Insurance

Question 1

What are the 2012 Health Savings Account (HSA) limits for:

1) maximum contribution,
2) maximum out-of-pocket, and
3) minimum deductible?

Answer 1

1) single $3,100 ($1k catchup @ 55)
family $6,250

2) single $6,050, family $12,100
3) single $1,200, family $2,400

Question 2

How are non-qualified distributions from HSA treated?

Answer 2

Ordinary income plus 20% penalty unless attained age of 65, disabled, or died

Question 3

Who is exempt from COBRA? (3)

Answer 3

• government
• churches
• small companies with fewer than 20 full-time employees (2 part-time = 1 full-time)

Question 4

What are the rules of risk management? (3)

Answer 4

1) don’t risk more than you can afford to lose
2) consider the odds
3) don’t risk a lot for a little

Question 5

Hazard

Answer 5

Condition that increases the probability of loss

Question 6

Peril

Answer 6

The cause or reason for loss (ie, fire)

Question 7

Risk

Answer 7

The potential for loss

Question 8

What are the components of a legal insurance contract? (5)

Answer 8

1) offer and acceptance
2) consideration
3) legal object
4) competent parties
5) legal form

Question 9

What are the special characteristics of insurance contracts? (7)

Answer 9

1) aleatory
2) adhesion
3) conditional
4) personal
5) unilateral
6) utmost good faith
7) contract of indemnity

Question 10

Aleatory

Answer 10

Subject to chance and involves unequal dollars

Question 11

Adhesion

Answer 11

if you wrote it, you are stuck with it

Question 12

What is the difference between “negligence” and “negligence per se?”

Answer 12

“Per se” is against a specific group

Question 13

Res ispa loquitur

Answer 13

“The thing speaks for itself” (plaintiff did NOT contribute to the accident

Question 14

Doctrine of waiver

Answer 14

Party gives up a right

Question 15

Doctrine of estoppel

Answer 15

Party is prevented from asserting a right that was previously misstated or given away

Question 16

Staff model HMO

Answer 16

Corp owns everything…equipment, staff, doctors

Question 16

Group Practice HMO

Answer 16

Doctors contracted and work in the HMO facility

Question 16

IPA HMO

Answer 16

Different practices join together to form HMO

Question 16

HSA minimum deductible for 2012

Answer 16

SGL 1,200

FAM 2,400

Question 16

HSA max out of pocket for 2012

Answer 16

SGL 6,050

FAM 12,100

Question 16

HSA max contribution of 2012

Answer 16

SGL 3,100

FAM 6,250

Question 22

Adjuster’s duties

Answer 22

• investigate loss
• determine liability
• determine payment amount
• be fair

Question 23

Parole evidence rule

Answer 23

Written overrules verbal

Question 24

Elements of an insurability risk

Answer 24

• law of large numbers
• definite and measurable loss
• accidental
• loss not catastrophic to insurER

Question 25

Methods of handling risk

Answer 25

``` Avoidance Reduction Retention Transfer Sharing ```

Question 26

What is a family income policy?

Answer 26

Provides decedent's family with income for a period of time usually build with permanent insurance with a decreasing term

Question 27

What is the 5th dividend option?

Answer 27

When policy dividends are used to buy 1 year term policy at attained age

Question 28

Premium for Medicare Part A

Answer 28

30-39 quarters, $248/mo | <30, $451

Question 29

Deductible for Medicare Part A

Answer 29

$1,156 per spell

Question 30

Medicare Part A coinsurance amount

Answer 30

0 for 60 days (per spell) $289 for days 61-90 $512 for 90-150-the 60 lifetime reserve days

Question 31

Medicare Part A maximum stay

Answer 31

150 days per single cause stay

Question 32

Medicare Part B premium

Answer 32

Sliding scale based on income SGL/JNT 85/170-$99.90/mo. Indexed to 213k@ $319/mo.

Question 33

Medicare Part B deductible

Answer 33

ANNUAL $140

Question 34

Medicare Part B coinsurance amount

Answer 34

20%

Question 35

Medicare Part D deductible

Answer 35

$320 annual deductible 25% copayment on next $2930 Donut hole for next $3,647.50 5% coinsurance after donut hole

Question 36

Medicare Medical Savings Account requirements

Answer 36

``` Medicare Advantage (Part C) HDHP with max deductible @ $10,500 ```

Question 37

Capitation

Answer 37

The annual fee paid to a healthcare provider per subscriber to the HCP

Question 38

Split definition disability

Answer 38

Insured must be unable to perform own occupation for stated period, then changes to any occ or modified any occ

Question 39

Presumptive disability

Answer 39

Loss of sight Loss of hearing/speech Loss of 2 limbs

Question 40

Noncancelable

Answer 40

Premiums guaranteed for contract period

Question 41

Medicare LTC coverage

Answer 41

3 days as an admitted patient Enter Medicare approved facility within 30 days Expected to recover 20 days fully covered 21-100 with $144.50 daily deductible

Question 42

Medicaid LTC coverage

Answer 42

Medically certified as needing care | Impoverished

Question 43

Basic HO coverages

Answer 43

Fire, lightning, theft, & WC SHAFER ``` Wind Civil disorder Smoke Hail Aircraft Vandalism Explosion Riot ```

Question 44

Broad HO coverage

Answer 44

``` Basic plus Volcano Power surge Frozen plumbing Hot water, a/c Plumbing discharge Building collapse Falling objects ```

Question 45

Structure of a HO policy

Answer 45

``` Section I: A - dwelling B - other structures C - personal prop D - loss of use ``` Section II: E - comprehensive liability F - medical payments, damage to others

Question 46

HO 2

Answer 46

A - broad B - broad C - broad D - 20% of A

Question 47

HO 3

Answer 47

A - open B - open C - broad D - 20% of A

Question 48

HO 4

Answer 48

Renter's insurance A - none B - none C - broad D - 20% of C

Question 49

HO 5

Answer 49

Comprehensive form A - open B - open C - open D - 30% of A

Question 50

HO 6

Answer 50

Condo insurance A - min B - incl. in A C - broad D - 40% of C

Question 51

HO 8

Answer 51

Historic buildings A - basic B - basic C - basic D - 10% of A

Question 52

HO 15

Answer 52

Added to HO 3 to increase C overage to open

Question 53

Max coverage calc

Answer 53

[(Have/reqr'd)*loss]- deductible

Question 54

Occurrence based professional liability insurance.

Answer 54

Policy in force at time of event pays Seen more with manufacturing industry

Question 55

Claims-made based professional liability insurance

Answer 55

Policy currently in force pays This is typical in most E&O policies in the service industry

Question 56

Subrogation

Answer 56

The insured cannot make a profit