citizens and legal residents to have health insurance
*those w/o coverage pay a tax penalty of $695 - $2085
OR
2.5% of household income above the filing threshold,
WHICHEVER IS GREATER
EXCHANGE FOR: income 133-400% of the federal poverty level
Employer with 50+ assessed $2000/per FTE fee
What is an HMO? (Health Maintenance Organization)
(also known as the NETWORK MODEL)
-Comprehensive health care in return for premium
-Disadvantage: No coverage outside HMO
What is a PPO? (Preferred Provider Organization)
-Network of health care providers with who an employer or insurance company contracts
-Provider offers a discount on services
-Insured receives a high rate of reimbursement in network
-Ability to chose outside of network if desired
What is Managed Care? (Primary Care Physician - PCP)
Physician provides referrals
Small copayment/deductible
What is an HSA? (Health Savings Account)
Provide employees/individuals seeking a health care tax deduction for amounts contributed to their accounts as well as use of the money and
earnings tax-free for qualifying medical expenses
Employer/Employee can both make contributions
Individual must have a high deductible
What disqualifies eligibility for an HSA?
-covered by a non HDHP
-FSA/HRAs can disqualify
-Medicare participation disqualifies
-Dependents are disqualified
Age for catch-up contributions to an HSA?
55 and older
HSA contribution limits
Single $3850
Family $7750
Are HSA contributions deductible for the employee? Employer?
Yes and Yes
Do OTC drugs qualify for HSA?
yes
Do health insurance premiums qualify for HSA?
No unless:
LTC premium
COBRA premium
Health care coverage while receiving unemployment
Medicare and other health coverage if 65+
Dental care
Vision
Penalty for non-qualified medical expenses
Subject to income tax
and
20% penalty if taken before 65
Characteristics of a Guaranteed Renewable Policy?
Right to renew is guaranteed until a specific age
-Can’t cancel, but can raise premiums
ALL policies must be guaranteed renewable under PPACA
Is group health insurance taxable to the employee?
NO
Health Insurance Portability and Accountability Act
HIPAA - obtain health insurance when changing jobs, laid off
No restrictions on preexisting conditions if switching from one group plan to another group plan
12 month exclusion window
COBRA coverage rules
Employer may charge 2% for administrative expenses
Applies to loss of coverage for covered employee (death, termination, covered employee separates from spouse, eligible for Medicare, dependent child no longer eligible)
COBRA applies 20+ employees
COBRA coverage specific periods of time
18 months: reduction in hours / termination
36 months: death, divorce, Medicare eligibility, loss of dependency status
Up to 29 months if employee meets SS definition of disabled
How many days do employees have to make a COBRA election?
60 days
MEDICAID is for
Nation’s poor
state or federal or combo of the 2
ACA expanded Medicaid coverage
MEDICAID penalty period
Based on the amount of gifted assets in the 5 years / 60 months prior to entering a nursing home
Does Medicare pay of the patient is incapable of realizing an improvement in his/her condition?
NO
Private Long-Term Care Policy
Provides coverage for nursing home stays and other types of care
1 Skilled Nursing
2 Intermediate Nursing
3 Custodial Care
4 Home Health Care
5 Assisted Living
6 Adult Day Care
7 Hospice Care
