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25 Cards in this Set
- Front
- Back
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Group basic vs Group major |
Basic covered hospital, physician, surgical but low limits so used in conjunction with major |
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Health Maintenance Organization (HMOs) |
Group organized in effort to keep control of rising cost of healthcare For-profit or Nonprofit Disadvantage: limited choices of where to receive medical care PCP, in network, co pays, cap fee |
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Preferred Provider Organization (PPOs) |
No gate keeper, in and out net work, coinsurance, contract discounted services |
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Point of service plans (POS) |
Freedom of choice for managed care, not limited to only HMO network provider, no referral needed for out of net work provider Disadvantage: co-pays for out of network providers are high, deductibles for out of network provider |
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Exclusive provider organizations (EPOs) |
Advantage: ability to select PCP, low co-pay, premiums are lower than PPO or POS but higher than HMO Disadvantage: no out of network coverage, unless emergency, limited to in network providers |
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Eligibility for HSA |
Full annual contribution allowed as long as they were eligible first day of the last month of tax year (December 1) but must remain covered for full year afterwards (“testing period “) through December 31 or taxes & 10% will apply to contributions allocated to months prior to being eligible for HSA |
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IRA rollover into HSA allowed? |
A taxpayer has the ability once during his lifetime to rollover funds from an IRA into the HSA up to the yearly HSA contribution. No deduction is allowed. But can access for healthcare expense. If coverage is lost over the next 12 months, rollover funds are subject to income taxes and penalty. |
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HSA distributions… |
Tax free, if use for qualified, medical expense Before age 65, subject to income tax, and 20% penalty tax ( all other distributions ) After age 65, non-qualified expenses, subject to income tax, but no penalty 20% penalty on non-qualified distributions waived, if account owner becomes disabled or deceased |
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Investing in an HSA |
Recommended to keep at least one or two years of maximum out-of-pocket expenses in MM CDs, stocks, bonds, mutual funds |
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HSA to HSA Rollovers |
One per year is allowed without triggering tax consequences 60 day rollover, if not done by trustee to trustee |
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Run out Period Versus Grace Period For FSA. |
Run out: allows extra time to be reimbursed for expenses incurred in the prior year (varies employer to employer) Grace: allow funds from the prior year to be used for expenses incurred during the first 2 1/2 months of the current year |
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FSA: alternative to the grace period rule |
S125 cafeteria plans allow up to $550 of unused amounts remaining at the end of the plan year to be paid or reimbursed to the plan participant to qualified medical expenses during the following year |
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Incontestability clause |
Issued on a non-cancelable or a guaranteed renewable basis Protects the insured by preventing the insurer from challenging the validity of health insurance contract after its been force for a specified period of time Unless it was initially obtain fraudulently |
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Time limit clause |
Attached to the policy so that the insurer may void a policy on the grounds of misrepresentation by the insured during the first two years of the contract in force |
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Non-cancelable |
Prevents the insurance company from cancel the policy for any reason provided that the policy premium is paid. Typically used with disability policy |
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Guaranteed renewable |
Requires the insurance company to renew the policy for a specified period of time, or until the insured attains a certain age, i.e. 65 Premium may be increased on a class basis |
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Conditionally Renewable Optionally Renewable |
Conditionally : insurance company may not cancel policy during term, but can at renewal Optionally : permits the insurance company to cancel the policy at any time, except during the term of the existing contract. Company can cancel coverage for any reason. |
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Who is required to offer COBRA? |
An employer that maintains a group health plan and employees 20 more people more than 50% of the calendar days in a year Not required to pay for premium |
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COBRA Coverage 18, 29, 36 mo |
18: normal termination (except gross misconduct), FT to PT 29: employee meets SS definition of disability 36: death of covered employee (spouse & dependents), divorce or legal separation, loss of dependent status, eligibility for Medicare |
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COBRA Premiums |
Cannot exceed 102% of the cost of the plan (2% admin costs) If beneficiary receives the 11th month disability extension of coverage, the premium for the additional 11 months may be increased to 150% Election. Begins on the date of the qualifying event and was last at least 60 days from the time the beneficiary receives notification |
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Medicare 4 parts |
Part A: inpatient hospital care, skilled nursing care, home, health care, and hospice care Part B: dr. services medical supplies provided by doctor in their office drugs administered by physician , outpatient hospital services, cost of home health care visits Part C: medicare advantage Part D: prescription drug coverage |
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Medicare part A |
Does not cover hospital stays be on 90 days. It only covers up to 100 days of skilled nursing care following at least three days of hospitalization |
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Medigap or Med. Supplement |
Strict federal guidelines that outline 10 different plans (A through N) plans E, H, I and J no longer |
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Medicare supp. Basic benefits |
1. Hospitalization - pays the coinsurance for days 61-90 under Part A, the 60-day lifetime reserve, and an additional 365 days after Medicare benefits end. 2. Medical expenses - pays the coinsurance for physician and medical service charges under Part B 3. Blood - pays for the first three pints of blood each year. |
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Medicare A deductible |
Hospital and skilled nursing care Deductible $1556 for 2022 per benefit period For the first 60 days. Daily coinsurance : $389 for 2022 per day for day 61 through 90 $778 for 2022 per day for days in excess of 90 Skilled nursing care $194 and 50 Cent for 2022 per day for 21st day to 100th |
