Types Of Health Policies

Front 1

first-dollar coverage

Back 1

Basic coverages which usually do not require the insured to pay a deductible.

Front 2

HMOs are required to provide the following basic benefits:

Back 2

*
Hospital inpatient services.
*
Physicians' services.
*
Outpatient medical services.
*
Preventive services.
*
Emergency services.
*
Diagnostic laboratory services.
*
Out-of-area coverage.

Front 3

MSAs are for groups of ____or fewer employees.

Back 3

50

Front 4

The maximum amount that can be contributed to an MSA is ___% of the high-deductible plan for individuals or ___% of the family deductible for those with family coverage. Non-qualified distributions have a ___% penalty tax.

Back 4

65%, 75%, 15%

Front 5

Flexible spending account (FSA) is exempt from what kind of taxes?

Back 5

federal income taxes, Social Security (FICA) taxes and, in most cases, state income taxes, saving 1/3 or more in taxes.

Front 6

Child and dependent care expenses must be for the care of one or more qualifying persons. The following would be considered a qualifying person:

Back 6

1. A dependent who was under age 13 when the care was provided and who can be claimed as an exemption on the employee's Federal Income Tax return;
2. A spouse who was physically or mentally not able to care for himself or herself; or
3. A dependent who was physically or mentally not able to care for himself or herself and who can be claimed as an exemption (or could claim as an exemption except the person had $2,900 or more of gross income).

Front 7

you might be able to make a change to benefits under one of the following circumstances referred to as Qualified Life Event changes:

Back 7

1. Your marital status changes;
2. Your number of dependents change;
3. One of your dependents satisfies or ceases to satisfy the requirements for coverage under the Medical Reimbursement plan for unmarried dependents due to attainment of age, student status, or any similar circumstances;
4. If you, your spouse or qualified dependent experience a change in employment status that affects eligibility under this plan or you terminate or take a leave of absence (must be at least a 31 day break in employment status to qualify as a change in status);
5. You change your Dependent Care provider; or
6. You go on Family Medical Leave.

Front 8

annual contribution for Dependent Care Accounts limit

Back 8

$5,000. This is a family limit, meaning that even if both parents have access to flexible care accounts, their combined contributions cannot exceed $5,000. Health Care FSAs are limited to $4,000.

Front 9

The following are key characteristics of HRAs:

Back 9

* They are contribution healthcare plans, not defined benefit plans;
* Not a taxable employee benefit;
* Employers' contributions are tax deductible;
* Employees can roll-over unused balances at the end of the year;
* Employers do not need to advance claims payments to employees or healthcare providers during the early months of the plan year;
* Provided with employer dollars, not employee salary reductions;
* Permit the employer to reduce health plan costs by coupling the HRA with a high-deductible (and usually lower-cost) health plan;
* Balance the group purchasing power of larger employers and smaller employers.

Front 10

HRA contribution limit:

Back 10

no statutory limit. Limits may be set by employer, and rollover at the end of the year based on employer discretion. Former employees, including retirees, can have continued access to unused HRAs, but this is done at the employer's discretion.

Front 11

What is the period of time during which the recurrence of an injury or illness will be considered as a continuation of a prior period of disability (recurrent disability)

Back 11

3 to 6 months

Front 12

A policy that uses the accidental bodily injury definition will provide _____coverage than a policy that uses the accidental means definition.

Back 12

broader

Front 13

Sickness or illness is defined as either a sickness or disease contracted after the policy has been in force at least_____days

Back 13

30

Front 14

LTC must provide coverage for at least _____ in a setting other than an acute care unit of a hospital.

Back 14

12 consecutive months

Front 15

must provide coverage for at least 12 consecutive months in a setting other than an acute care unit of a hospital.

Back 15

*
The only insurance protection provided under the contract is coverage of qualified long-term care services.
*
The contract does not pay or reimburse expenses incurred for services that are reimbursable under Title XVIII of the Social Security Act.
*
The contract is guaranteed renewable.
*
All premium refunds and dividends under the contract are used to reduce future premiums or increase future benefits.
*
The contract satisfies certain consumer protection provisions concerning model regulation and model act provisions, disclosure, and nonforfeitability.

Front 16

A long-term care policy cannot fall into any of the following categories:

Back 16

*
Be canceled, nonrenewed or otherwise terminated on the grounds of age or the deterioration of the insured’s mental or physical condition;
*
Establish a new waiting period when coverage is converted or replaced within the same company, except for increased benefits voluntarily selected by the insured; or
*
Cover only skilled nursing care, or provide significantly more coverage for skilled care than lower levels of care.

Front 17

an association group must have at least _____ members

Back 17

100

Front 18

Group conversion option must be initiated during the conversion period, which is within ____days of termination of employment

Back 18

31

Front 19

after the _____time period, any pre-existing conditions will be covered, unless the insurer has specifically excluded them with an impairment rider.

Back 19

2-year

Front 20

(COBRA) requires any employer with ______or more employees to extend group health coverage to terminated employees and their families after a qualifying event.

Back 20

20

Front 21

COBRA Qualifying events include the following:

Back 21

* Voluntary termination of employment;
* Termination of employment for reasons other than gross misconduct (e.g. company downsizing);
* Employment status change: from full time to part time.

Front 22

For any COBRA qualifying events, coverage is extended up to ______

Back 22

18 months

Front 23

The terminated employee must exercise extension of benefits under COBRA within _____days of separation from employment. The employer is permitted to collect a premium from the terminated employee at a rate of no more than _____% of the individual’s group premium rate. The 2% charge is to cover ________. For events such as death of the employee, divorce or legal separation, the period is _______ for the dependents.

Back 23

60

102%


the employer’s administrative costs.

36 months

Front 24

To be eligible under HIPAA regulations to convert health insurance coverage from a group plan to an individual policy, an individual must meet the following criteria:

* Have _____months of continuous creditable health coverage;
* Have been covered under a group plan in most recent insurance;
* Have used up any COBRA or state continuation coverage;
* Not be eligible for Medicare or Medicaid;
* Not have any other health insurance;
* Apply for individual health insurance within _____of losing prior coverage.

Back 24

18


63 days

Front 25

When an individual is converting from a group plan to another group plan, he or she must have at least _______of creditable coverage under the old plan.

Back 25

12 months

Front 26

Under HIPAA, a pre-existing condition is a condition for which the employee has sought medical advice, diagnosis, or treatment within the previous ____months. Group plans can impose a ______waiting period (18-month if a late enrollee) before pre-existing conditions can be covered.

Back 26

6 months


12 month