Ch 4 Flashcards
Disability policy that cannot be canceled by the insurance company and the company cannot make any changes to the policy.
Non-cancelable
Disability policy that cannot be canceled by the insurer but the insurer can raise premiums.
Guaranteed tenewable.
Disability policy that allows insurer to cancel the policy if renewal conditions are not met.
Conditionally renewable.
What percentage of income does individual disability insurance pay?
60-80%
Is individual disability insurance purchased pre-tax? What is the treatment of the benefit?
Not pretax. Benefit tax-free.
If an employer pays for group disability, who gets tax deduction. What is tax treatment of benefit?
Employer gets tax break. Employee’s benefit is taxes. If employee contributes some it is pro-rated.
Does coordination of benefits under a group policy consider individual disability?
Most often it does not.
Social security definition of disability?
Unable to engage in any substantial gainful activity because of a physical or mental impairment. The impairment must be expected to last at least 12 months or result in death.
What is the monthly benefit amount under social security disability?
It is generally equal to the primary insurance amount.
How long is the waiting period under SD disability?
5 months.
How does traditional health insurance work?
Chose own provider
Get reimbursed after deductible paid
Usually provide basic coverage and major medical coverage
What is the downside to managed care plans?
Flexibility is reduced
This health plan contracts with providers to offer various services. It has a gatekeeper physician. Providers get paid a monthly fee.
HMO
Type of managed care plan which charges insurers an access fee for use of the network. It negotiates with healthcare providers to set fees for guaranteed service levels. Providers only get paid for services rendered.
EPO
Percentage of USA covered under governments disability insurance?
75%
Difference in payment to physicians EPO vs PPO.
HMO paid a fee regardless of services provided.
EPO only pays for services rendered.
Health plan that gives more coverage if you go outside the network. Also one of the most expensive plans. No gatekeeper.
PPO
What are a few pluses of a consumer-directed health plan?
Low premiums
Pretax health savings account
When does Medicare begin?
65
How do you qualify for Medicare?
Must work 10 years
What are the 4 parts of Medicare?
A: hospital coverage (in-hospital services, hospice). Does NOT pay for custodial care.
B: medical insurance coverage (necessary non-hospital services
C: managed care version of Medicare (Medicare advantage)
D: prescription drug coverage
Who pays for Medicare A?
Payroll taxes
Who pays for Medicare part b?
Monthly premium paid by beneficiaries. Can get state assistance if the person has limited income or resources.
When does someone have to enroll in Medicare Part B?
3 months before turning 65. You have 7 months to enroll.
