Insurance - Employee Benefits,health Insurance, Medicare & Medicaid

Front 1

What are the the three major types of managed care plans

Back 1

Health maintenance organization, PPO, preferred provider and point of service plans. All managed care plans provide a primary care physician or gatekeeper

Front 2

What is the stop loss limit

Back 2

the dollar amount of covered benefits to which the coinsurance provisions is applied and does not include the deductible. Alternatively, if the policy has a maximum out of pocket amount, the amount that the insured must pay includes the deductible and any coinsurance amount

Front 3

What is an HMO

Back 3

An HMO is an organization that provides a broad range of health services to its group for a fixed monthly fee. The medical providers receive a monthly fixed payment for each enrolled participation (capitation fee). APCP manages the medical care of the subscriber.

Front 4

What is a PPO

Back 4

similar to HMO. Health care providers paid on a fee for service basis. However It allows members to receive care outside of the network.

Front 5

What is a point of service plan

Back 5

Includes a network of participating providers and other policies of a managed care plan, but also includes indemnity type benefits for patients receiving services from nonparticipating providers.

Front 6

What are names of savings plans for health insurance?

Back 6

Archer Medical Savings Account; Health Savings Account; and Health Reimbursement Arrangements

Front 7

What is an Archer Medical Savings Account

Back 7

tax favored savings account for medical expenses. Earnings are tax deferred until distribution. If not used for medical expenses ther is a 20% penalty. For an employer to qualify employer must have a high deductible helath plan with a max out of pocket expense limit.

Front 8

What is a health savings account?

Back 8

Must have a high deductible health insurance policy and tax free . 20% penalty if misused. Anyone below medicare age may establish one. Maximum out of pocket is $6260 to $12500 Catch up provisions like an IRA Can be xferred to spouse at death.

Front 9

What is a health reimbursement arrangements?

Back 9

Employees are reimbursed for medical expenses by employer

Front 10

How did the medicare payroll tax change in 2012?

Back 10

Starting in 2012 individuals with over $125K to 250K/threshold, pay 2.35% in medicare tax rather than 1.45% on earned income. Companies cannot deduct maintenance expenses toward Medicare Part D subsidy program for their retirees.

Front 11

How long does an employee have to elect COBRA

Back 11

60 days. Once elected, the employee or beneficiary has 45 days to pay the premium

Front 12

Which employers must offer COBRA

Back 12

All employers with 20 or more employees

Front 13

What is HIPPA

Back 13

Health Insurance Portability and Accountability Act of 1996-provides that there cannot be enforcement of a preexisting medical condition if employee was covered by the prior employer's health insurance plan for at least 12 months; fewer than 63 days have elapsed since the loss of coverage

Front 14

What is Obamacare, PPACA

Back 14

beginning in 2014, people who are not eligible for other insurance must maintain certain minimum levels of health care coverage or be subject to a penalty., prohibits lifetime coverage limits for essential health benefits, and requires plans to provide preventive services without charging deductibles, copayments or coinsurance.

Front 15

What is Medicare

Back 15

federal government health insurance plan that covers individuals 65 and over, who have been receiving SS disability benefits for at least 24 months, who are on kidney dialysis treatment

Front 16

What does Medicare Part A cover?

Back 16

Hospital care limited to 90 days each benefit period; a lifetime reserve of 60 additional days; skilled nursing care; home health services; care in a hospice for terminally. Skilled nursing provides full payment for 20 days. Next 80 days, there is daily copayment of 144.5 per day.

Front 17

What is medicare Part B

Back 17

aka supplementary medical insurance covers ambulances, durable medical equip, mental health, physician services, diagnostic tests drugs that cannot be self administered. Requires a monthly payment of $99

Front 18

What is Medicare Part D

Back 18

drugs. Must pay monthly premium and annual deductible of $320 plus copayment. Once the individual has spent $2930, then a 50% discount kicks in until the individual has spent $4700, then pays small copayment.

Front 19

What are some of the qualifying events for COBRA?

Back 19

Qualifying events include death of the covered employee, termination of employment, including retiring, voluntary resignation, being laid off, and being fired for anything except gross misconduct, a change in status (e.g., full time to part time), divorce or legal separation causing spouse and/or dependent children to lose coverage, child reaching an age where the child is no longer eligible to be covered, employee reaches Medicare age, and spouse and/or dependent child loses coverage as a result. Voluntary or involuntary termination qualifies the individual for 18 months of COBRA coverage. Divorce or legal separation will qualify the individual for 36 months of COBRA coverage.

Front 20

What is a cafeteria plan?

Back 20

A section 125 planthat eEs may choose the form of EE benefits from a selection provided by fER. If meets Section 125, benefits are not taxd to EE. Cannot provide educational related benefits, EE discouts or retirement benefits under section 125.

Front 21

What is a SIMPLE cafeteria plan?

Back 21

USed by ERs with 100 or fewer EES NonEEs and 2% owners are not eligible. EEs under 21 and nonresident aliens are not eligible.

Front 22

What is a flexible spending account?

Back 22

A cafeteria plan which EEs can be reimbursed for certain qualified expenses. It cannot be provided to self employed persons or partners It cannot be discriminatory

Front 23

What is the maximum amount of qualified ER provided education assistance that can be excluded from EEs income

Back 23

$5250

Front 24

What are the limits of qualified EE discounts?

Back 24

for property=gross profit percentage
For services=20% of the regular customer price

Front 25

What is a VEBA?

Back 25

Voluntary Employees beneficiary association. It is a welfare benefit plan. ERs make deposits that will be used to provide specified EE benefits in the future.. The level of annual contributions to the VEBA is determined actuarially. Can pay for life insurance sickness and accident benefits as well as training, legal service, severance pay etc.. Cabnot be used for retirement, commuting expenses, property damage and other items unrelated to maintenance of EEs earning power. If VEBA is 501c3, income is exempt from tax

Front 26

What are the 5 principles upon which workers compensation laws are based

Back 26

Employers strict liability (nofault); EEs cannot sue for damages; benefits are paid periodically, no EE contribution

Front 27

Which EEs are not covered by workers compensation

Back 27

Usually domestic and agriculture EEs

Front 28

What are the benefits under workers compensation

Back 28

medical expenses, disability income, burial expenses, survivors benefits, rehabilitation benefits, benefits are excluded from FIT

Front 29

What are the eligibility requirements of workers compensation?

Back 29

To be eligible the disabled person must work in a covered occupation and the worker must have a job related accident or disease

Front 30

What is the purpose of second inury funds in workers compensation?

Back 30

Second injury funds have been established in most states to encourage the employment of disabled workers by not requiring the ER to pay indemnity should a second accident occur

Front 31

What are some xteristics of a flex account

Back 31

EE funded. EE funds NOT subject to SS tax. If EE does not use funds, balances are lost. A separate FSA salary reduction account must be made for each type of benefit. Salary reductions lower EEs income for social security purpose. Cannot be used for health savings account.

Front 32

Can ER offer one class of EEs a higher EE discount than another class of EEs

Back 32

No All $$f discounts or "no additional cost" discounts must be given to all. ER can discriminate on deminimus, free parking, working condition fringes.

Front 33

What are some xteristics of a health service agreement

Back 33

above line deduction, tax free to contributed, must have high deductible. Can fund up to tax due date. Limits approximately $3K single and $6K MFJ. Can add more if you are 55 or older. 20% penalty if you use money for other than medical reasons.

Front 34

When does COBRA not apply

Back 34

to companies with less than 20 EEs

Front 35

What coverages does a medicare supplement policy provide

Back 35

It covers the deductibles and pays the amounts that Medicare doesn't cover likedeductibles for days 21-100. However it is not major medical.