Definitions Flashcards
3 Types of Hazards?
Moral, Morale, Physical
Moral Hazard
Character Flaw, filing a false claim
Morale Hazard
Being careless b/c you have insurance
Physical Hazard
Tangible condition that increases chance of a peril occurring (icy road, poor lighting)
Adverse Selection
People w/ higher risks to buy or renew insurance policies. Managed through underwriting, denying insurance, or raising premiums
Requisite for Insurable Risk (6 of them)
- Large # of similar exposure units
- Losses must be accidental
- Losses must be measurable
- Losses must not pose catastrophic risk for insurer
- Insurer can’t give coverage that would cause it to become financially insolvent
- Premiums must be affordable
Elements of Valid Contract
- Legal competency of all parties
- Legal consideration (money, services, property)
- promise to pay (insurer) & payment of premium (insured) - Must have lawful purpose
Principle of Indemnity
Can’t profit from insurance contract
Subrogation Clause
Insurance company can sue person who injured you to recoup their loss
Participating Dividends options in Whole Life
CRAPO
- Cash
- Reduce future premium
- Accumulate @ interest
- Paid up permanent additions
- One - year term ins additions
HSA non-qualified Distribution Penalty & Age
- Income taxed and 20% penalty before 65
- Only income tax at 65 or older
Non-Cancelable Health Ins
- Guaranteeing insured can renew until specific age or stated # of years
- Premium is FIXED
- Continuous
Guaranteed Renewable Health Ins
- Right to renew is guaranteed
- Insurance company can adjust (increase) premiums
COBRA Eligibility
- Death of covered employee
- Voluntary/involuntary termination
- Reduction in hours to part time
- Separation of covered employee from spouse
- Employee eligible for Medicare
- Dependent child is no longer eligible for coverage (age, left school)
Employer may charge 2% for admin exp. (Total cost to employee is 102%)
When does employer have to offer COBRA?
- offer group health plan and have at lease 20 FT employees
(2 PT = 1 FT employee) - Employee has 60 days to make COBRA election
COBRA Employer Coverage for:
- 18 months = reduction in hours or normal termination
- 36 months for death, divorce, Medicare eligible
- 36 months for loss of dependency status by kids of employee
- 29 months if meets SS definition of disabled
Long Term Care Eligibility
- Chronically ill: can’t perform 2 of 6 ADL’s for at least 90 days
- Substantial cognitive impairment (Behavior threatens own/others health/safety
Activities of Daily Living
Eating
Bathing
Dressing
Transferring (from bed to chair, using toilet)
Continence
“BED To Chair”