Risk Management & Insurance Flashcards
What does Medicare Part A cover?
“HHH SNaCk”
- hospital fees
- hospice care
- home health care
- skilled nursing care
Who is eligible for Medicare Part A?
- generally anyone age 65+
- anyone with end stage renal failure
- anyone age 65+ who’s also receiving social security/railroad retirement benefits
- anyone receiving social security disability payments for at least 24+ months
Generally anyone eligible for part A is automatically signed up for Part B (they can opt out)
If insured is still employed they must be given an option to participate in their ER’s group insurance
- Medicare would be secondary to ER’s insurance
What are the two death benefit options for Universal & Variable Universal Life?
Option A
- level death benefit
- pays out the face value only
Option B
- increasing death benefit
- pays out face value and cash value
How long, and for what, does Medicare Part A cover hospital stays? What’s the cost?
For people w/
- 40+ quarters coverage -> no premium
- 30-39 Q coverage -> premium is $259/m
- < 30 Q coverage -> premium is $471/m
Hospital stays
- 0-60d; paid in full, insured pays dedt
- 61-90d; insured pays co-insurance
- 91+; lifetime reserve days (60)
• benefit period (90d) restarts after 60 days out of hospital, higher coinsurance
How long does Part A cover skilled nursing care?
- 0-20d; paid in full
- 21-100d; insured pays co-insurance
- 101; insured pays in full
• must be ordered by doctor, insured was hospitalized for at least 3 days within the last 30 days
How long does Part A cover Home Health Care?
Part A pays for first 100 home health visits for an illness that requires home health care
A hospital stay don’t need to precede the claim
Must be ordered by a doctor
What does Part A cover for hospice benefits?
Available for the terminally ill
Life expectancy must be 6 months or less
Limited to 210 days unless individual is recertified as terminally ill
What are the eligibility requirements for LTC?
Must be “chronically ill”
- chronically ill -> can’t do 2/6 ADL’s for more than 90 days
- cognitive impairment (Alzheimer’s, etc)
ADL’s -> “BED To Chair”
- bedding
- eating
- dressing
- toileting
- continence
- transferring (going from bed to chair)
What are some mandatory provisions of LTC?
- must be guaranteed renewable or noncancelable
- 60 day look back period
- 2yr incontestability clause for misrepresentation
- words must be defined
- contract cannot require a prior hospital stay or for only skilled nursing care
- limitation and exclusions are prohibited except for pre-existing conditions (6m)
What are marketing requirements for LTC?
- provide applicants for an outline of coverage & a shoppers guide
- 30 day free look period
- policy comparisons are fair and accurate
- expected loss ratio thats at least 60%
- IF A REPLACEMENT POLICY -> insurer must waive period regarding pre-existing conditions
What are the tax implications for the individual regarding LTC?
- deductible as a medical expense (itemized deductions, Ltd by persons age)
- premiums paid by self employed are deduction for AGI (above the line, Ltd by age)
- ER payments for group premiums -> TAX DEDT FOR ER; NOT TAXABLE to EE
- LTC benefits CANNOT be included in cafeteria plan or FSA in tax advantage basis
- benefits paid are generally excludable from GI up to $400/day max
What are tax advantages for LTC?
Must meet all federal standards outlined in HIPAA to be a qualified policy
- contract must be limited to LTC only
- can’t pay for expenses reimbursable under Medicare
- must be guaranteed renewable
- may not provide for any surrender value or other dollars that can be borrowed, paid, assigned, or pledged
- all refunds of premium/dividends MUST either
• reduce future premiums; or
• increase future benefits
What’s a 1035 exchange?
A tax free exchange of one life insurance policy, endowment contact, or annuity for another policy/LTC policy
LI can be exchanged for
- another LI policy
- endowment contract
- annuity
- LTC
endowment contract can be exchanged for
- another endowment contract
- annuity
- LTC
an annuity can be exchanged for
- another annuity
- LTC
What is the treatment of premiums to ER/EE for group health & LI plans as an EE benefit?
Premiums paid by ER for group health insurance plans are
- deductible for ERA
- tax exempt to EE
Group term life
- premiums up to first $50k are tax exempt to EE
Group perm life (not UL)
- if ER pays entire premium, EE taxed on non-term portion of premium & this part is deductible by ER
Group perm life (universal life)
- NO tax adv to ER; EE pays whole premium
What is the equation to determine amount of Group Term LI included in a covered EE’s W2 income?
Excess coverage (above $50k) * Section 79 premium = Monthly cost of coverage * 12 months = Annual cost of coverage - annual cost of coverage paid by EE = Taxable amount of coverage in W2 income
What is split dollar LI and what are the 2 forms of policy ownership?
Split-$ life is a LI arrangement between EE & ER where the cost/benefits
- ER provides LI to an exec w/ a low cost/cash outlay for the executive
- fringe benefit
- pre-retirement DB is a major objective for executive
Policy ownership
1) endorsement method (“the ER endorses”)
- ER owns policy and pays whole premium
• EE dies -> ER receives agg premiums; Beneficiary receives remaining DB tax free
• ER terminates plan -> ER receives cash value, EE gets nothing
2) collateral assignment method
- EE owns policy, ER makes interest free loan to EE in amount of the premium to be paid
• EE dies -> ER recovers agg loans made, EE’s Benny receives remaining DB
• ER terminates plan -> ER receives amount = to total loans made, EE receives the policy
What are the income tax treatments of split $ LI and its various ownership forms?
Endorsement method
- economic benefit receives by EE must be treated as compensation income
• “ER endorses compensation”
Collateral Assignment
- pmts by ER accounted for as a loan to under IRC S. 7872
DB loses tax free nature if transferred for value except when
- transferred to insured
- transferred to a partner of insured / partnership where insured is a partner
- transferred to a Corp where EE is a shareholder/officer
- transfer in which EE’s receives in whole/part carryover basis
What is Key Employee Life Insurance?
Covers EE’s who are critical to the biz
The Business
- has insurance interest in K-EE’s
- biz owns the policy, pays premium, and is the beneficiary
- premiums NOT tax deductible but DB IS received by biz tax free
How much LI can be included in included in a Qualified Plan?
25% test (first test)
- typically DC plans
- no more than 50% of ER’s contributions can be used to pay for whole life
- no more than 25% of ER’s C’s can be used to pay for any LI other than WL (term/UL)
• “50% is a WHOLE lot more than 25%”
100: 1 test (second test)
- typically DB plans
- the Death Benefit cannot exceed 100x the expected monthly benefit to the employee
- cost of LI in QP’s is not deductible to SE people
- NO IRA’s
What are tax issues during participation and at death for LI in QP’s?
During participation
- the pure protection cost of LI must be included in EE’s gross income
- that amount is treated as the EE’s basis for subsequent distributions
Tax issues at death
- value of life insurance is included in decedents gross estate
- cash surrender value is income taxable to beneficiary
What are the sections of PAP?
“LMU DDG”
A - Liability (mandatory) B - Med Pay C - Uninsured motorist D - Damage to your auto E - Duties after a loss F - General Provisions
What are the six standard HO policy forms and the 2 sections of those forms?
2 sections of HO forms
- Section 1: Property/loss of use
- Section 2: liability/med expenses
6 HO Forms
- HO2: Broad Form
- HO3: Special form (dwelling/other -> open peril)
- HO4: Contents broad form (Renters insurance)
- HO5: comprehensive form, open peril
- HO6: condo owners
- HO8: Mod. Coverage Form (old homes)
Which property is valued on an Actual Cash Value basis and how do you calculate it?
Personal property under all forms is valued on an ACV basis, unless covered by an HO3 policy (switches to replacement cost)
ACV = replacement cost - depreciation
What property is valued on a replacement cost method and what are the stipulations of it?
Dwellings and other business structures are covered for loss on a replacement cost basis (and personal property under an HO3)
Insured must typically insure home for at least 80% of R cost* or insurer will pay for claims on a coinsurance basis, the formula is;
[(Insured $ / 80% of R cost) * loss] - deductible = amount insurer pays
*rule is 90% of R-cost for commercial bldgs
What are the 5 subsections of Section 1 for Homeowners Insurance?
A -> Dwelling B -> other structures (detached) C -> Personal Property D -> Loss of use \+ Additional Coverage (debris removal, damage to trees, credit card loss)
What does Coverage A of Homeowners insurance cover?
Dwellings
- any structure attached to dwelling
- materials & supplies used for construction of dwelling
Land is always excluded
What does coverage B of homeownership insurance cover?
Other structures (detached)
- structures not attached to dwelling
- covered by 10% of A’s coverage
Exclusions
- land
- business use
- rental property
What does coverage C of homeowners insurance cover?
Personal Property
- broad & worldwide coverage
- anything inside the house is covered (aka stuff you’d take out when you move)
ACV basis unless covered by HO3 policy
Covered by 50% of A’s coverage
What does coverage D of homeowners insurance cover?
Loss of Use / Loss of Income
- additional living expenses
-
-
ADL is actually the difference between what it cost you before the loss of use and how much if costs now
Covered by 20% of A’s coverage
What are the HO2, HO3, and HO5 policies?
HO2
- broad form
- 18 named perils (12 basic + 6)
HO3
- open form (dwell, other)
- broad form (pers prop)
- HO15 rider = HO5 policy
HO5
- open peril form
What are the HO4/6/8 policies?
HO4
- renters insurance
- tenants pers prop covered w/ broad form
- loss of use limited to 30% of coverage C
HO6
- condo owners insurance
- broad form coverage for personal property
- 40% of C coverage for loss of use
HO8
- modified coverage
- “old Victorian home”
- for when R-cost exceeds market price
- uses a functional r-cost provision
- theft coverage to premises only, Ltd to per $1000/occurrence
What are the basic named perils (1-12)?
“Wizards and riots”
- fire/lightning/windstorms (tornado)/hail
- riots/theft/vandalism/mischief
- explosions/volcanic eruption
What are the broad named perils?
18 broad named perils
- 12 basic (wizards and theft)
- falling objects
- weight of ice/snow/sleet
- accidental discharge of water (internal) etc
- sudden accidental damage due to electrical current
“12 basic (wizards/riots/theft) + ice, internal water, electricity”
What’s the tax treatment of annuities prior to annuitization?
Before 8/14/1982
- FIFO
On/after 8/14/1982
- LIFO
“Before 8/14 is FIRST”
Any premature distribution (before 59.5) is subject to 10% penalty + tax
How are annuities owned by non natural entities (corporations) taxed?
Earnings are taxed as ordinary income
Losses are treated as ORDINARY loss, not subject to annual $3,000 limit
How are NQSOs taxed?
At Grant
- No tax
At Exercise
- Bargain Element is taxed as W-2 Incoem (subject to FICA)
- BE = FMV - Exercise Price
At Sale
- Amount realized - Basis = capital gain
- basis is FMV @ purchase (BE + ex price)
How are ISO’s taxed?
At Grant
- no tax
At Exercise
- No income tax
- the bargain element is a positive adjustment for AMT
At Sale
- if HPR is met (held 2y from G, 1y from Ex)
- Sale - Ex Price = LTCG
- if HPR is NOT met (disqualifying disposition)
- Bargain Element = W-2 Income (no FICA)
- other gain is either short/long term cap gain
- AMT adjustments
- Regular taxable income - BE (neg adjust.)
What are some stipulations of the ISO?
HPR
- 1 year from Exercise
- 2 years from Grant
Option must be exercised within 10 years
EE’s cannot receive more than $100,000 in a given year, based on FMV @ grant
- if above 100k -> amount above 100k are NQSO
ER’s receive no deduction unless disqualifying disposition is made (violate HPR)
What’s a Rabbi Trust?
Informally funded trust (not considered funded due to tax deferral)
Set up to hold property for funding a Deferred Comp plan
Funds SUBJECT TO CLAIMS of general creditors
No current taxation to EE’s