Risk Management & Insurance Flashcards
High Frequency, High Severity
Avoidance/Reduction
High Frequency, Low Severity
Reduction/Retention
Low Frequency, High Severity
Transfer
Low Frequency, Low Severity
Retention
HSA Last Month Rule
If eligible under HDHP on the first day of the last month of the tax year, may fund HSA as if eligible for the entire year
Can you continue to contribute to an HSA once enrolled in Medicare?
No
IRA Transfer to HSA
- Once per lifetime
- Only up to annual HSA funding limit
Employer’s contribution to HSA is (included in/not included in) annual HSA contribution limit
included in (not in addition to)
To be eligible for an HSA, you have to meet (either/both) minimum deductible and maximum out-of-pocket tests
both
HSA maximum out-of-pocket (includes/doesn’t include) deductibles and co-pays
includes
Health plans sponsored by employers with _____ or more employees in the prior year must offer COBRA coverage
20
Qualifying events for COBRA
- death of covered employee
- termination of employee for any reason other than gross misconduct
- reduction of the employee’s hours
- divorce or legal separation
- for spouses, employee’s eligibility for Medicare
- child ceasing to be an eligible dependent under the plan
The cost of COBRA cannot exceed _____% of the costs paid by the employer and employee.
102%
COBRA premiums are due __________
monthly
COBRA continuation period for termination (other than for gross misconduct)
18 months
COBRA continuation period for employee meeting definition of Social Security disability
29 months
COBRA continuation period after employee enrolls in Medicare
36 months
COBRA continuation period after divorce or legal separation
36 months
COBRA coverage period after death of employee
36 months
COBRA coverage period after loss of “dependent child” status
36 months
Medicare does not pay for __________ care.
custodial
Medicare pays for __________ __________ care.
skilled nursing
Medicare coverage for nursing home skilled care
Days 1-20: $0 co-pay for each benefit period
Days 21-100: patient pays $194.50 coinsurance/day
Days 100+: patient pays all costs
What is considered skilled care?
Doctor or nurse-provided care on a daily basis
LTCi Benefit Period
Time that LTCi benefits will be received; specific timeframe or pool of money options
LTCi Elimination Period
Waiting period before benefits become payable; available range from 0 to 365 days
LTCi Daily Benefit
Maximum amount that a policy will reimburse for daily LTC services; set at policy inception according to benefit schedule
LTCi Riders
Add-on features; inflation protection most important
LTCi Waiver of Premium
Insured does not have to pay premiums while receiving benefits