Insurance Ch 5 Flashcards
When selecting disability, income insurance, the best definition of total disability for the benefits is _______.
Own Occupation
Defined as the inability of the insured to engage in his or her own occupation
Own occupation
The insured is unable to engage in any occupation for which he, or she is qualified by reason of training, education, or experience.
Modified any – occupation, or modified own-occupation
Reflects the Social Security rules. The insured is deemed ________ if unable to engage in any substantial gainful activity by reason of any medically, determined, physical or mental impairment, which can be expected to result in death, or which has lasted, or can be expected to last for continuous period of not less than 12 months .
Totally disabled
With a loss of income type disability insurance policy, the disability insurer will review the earning history for the prior _____.
Two years
__________ disability contracts guarantee that the individual can keep the policy enforce by paying the stated premium, and that the premium will not increase.
Noncancelable
_________ disability contracts, guarantee that the individual can keep the policy enforced by paying the premium, but the premium may be increased on a class basis, not an individual basis.
Guaranteed renewable
_________ allows a noncable or guaranteed renewal policy to continue beyond age 65. The policy usually only has a two-year benefit, and the premium is adjusted for both benefits and age. It can only be extended if the insured is still an active employee.
Conditionally renewable
Disability income insurance policies, no longer offer_______.
Lifetime coverage
On a disability policy the________ acts like a deductible.
Elimination period / waiting period.
The longer the waiting period, the lower the premium.
Most policies written today feature a 90 day wait.
_______ disability - that total disability benefits will be paid. If the insured loses sight, hearing, speech, both hands, both feet, or one hand and 1 foot.
Disability underwriting requires _______ financial information, then life insurance underwriting.
More detailed
If the employee owns the disability contract and pays the premium, benefits are ______ to the employee.
Tax-free
With a ________ plan, the employer pays the entire cost, and the benefits are included in an employee’s gross income.
Formal
With a(n)_______ , the employer uses an employee bonus to pay the insurance premium on selected employees. The employee also pays income tax on that bonus, but would then receive the benefits tax free.
If the premium is paid by the employee and the contract is owned by the employee, the benefits are _______ and the premiums are ________.
Tax-free / not deductible
If the premium payment is paid by the employer under a salary continuation plan, and the contract is owned by the employee, the benefits are______ , and the premiums are ____ by the employer
Taxable /deductible
A chronically ill person has been certified as meeting one of the following requirements:
The individual is expected to be unable to perform without substantial assistance from another person, at least _____ activities of daily living for a period of at least ______ days.
Substantial services are required to protect the individual from threats to health and safety, due to substantial cognitive impairment
2 / 90
Eligibility for benefits for long-term care insurance
Name the six activities of daily living.
Eating
Bathing
Dressing
Transferring from bed to chair
Using the toilet
Maintaining continence
______ policies contain both an elimination period of 30 days to 365 days and a maximum benefit period of two years to lifetime.
Long-term care
The provision of a long-term care policy that is generally most important is ______. O
Inflation protection
Premiums for long-term care insurance are seldom _______ .
Fully deductible
To qualify for skilled nursing facility reimbursement under Medicare, the patients condition must be expected to______ within a predictable time.
Improve
Thus, Alzheimer’s coverage is excluded
To qualify for skilled nursing benefits under Medicare part ______, the patient must meet all the following conditions:
-The patient condition requires skilled nursing ,
- The patient has been in the hospital for at least three days in a row before admission to a participating skilled nursing facility.
-The patient is admitted to the skilled nursing facility within a short time (generally within 30 days) leaving the hospital.
-The patient’s care in the skilled nursing facility is for a condition that was treated in the hospital.
_ a medical professional certifies that the patient needs and receives skilled nursing care.
Part A
_______ is jointly financed by federal and state governments and administered by the states
Medicaid
Other than LTC insurance, what other means provides nursing home care coverage for longer than 100 days?
Medicaid
Medicare is limited to 100 days. A Medicare supplement policy or a Medigap policy may provide for a rehabilitation stay, but not for nursing home coverage.
Individuals are generally in eligible for Medicaid coverage, if they give money or assets away within_______ of incurring nursing home expenses.
5 years
People are in eligible for Medicaid if they have more than approximately _______ in-home equity.
$650,000 in 2023
Medicaid recipients, who have annuities, must name ________ as a remainder beneficiary to cover expenses.
The state
