Insurance Flashcards
What are the 2012 Health Savings Account (HSA) limits for:
1) maximum contribution,
2) maximum out-of-pocket, and
3) minimum deductible?
1) single $3,100 ($1k catchup @ 55)
family $6,250
2) single $6,050, family $12,100
3) single $1,200, family $2,400
How are non-qualified distributions from HSA treated?
Ordinary income plus 20% penalty unless attained age of 65, disabled, or died
Who is exempt from COBRA? (3)
- government
- churches
- small companies with fewer than 20 full-time employees (2 part-time = 1 full-time)
What are the rules of risk management? (3)
1) don’t risk more than you can afford to lose
2) consider the odds
3) don’t risk a lot for a little
Hazard
Condition that increases the probability of loss
Peril
The cause or reason for loss (ie, fire)
Risk
The potential for loss
What are the components of a legal insurance contract? (5)
1) offer and acceptance
2) consideration
3) legal object
4) competent parties
5) legal form
What are the special characteristics of insurance contracts? (7)
1) aleatory
2) adhesion
3) conditional
4) personal
5) unilateral
6) utmost good faith
7) contract of indemnity
Aleatory
Subject to chance and involves unequal dollars
Adhesion
if you wrote it, you are stuck with it
What is the difference between “negligence” and “negligence per se?”
“Per se” is against a specific group
Res ispa loquitur
“The thing speaks for itself” (plaintiff did NOT contribute to the accident
Doctrine of waiver
Party gives up a right
Doctrine of estoppel
Party is prevented from asserting a right that was previously misstated or given away
Staff model HMO
Corp owns everything…equipment, staff, doctors
Group Practice HMO
Doctors contracted and work in the HMO facility
IPA HMO
Different practices join together to form HMO
HSA minimum deductible for 2012
SGL 1,200
FAM 2,400
HSA max out of pocket for 2012
SGL 6,050
FAM 12,100
HSA max contribution of 2012
SGL 3,100
FAM 6,250
Adjuster’s duties
- investigate loss
- determine liability
- determine payment amount
- be fair
Parole evidence rule
Written overrules verbal
Elements of an insurability risk
- law of large numbers
- definite and measurable loss
- accidental
- loss not catastrophic to insurER
Methods of handling risk
Avoidance Reduction Retention Transfer Sharing
What is a family income policy?
Provides decedent’s family with income for a period of time usually build with permanent insurance with a decreasing term
What is the 5th dividend option?
When policy dividends are used to buy 1 year term policy at attained age
Premium for Medicare Part A
30-39 quarters, $248/mo
<30, $451
Deductible for Medicare Part A
$1,156 per spell
Medicare Part A coinsurance amount
0 for 60 days (per spell)
$289 for days 61-90
$512 for 90-150-the 60 lifetime reserve days
Medicare Part A maximum stay
150 days per single cause stay
Medicare Part B premium
Sliding scale based on income
SGL/JNT 85/170-$99.90/mo.
Indexed to 213k@ $319/mo.
Medicare Part B deductible
ANNUAL $140
Medicare Part B coinsurance amount
20%
Medicare Part D deductible
$320 annual deductible
25% copayment on next $2930
Donut hole for next $3,647.50
5% coinsurance after donut hole
Medicare Medical Savings Account requirements
Medicare Advantage (Part C) HDHP with max deductible @ $10,500
Capitation
The annual fee paid to a healthcare provider per subscriber to the HCP
Split definition disability
Insured must be unable to perform own occupation for stated period, then changes to any occ or modified any occ
Presumptive disability
Loss of sight
Loss of hearing/speech
Loss of 2 limbs
Noncancelable
Premiums guaranteed for contract period
Medicare LTC coverage
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
Medicaid LTC coverage
Medically certified as needing care
Impoverished
Basic HO coverages
Fire, lightning, theft, & WC SHAFER
Wind Civil disorder Smoke Hail Aircraft Vandalism Explosion Riot
Broad HO coverage
Basic plus Volcano Power surge Frozen plumbing Hot water, a/c Plumbing discharge Building collapse Falling objects
Structure of a HO policy
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
HO 2
A - broad
B - broad
C - broad
D - 20% of A
HO 3
A - open
B - open
C - broad
D - 20% of A
HO 4
Renter’s insurance
A - none
B - none
C - broad
D - 20% of C
HO 5
Comprehensive form
A - open
B - open
C - open
D - 30% of A
HO 6
Condo insurance
A - min
B - incl. in A
C - broad
D - 40% of C
HO 8
Historic buildings
A - basic
B - basic
C - basic
D - 10% of A
HO 15
Added to HO 3 to increase C overage to open
Max coverage calc
[(Have/reqr’d)*loss]- deductible
Occurrence based professional liability insurance.
Policy in force at time of event pays
Seen more with manufacturing industry
Claims-made based professional liability insurance
Policy currently in force pays
This is typical in most E&O policies in the service industry
Subrogation
The insured cannot make a profit
