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Insurance CFP > Health Insurance > Flashcards

Health Insurance Flashcards

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1
Q

Hospital Insurance

A

-expense reimbursement or service contract

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2
Q

Hospital insurance expense reimbursement

A
  • pays for all or parts of the hospital stay
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3
Q

Hospital insurance service contract pays for what (time period)

A

-pays for a specific number of days

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4
Q

Surgical Expense

A

-reimbursement contract
-schedule of payment based on surgery type
-customary payment unless procedure is not customary then pays more

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5
Q

Health Maintenance Organization

A

-comprehensive & lower cost to insured
-contracted physicians and facilities are employee of HMO
-pre-set costs
-see primary doc first before specialists

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6
Q

Physicians expense health ins.

A

nonsurgical physician expenses

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7
Q

Preferred Provider Organization

A
  • like HMO but can receive care outside of network
    -out of network causes higher deductibles
    -Docs not employees - negotiate prices for increased patient count
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8
Q

Deductible

A

-stated dollar amount per family member per each visit or procedure
-overall max $ per calendar year

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9
Q

Coinsurance

A

-copayment in addition to deductible
-percentage of costs for service that the insured pays over the deductible

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10
Q

Stop loss

A

amount that includes the deductible and coinsurance

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11
Q

Coordination of benefits provision

A

-2 policies covering the same insured
-after first policy pays, 2nd policy pays the difference
-married couple person w/earlier birthday in the year

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12
Q

COBRA

A

-keep your insurance at the group rate after a qualifying event
-employee, spouse, child, who was on the plan day before qualifying event

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13
Q

Can you get COBRA if you quit or are fired?

A

Yes - as long as you weren’t fired for gross misconduct

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14
Q

Can a child get COBRA once they’re not a dependent?

A

yes child ceasing to be a dependent is a qualifying event

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15
Q

COBRA Qualifiers

A
  • if your hours are reduced
    -qualify for medicare
    -death of covered employee
    -termination, retiring, quitting (not gross misconduct)
    -divorce or legal separation
    -child ceases as dependent
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16
Q

How long can you get COBRA after death, divorce or medicare

A

36 months

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17
Q

How long can you get COBRA if you’re fired or have reduction in hours

A

18 months

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18
Q

How long can you get COBRA if you meet disability requirements?

A

29 months

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19
Q

How long do you have to notify your employer after a qualifying event?

A

60 days

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20
Q

When does COBRA election period start?

A

The day of the qualifying event

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21
Q

Max percent charge for COBRA

A

102% of regular coverage for employee - 2% is for employer admin costs

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22
Q

Can beneficiaries pay COBRA premiums in installments?

A

Yes and you get a 30 day grace period on each installment

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23
Q

Medigap

A

medicare supplement insurance - fills in gaps after medicare is exhausted

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24
Q

Part A hospitalization benefits

A

-Lifetime reserve of 60 days
-1 time deductible for hospital stays 60 days or less
-61-150 days = co payment or cost sharing

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25
Q

Medicare Blood Payment

A

payment for first 3 pints of blood each year

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26
Q

Medicare Part A Benefits

A

-hospital services up to 90 days in each benefit period
-period ends when out of hospital for 60 consec days
- lifetime reserve of 60 addtl days to those who exhausted 90 days

27
Q

Under Part A - what resource do you have if you don’t require continuous hospitalization?

A

-skilled nursing care
-physician must certify condition occurred within past 30 days
-prior hospitalization must have last at least 3 days

28
Q

When does a new benefit period begin under part A?

A

-After you’ve been out of the hospital for 60 consecutive days
-upon subsequent hospitalization you have to pay the deductible again

29
Q

When would you pay a Part A premium

A

only required for a person or spouse who doesn’t have 40 quarters of qualified employment

30
Q

When would you pay a Medicare part A premium?

A

When you have less than 40 quarters of qualified employment

31
Q

How much would you pay for part A if you had between 30-39 quarters of medicare qualified employment?

A

$278 a month in 2023

32
Q

What is the max hospital services days part A will pay in 1 benefit period?

A

90 days

33
Q

What can you get under part A if you no longer require continuous hospital care?

A

Skilled nursing care

34
Q

To qualify for skilled nursing care after a hospital stay under Part A

A

-prior stay must have been at least 3 days
-physician must certify that nursing or rehab is required for a condition treated in previous 30 days

35
Q

How long is skilled nursing fully paid for by Part A

A

Benefits paid in full for 20 days of skilled nursing

36
Q

Medicare Part D covers what

A

Drugs - D for Drugs

37
Q

How would you pay for days 21-100 of Skilled Nursing under Part A

A

Copay

38
Q

When does Medicare stop paying for skilled nursing under part A?

A

After 100 days

39
Q

Should skilled nursing under Part A substitute for LTC coverage?

A

No

40
Q

How many home health visits are covered under Part A?

A

100 during an illness that requires home health care - hospital stay need not preceed the care

41
Q

How much would your copay be for home health equipment under Part A?

A

20% copayment for oxygen tanks, hospital bed, dialysis, iron lung

42
Q

How can you qualify for hospice under part A?

A

certified as terminally Ill - life expectancy of 6 months or less - can get 210 days of care

43
Q

What is the max hospice days under Part A?

A

210 - unless you’re recertified as terminally ill

44
Q

What does part B cover

A

physicians services, home health services not requiring hospital stay, diagnostic test, medical equipment, all outpatient services of a hospital

45
Q

Do you pay a deductible for Part B?

A

Yes, AFTER THAT 80% of the services are covered and you pay for the remaining 20%

46
Q

Which Part would x-ray and pathology services fall under?

A

Part B

47
Q

How much of the cost will Part B pay for X ray and pathology services

A

100%

48
Q

Does Part D Cover brand name?

A

yes - generic and brand name

49
Q

Do you have a premium on Part D?

A

Yes monthly

50
Q

What is not covered under part A?

A

Custodial care, cosmetic surgery, private rooms, televisions

51
Q

Who is eligible for Part D?

A

everyone covered under medicare regardless of income, health status etc.

52
Q

What type of payments would you make under part D?

A

cost of prescriptions, deductible, and/or coinsurance

53
Q

Can you pay more for better coverage under part D?

A

Yes - some plans offer more coverage and and additional drugs for a higher premium

54
Q

Benefits NOT covered under part B

A

cosmetic surgery, glasses, dental care, routine foot care, orthopedic shoes, hearing exams, eye exams

55
Q

In a PPO plan, who selects the doctor?

A

The patient

56
Q

Is there a copay with PPO?

A

Yes

57
Q

How many months must you be on social security disability before you can get medicare?

A

24 months

58
Q

If you’re eligible for social security disability and have ALS can you get medicare?

A

Yes

59
Q

If you’re on dialysis and have end stage renal failure what coverage can you get?

A

Medicare

60
Q

Does part A cover diagnostic tests?

A

No

61
Q

Will the premium schedule ever change in a non cancellable policy?

A

Not unless the policy owner purchases additonal coverage in the future

62
Q

Who funds a health reimbursement program?

A

The employer

63
Q

Who can fund an HSA?

A

Employee and employer

64
Q

Does first dollar coverage require out of pocket expenses?

A

No

Insurance CFP (14 decks)

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