Health and Accident

Question 1

business overhead expense insurance

Answer 1

designed to help day to day expenses in the event the business owner becomes disabled; includes rent and utilities
TAX-DEDUCTABLE

Question 2

disability buy-sell

Answer 2

assists in the sell of the business in the event of a disability of the business owner; TAX-FREE because premiums are NOT TAX DEDUCTABLE

Question 3

key person disability insurance

Answer 3

pays for expenses for additional help when a key person becomes disabled; TAX-FREE

Question 4

multiple employer welfare arrangement

Answer 4

gives to small, non-affiliated members

Question 5

multiple employer welfare arrangement

Answer 5

gives to small, non-affiliated members

Question 6

health maintenance organization

Answer 6

prepaid health services to subscribing members;
delivers said services using their own facilities;
subscribers pay a fixed fee;
only use their doctors and services;
payment for these doctors are called CAPITATION;
CLOSED PANEL: salaried doctors providing services outside of HMO facilities
OPEN PANEL; doctors providing services in their own facilities who work HMO on a part time basis;
stresses PREVENTATIVE CARE;
group of 25 or more employees

Question 7

preferred provider organization

Answer 7

offer services to a certain group at PREARRANGED DISCOUNT PRICES;
unlike HMO, PPO:
1. has a fee for service rendered basis
2. wider choice of physicians
3.

Question 8

service providers

Answer 8

offers benefits (services) to subscribers in return of payment of premium, i.e. blue cross blue shield

Question 9

medicare

Answer 9

for people: 65+, people with chronic kidney disease, people with disability 24 months+

Question 10

Medicare Part A

Answer 10

i.e. HOSPITALIZATION; inpatient care, nursing facilities, care provided in hospice and some homes

Question 11

Medicare Part B

Answer 11

i.e. DOCTOR SERVICES

Question 12

Medicare Part D

Answer 12

drug coverage; MUST have A or B in addition

Question 13

SSDI

Answer 13

must be completely disabled in order to not attend gainful work, and expected to remain as such for 12 months or die in 12 months;
40 credits needed and 5 month waiting period until you can receive SSDI

Question 14

Medicaid

Answer 14

low income who are blind, disabled, or under 21;

benefits may be applied to medicare deductibles and co-payment requirements

Question 15

workers compensation benefits

Answer 15

lost wages and medical expenses due to occupational accidents

Question 16

501(c)(9)

Answer 16

a trust from which benefits are paid from a multiple employer trust

Question 17

501(c)(9)

Answer 17

a trust from which benefits are paid from a multiple employer trust

Question 18

total disability considers the person’s:

Answer 18

training, education, and experience

Question 19

rehabilitation benefit

Answer 19

insured cannot return to original occupation but can work, and rehab needed to return to this new occupation is paid by insurer

Question 20

probationary period vs. elimination period

Answer 20

probationary: begins at time of policy
elimination: begins at time of disability

Question 21

probationary period vs. elimination period

Answer 21

probationary: begins at time of policy
elimination: begins at time of disability

Question 22

hospital expense policies

Answer 22

covers room and board, misc expenses such as xrays so as long as you are in the hospital;
no deductible, limited dollar amount per day

Question 23

basic surgical expense coverage

Answer 23

covers all surgeon’s fees;

1. surgical approach: dollar amount assigned by surgeon
2. reasonable and customary approach: dollar amount according to goegraphical location

Question 24

basic physician expense coverage

Answer 24

coverage for limit of time, such as maternity benefits, outpatient care, ect

Question 25

major medical expense plans

Answer 25

broad coverage under 1 policy, covers what basic medical expense does, except it has deductibles, coinsurance requirements, and large benefit max

Question 26

comprehensive major medical

Answer 26

basic expense coverage and major medical coverage all in 1 policy; include deductible, coninsurance, and sold on group basis

Question 27

deductible

Answer 27

stated dollar amount insured is required to pay before insurance benefits are paid

Question 28

coinsurance

Answer 28

after deductible is met, both insured and insurer share remaining expenses

Question 29

stop-loss

Answer 29

limit the amount of expense the insured is exposed to within a given year; after you pay a specific amount of expense, the insurer will cover 100% of remaining expense

Question 30

health savings account

Answer 30

not subject to taxes, for plans with high deductibles, not covered under other plans, not eligible for medicare, and cannot be claimed by someone’s taxes; are tax deductible; use it to pay for out of pocket medical expenses

Question 31

health reimbursement arrangements

Answer 31

established by employer only; reimburses for out of pocket medical expenses