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33 Cards in this Set
- Front
- Back
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Individual Disability Income |
-insures your net income -long term coverage 2+ years -has elimination/waiting period -longer waiting period, lower the premium -not retroactive -must meet total disability definition (varies) -can ask insurer to take physical every 6 months to confirm disability -benefits must be paid monthly -covers accident and sickness |
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Total Disability |
-typically inability to perform your job for first 2 years -after 2 years must prove cannot perform any job you aren't suited for by virtue of education, training, or expierence |
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Business Overhead Expense Policy |
-purchased by small business owners -covers overhead costs while they are disabled -NOT owner's salary -premiums are tax deductible -benefits paid are taxable |
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Business Disability Buyout Option |
-used to buyout disabled business partner -similar to partnership life insurance -utilizes buy sell agreement -if partner becomes disabled proceeds are paid to able partner in lump sum -money used to buy out disabled partner -does not cover death -premiums not tax deductible -proceeds not taxable |
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Group Disability Income Policy |
-employer is policyholder, employees receive certificate of insurance -benefits based on gross income -premiums either non/contributory -Employer pays 100% noncontributory, premiums paid are tax deductible, employee taxed on benefits -Contributory premiums are shared, whatever portion paid my employer is taxable to employee -usually considered short-term coverage -short waiting/elimination period -usually nonoccupational coverage |
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Key Employee Disability |
-policy pays employer in even key employee becomes disabled -pays lump sum to train someone to replace employee -premiums not tax deductible -proceeds not taxable -Ex: corporate officer |
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Accidental Death and Dismemberment (AD&D) |
-covers accident only -can be added as a rider to life insurance -2 parts: principal sum (amount paid for accidental death/severe dismemberment) capital sum (amount paid for dismemberment) -many exclusions (no coverage while not sober, occupational related injuries, loss of use of limb, loss of hearing, digits) -loss of eyesight is covered -inexpensive due to so many limitations |
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Travel Accident Insurance |
-type of AD&D -blanket accident policy -includes flight insurance sold at airport -often attached to credit cards |
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Basic Hospital Policy |
-follows principle of indemnity -pays policy limit or amount of claim (whatever is less) -first dollar coverage w/ no deductible -covers room/board up to certain limit per day -limited to max number of days during policy period (1 year) -also covers misc. expenses while in hospital |
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Basic Surgical Expense Policy |
-alone or combined w/ basic hospital -each covered surgery is listed (not listed, not covered) -subject to inside limit -only policy associated with relative value schedule ($ limit for most expensive surgery and all others are listed as % of most expensive) |
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Major Medical Policies |
-covers catastrophic illness in and out of hospital -high policy limits -calendar year deductible- per person per year -family deductibles available -carry-over deductibles are available -can add supplemental accident rider -has coinsurance requirement (80%/20%) to prevent overutilization -may have stop-loss feature |
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Stop-Loss Feature |
-optional, sometimes called coinsurance maximum -most insured will pay after deductible -often $5000 -applies after the deductible -on a large claim the most the insured would have to pay is deductible+stop-loss |
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Health Maintenance Organizations (HMOs) |
-must stress preventative medicine -founded by doctors -excellent in-network coverage -utilize copayments (instead of coinsurance) -pay $ amount per visit -insured and insurer share claim -often can only use HMO doctors and clients are assigned a PCP (primary care physician) -gatekeeper system -also known as managed care providers -doesn't cover emergencies |
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Preferred Provider Organizations (PPOs) |
-developed by commercial insurers -broader choice of doctors/hospitals -coverage subject to nominal copayments -can also use outside providers (less coverage) -out of network subject to deductible and coinurance -not required to stress preventative medicine -excellent in-network coverage -type of managed care |
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Point of Service (POS) Plans |
-type of managed care plan -combines characteristics of HMOs and PPOs -you have a primary care physician -insurer will pay in network (subject to copayment) -can even go out of network but subject to higher expenses |
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Health Reimbursement Accounts (HRAs) |
-tax qualified account used to set aside money for medical expenses -contributions made by employer (not required to fund account in year of low/no net income) -account owned by employer -can be set up in conjunction with ANY health plan -account value only accessible while employed |
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Flexible Spending Accounts (FSAs) |
-tax qualified account to pay for medical expenses OR childcare -money that goes in is pre-tax dollars -contributions made by either employer or employee -account value does NOT rollover from year to year "use it or lose it" rule -$ may be used to pay for prescriptions |
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High Deductible Health Plans (HDHPs) |
-designed to lower medical expense premium -high deductible in exchange for low premium -min. amount to qualify varies yearly (indexed for inflation) -also have max out of pocket amounts (includes deductibles and copays) -typically paired with HSAs |
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Health Savings Accounts (HSAs) |
-participants can deposit on an annual basis an amount equal to the deductible in a tax preferred account -money that goes in is pre-tax dollars -earnings grow tax deferred -earnings tax free is go towards qualified medical expenses -$ can pay for individual, spouse, dependent -certain preventative services must be allowed first dollar (annual physicals, immunizations, certain cancer screenings) -can apply even if no longer covered by HDHP -will roll over from year to year -individual (not employer) owns HSA -can roll from one HSA to another w/in 60 days of distribution at most 1 time per year |
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Out of Pocket Maximum |
-most insured would pay including deductible -can be per person or family |
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Medicare Supplement Policies (Medi-Gap) |
-sold by private insurers to fill in gaps in Medicare coverage -only 10 standard plans available (A through D, F, G, K through N) -A is known as basic plan -cannot sell a person more than 1 plan -premiums may vary but coverage is standardized -dental and long term care not covered -at time of application producers are required to give: The Guide to People with Medicare and outline of coverage -guaranteed renewable and 30 day free look -max pre-existing condition exclusion is 6 months -6 month open enrollment period -individuals enrolled in Medicare Part C NEVER need a medicare supplement |
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Group Health Insurance |
-employer is policyholder -employer may pay all or part of premium -noncontributory group- employer pays all of premium, requires 100% participation -contributory- premium shared, 75% participation, any premium paid by employer is tax deductible, medical benefits not taxable -group coverage is better and less expensive -may not have pre-existing condition limitations -applicant enrolls during open enrollment period (may not require physical exam) -31 day grace period -if quit/fired from job, you have 31 days to convert or continue in group |
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Group Conversion |
-terminated employees may convert to an individual policy -issued by same insurer -w/in 31 days of termination -no physical exam required -covered dependents may also convert |
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Group Continuation (COBRA) |
-federal and state regulation -person insured and dependents can continue in group -up to 18 months upon termination -36 months upon death/divorce of employee -insured must pay entire premium -can still convert to individual policy after 18 months (w/out evidence of insurability) -continuation provides better coverage |
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HIPPA |
-law created so that individuals switching jobs would not lose coverage -individual w/ preexisting condition who has group coverage may obtain new coverage w/ reduced or no exclusion period -in order to apply new coverage must be: group coverage, individual policy from same carrier, or special group) -limits max probationary period to 12 months -limits max pre-existing condition clause to 6 months -employees covered by group insurance for at least 18 months may not have a new probationary period on an individual policy -must have been continuous qualifying coverage (without any gaps 63 or more days) - |
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Long Term Care Insurance (LTC) |
-provides custodial care in nursing homes -available regardless of age -does not cover acute care in a hospital -underwritten based on ability to perform ADLs -ADLs include: eating, bathing, dressing, feeding, toileting, continence, mobility -provides coverage excluded on most health policies -additional coverage available for: adult home/day care, hospice care, respite care -pay claims on expense incurred basis -usually pay daily benefit amount -bed reservation benefit -have elimination periods that act like deductible
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Tax-qualified LTC Policies must have: |
-guaranteed renewability -nonforfeiture benefits -disclosure requirements -optional inflation protection |
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Cancer Plans |
-pay the insured a specific $ amount is diagnosed with cancer -pays in addition to any other policy in force -does not follow principle of indemnity -provided coverage for cancer related expenses |
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Critical Illness Plans |
-function same way as cancer insurance policies -payout if insured suffers from specific major illness like heart attack or stroke -pays in addition to any other policy in force -benefits paid directly to insured |
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Worksite (employer- sponsored) Plans |
-employers choose which plans shall be available for their employees to enroll in -choose waiting period for before new employees are eligible to enroll in health insurance policy -3,6,12 months- encourage employee retention -employer chooses premium and how much employee must contribute |
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Hospital Indemnity Plans |
-do not follow principle of indemnity -pay amount directly to insured -premiums not tax deductible -plan pays daily fixed amount for each day you are confined to a hospital (regardless of cause) |
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Dental Insurance |
-sold on individual, family, or group basis -can be part of Medical Expense policy or stand alone -may have in-network coverage (reduced rates) -deductible, coinsurance amount, and annual max benefit amount -some plans have probationary period -covers expenses related to dental health maintenance -if an accident causes dental damage, the medical expense policy would provide primary coverage |
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Vision Care |
-similar to dental insurance -generally set amount for contacts lenses/eye glasses on annual basis -does not cover cataracts (covered by medical expense coverage) -does not cover laser surgery -covers eye exam, glasses, contacts subject to deductible and and/or coinsurance |
