Exam 2 Flashcards
how was worker’s comp in the last half of the 19th century
employees could sue for injuries
long process and worker were often not paid much
employers sometimes paid huge amounts
1913 California passed worker’s comp act called…
Boynton
The system for “compensation bargaining” (Boynton Act) allowed for
seed for todays worker comp system
eliminated lawsuits to resolve worker comp
employees received timely benefits
requirements for benefits to be paid for worker’s compensation
must be evidence based medical treatment
must be through an approved medical provider network
Utilization review required
treatment denials can be appealed
Benefits paid for temporary Disability are:
2/3 of gross pay
ranges from $169.26 to $1128.43 per week
requirement and limit for temporary disability (worker’s comp)
must be absent at least for three days
maximum of 104 weeks of benefits in a 5 year period
how are worker’s comp benefits determined for permanent disibility
Your disability rating (it is a %)
Date of injury
wages before you were injured
ranges from $160 to $260
amount of money paid out to death benefits (worker’s compensation)
$10,000 for burial benefit
there are no worker’s comp benefits for
pain suffering
Punitive damages
Employer Negligence (exception must prove employer is grossly negligent)
Employer’s worker’s comp responsibilities
must obtain worker’s comp at no cost to employee
or be self-insured (requires approval)
display worker’s comp poster
consequences for employer not having worker’s comp insurance:
must pay all of the employee’s medical bills
they can be sued for torts
criminal offense: fine of up to $10,000 and one year in jail
Civil fines up to $100,000
employer’s responsibility when an employee mentions an injury
provide the employee with a claim form within one day
complete employer’s report of occupational injury
return complete claim form to employee
send claim form and employers report to claims administrator
accept or deny claim within 90 days
employer must compensate injured employee by authorizing $ and transitional work toward
$10,000 (within 1 day of receipt of claim form)
light duty
common problems for worker compensation, coming from employer
under-reporting payroll
claiming employees as independent contractors
overstating employee experience
not obtaining worker’s comp insurance
examples of employee fraud in worker’s comp
injury was not related to work
exaggerated injuries
fake injuries
pre-existing injuries
FUTA and SUTA stand for
Federal Unemployment Tax Act
State Unemployment Tax Act
Who pays for FUTA and SUTA
Employer
Paying for FUTA is for
Federal administration (Federal Government monitoring the states)
Paying for SUTA is for
administration and benefits for state programs
Criteria for a “covered employer” under FUTA
EITHER
Pay wages of $1500 in any quarter
employs 1 or more people in each of 20 weeks in a row (in current or previous year)
Coverage under California SUTA required for employer
if employer pays as little as $100
examples of what UI pays out
Salaries, wages, Bonuses, Commissions,
not reimbursements or for independent contractors
How are SUTA taxes rates determined?
Experience Rated (if employer costs more UI then they get a higher rate)
California SUTA rates range from
1.5%-6.2%
This is on the first $7000 of wages for each employee
SUTA tax for new employers
3.4%
what are the two FUTA tax rates
GROSS FUTA tax rate
NET FUTA tax rate
What is gross FUTA tax rate
6% of the first $7000
What is the NET FUTA tax rate
it is the amount actually paid out by employers
how is the NET tax rate determined?
reducing the gross FUTA tax rate by two credits
what are the two credits when determining NET tax rate
credit for paying SUTA tax on time
the additional tax credit is whatever is needed to get the total tax credit to 5.4%
reasons why an employer can pay more than 0.06% in NET FUTA tax
The employer did not pay the SUTA tax on time
Employer is in a “Credit Reduction” state
penalty for not paying SUTA tax on time
The SUTA tax credit is only worth 90% of the amount paid to the state
(additional credit is not increased to offset this loss)
what happens if State UI funds run out of money
Title XII (12) Advance State borrows money but employers must pay more FUTA in order to pay back the loan (Within 1 year)
what happens for every year the TITLE XII is not paid back
the FUTA tax Rate increases 0.3%
California is expected to fully repay Title XII in what year?
2017
What is the leading cause of bankruptcy?
not having health insurance
tools for designing the right health plan for diverse groups
Flexible Spending Accounts
Cafeteria Plans
Health Savings Accounts (accumulates tax free)
what are Postpaid plans in health insurance?
paid AFTER care provided
Ex. Fee for service and indemnity plans
What are Prepaid plans in health insurance?
paid BEFORE care provided
Ex. HMO and PPO
what is prospective pricing?
a predetermined price
what is channeling in health care?
technique to move patients and employees to certain places ex. Kaiser patients must go to Kaiser
utilization review in health care is
it uses a utilization group within the department and they must give approval for the care or surgery before it takes place.
cost sharing in health plans
employee and employer share costs of with premiums, deductibles, and copayments
Process of plan design and maintenance of health plans
Design the best plan for the work group
Determine plan financing
Inform and educate employees
administer the plan
what are tiered rate structures
charging depending on the size of your family
what is COBRA
it continues healthcare after termination but allows only 18 months to stay on (29 months if disabled)
how much does employee pay for COBRA?
102% of employer’s cost
2% is for administrative fees
Penalty violation for COBRA
$100 per day per employee
how to finance retire healthcare continuation
Pay as you go
increase pension benefit
Incidental pension benefit
Voluntary Employees’s Benefit Association (similar to 401k)
types of medical plans
Basic Plan (similar to part A of medicare)
Prescription plans (similar to part D of medicare)
Major medical (similar to par B of medicare)
Catastrophic plans (high deductible plans)
Comprehensive plans (one plan that covers all of the above)
How do Fee for service/ Indemnity plans work? (how they use to be)
choose any care provider you want
annual deductible $500-$5000
after deductible you pay part of the bill
(very expensive)
How do PPOs work
Choose any provider but encouraged to choose “preferred providers”
with “preferred provider’ you pay 10% or small copayment
different care provider you pay 30% after deductible
Health Maintenance Organizations info
these are are capitations
use network providers
co-payment $15-$50
always includes manage care (need for pre approvals)
