Risk Management & Insurance Flashcards
If eligible under a _______ on the first day of the last month of the tax year, tax payer may fund an HSA for the max allowed for the full year.
High deductible health plan (HDHP)
Advantages of an HSA
1) Pre-tax contributions
2) Tax-deferred earnings
3) Tax-free distro
4) Balance not subject to use-it-or-lose-it
5) May use for OTC drugs, dental, vision, LTC insurance
6) Most employers also contribute
7) Cannot fund once enrolled in Medicare
8) Upon death, HSA will be includes in gross estate, but avoid probate with named beneficiaries
Medicare and Long Term Care
Medicare does not pay for long-term custodial care
Long Term Care - rank order of locations
“FCH”
Facility: Nursing home care & Assisted Living Facility (Residential, higher care, personal care, rehab, meds, 24-hour support)
Community: Adult Day Health Care (Residential or day, may include med mgmt,
Home: Home Health Aide Services & Homemaker Services. (Personal care, non-medical)
Long Term Care - Features & Benefites
“Dials to influence premiums”
1) Benefit Period
2) Elimination Period
3) Daily Benefit
4) Riders
5) Waiver of Preimum
6) Renewability
Medicare pay schedule of skilled nursing care
Day 1 - 20: Zero $ co-pay
Day 21 - 100: Patient pays $194.50 co-insurance per day
Day 101+: Patient pays all costs
Employee count requirement for COBRA
20
COBRA, what does it cost?
Cost cannot exceed 102% of the costs paid by the employee and employer originally
COBRA - max period of continuation coverage
Termination other than gross misconduct or reduction of hours; 18 months (includes employee)
Employee/qual’d bene meets SS definition of disability; 29 months (includes employee)
Employee enrollment in Medicare; 36 months
Divorce or legal separation; 36 months
Death of employee; 36 months
Loss of dependent child status; 36 months (dependent child only)
Qual’ed Long-Term Care Insurance requirements and features
Benefits payable only for qual’ed l/t care services
Contract must be guaranteed renewable
Contract does not pay or reimburse expenses reimbursable under Medicare
Contract does not provide for a cash surrender value
Policy dividends must be applied as a reduction in future premiums or increase future bene’s
Limitations and exclusions are prohibited (except pre-existing w/in 6 months of application)
Contract cannot provide for skilled nursing care only or require prior hospitalization
Contract must have 2-yr incontestable clause for misrepresentation
LTCI tax benefits
Bene’s are tax-free
Premiums paid are qual’d medical expense for itemized deduction (Skd A - itemized deductions; greater than 7.5% of AGI)
Premiums can be paid from HSA
Premiums paid by employers are tax-free to employees and benefits remain tax-free
LTCI benefit triggers
2 of 6 ADLs, or
Substantial cognitive impairment (e.g. dementia)
What are the ADLs?
“BED COT”
Bathing
Eating
Dressing
Contintence (ability to control bowels)
On - off toilet
Transferring (ability to move to-from bed or wheelchair)
Disability Income Insurance - Policy Types
Any-occ
Own-occ
Modified own-occ
Social Security Disability
Presumptive Disability Clause
An insured is always considered totally disabled, even if he is at work, if sickness or injury;
(1) results in the loss of sight of both eyes
(2) hearing in both ears
(3) ability to speak, or
(4) use of any two limbs
If employer paid premiums for disability insurance, benefits are ________.
Taxable
If employee paid disability insurance premiums with after-tax dollars, benefits are _____________.
Tax-free
If employee paid disability insurance premiums with pre-tax dollars, benefits are __________.
Taxable
Section 162 arrangement; Disability insurance
If the employer pays the premium but reports the payments as compensation to the insured, benefits are tax-free to the insured. It’s as if the employee paid the premiums with after-tax dollars.
Types of Life Insurance
Term Life
Universal Life
Option A
Option B
Whole Life
Universal Life Insurance Option A
Death benefit remains level
Universal Life Option B
Death benefit is face amount PLUS cash value
Universal Life Policies
Fixed Universal Life: Premiums stay the same; fixed interest rate; least riskiest of UL;
Variable Universal Life: Variable interest rate, cash value is invested in mutual funds that can increase or decrease
Indexed Universal Life: Cash value account has a min & max guaranteed interest rate based on an index
Life Insurance Non-Forfeiture Options
(1) Cash Surrender Value
(2) Extended-Term Option
(3) Reduced Paid-Up Insurance