Chap 5 Cont 7 Flashcards
Optional benefits with long term care policies
Included in all policies
Available for additional premium
Only standard benefits are available with LTC policies
Available for an additional premium
Not an activity of daily living ADL
Dressing
Bathing
Talking
Eating
Talking
Regarding optional benefits with long term care policies
All included in all policies
Available for additional premium
Only standard benefits are available with LTC policies
Available for an additional premium
Longterm care covers three levels of care:
Skilled nursing, intermediate care custodial care
Home care home convalescent residential
Adult day care respite care adhesion care
Intermediate care custodial care skilled nursing care
Daily nursing and rehabilitative care only provided by medical personnel under direction of physician
Intermediate care
Skilled care
Custodial care
Skilled care
Care that can be given by nonprofessional staff is not considered
Skilled care
Occasional nursing or rehabilitative care provided for stable conditions that require daily medical assistance on a less frequent basis than skilled nursing care/ordered by physician and skilled personallel would deliver or monitor type of care
Intermediate care
Skilled care
Custodial care
Intermediate care
Could be as simple as medication to a group or changing bandage
Home health care
Residential care
Custodial care
Intermediate care
Intermediate care
Care for meeting personal needs such as assistance in eating, dressing, or bathing
Respite care
Custodial care
Intermediate care
Custodial care
Provided by a skilled nursing or other professional services in ones home/occasional visits to person’s home by registered nurses or community based orgs like hospice
Adult day care
Residential care
Home health care
Home health care
Provided in insureds home under a planned program established by the insureds attending physician by long term care facility home health care agency or hospital
Adult day care
Respite care
Home convalescent care
Home convalescent care
Provided while insured resides in a retirement community or residential care facility for elderly RCFE with some degree of independences (possibly) same as living in one[‘s own home
Bc of costs for middle and upper classes
Adult day care
Respite care
Residential care
Residential care
Provided for functionally impaired adults on less than 24 hour basis. Could be by neighborhood recreation or community center …includes transportation to and from day care center and activities/meals usually included
Respite care
Consideration
Home health care
Adult day care
Adult day care
Designed to provide relief to family caregiver and can include services such as someone coming over during nap for caregiver
Respite care
Consideration
Aleatory
Asset
Respite care
In longterm care ins what is provided with intermediate care
Intensive care
Occasional nursing or rehab care
Non medical daily care
Occasional nursing or rehabilitative care
Occasional visits where following with NOT be covered under LTC home health care
Nurses
Licenses practical nurses
Attending physician
Attending physician
Not covered under long term care policy
Hospice care
Home health care
Acute care in hospital
Acute care in hospital
Who can provide skilled nursing care
Spouse
Doctor
Family member
Doctor
Which location would skilled care be provided
Patients home
Outpatient setting
Institutional setting
Institutional setting under direction of physician
Functionally impaired adults on a less than 24 hour basis coverage
Adult day care
Residential care
Assured living
Adult day care
Skilled nursing intermediate and custodial care may all be provided in an intituational setting true or false
True
Not provided in institutional setting
Skilled nursing
Intermediate care
Home health care
Custodial care
Home health
Can group formed for sole purpose of obtaining group ins qualify for group coverage
Yes any group scan apply for group coverage
Yes but only if group is over 35 ppl
No group must be formed for purpose other than obtaining group insurance
No group must be formed for purpose other than obtaining grou insurance
Association could buy grou ins for its members if it meets all of following except
Has at least 50 members
Has constitution and by laws
Holds annual meetings
Is contributory
Has at least 50 members
Must have at least 100
Less than 100 hours=adult daycare
Underwriting a group health ins plan that is paid for by employer requires all except
Eligible employees must be covered
Coverage for plan Ppts is uniform
Individual members of group may select level of benefits fo their own coverage
Individual members of group may select the level of benefits for their own coverage
Group health ins means all individual are covered under
Contract
Bill
Asset
Master policy
Master policy for same coverages
Not characteristic of group health ins
Policy is issued to each insured individual
Dependents of insureds can be covered under group health plans
Group coverage may be converted to individual coverage if group contact is ended
Policy is issued to each insured individual
Small company offers grou health ins to its employees but recently has decided to terminate the health ins contract leaving the workers without ins
Request a refund of unearned premium
Convert to individual health policy
Sue employer
Convert to an individual health policy
Which concerning group health ins is correct
Only employer receives a certificate of ins
Each employee receives a policy
Employer ithe policyholder
Employer is the policy holder
Employer receives master policy and each employee receives
Executive contract
Policy
Group ins
Certificate of ins
Employee receives certificate of ins
Which statement is NOT true regarding underwriting group health insurance
Premiums are reassessed annually
Everyone is covered regardless of medical history
Group is assessed individually for insurability
Assessed individually for insurability
Following are differences between individual and group health insurance EXCEPT
Individual can be written on an occupational or non occupational basis; grou plans cover only non occupational
Individual policies are renewable at the option of the insured while group usually terminate when the individual leaves the group
Individual ins does not require medical examination while group ins does not require medical examinations
Individual ins does not require medical exams while group ins does require medical exams
Group health ins is characterized by all of the following except
Lower admin costs
Conversion privilege
Adverse selection
A master contract
Adverse selection
What is the period of coverage for events such as death or divorce under cobra
12 months
36 months
60 days
31 days
36 months
Which is NOT correct re cobra act of 1985
Cobra stands for consolidated omnibus reconciliation act
Requires all employers regardless of number or age of employees to provide extended group health coverage
Covers termed employees and/or their dependents for up to 36 months after qualifying event
Requires all employers regardless of number of age of employees to provide extended group health coverage
Cobra act applies to only employers with
5
10
15
20
20 or more employees
Re group health ins cobra stipulates that
Group coverage must be extended for terminated employees up to certain period of time at employer’s expense
Group coverage must be extended for terminated employees up to a certain period of time at former employee’s expense
Retiring employees must be allowed to convert their group coverage to individual policies
Group coverage must be extended for terminated employees up to a certain period of time at the former employee’s expense
Cobra requires employers with twenty or more employees to continue group medical ins for termed workers and dependents for up to 18 to 36 months. Employee can be required to pay up to
5%
4%
102%
100%
of coverage’s premium
102%
