Disability Income Insurance Overview
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Questions and Answers

What characterizes High Deductible Health Plans (HDHPs)?

  • Lower premiums but higher deductibles. (correct)
  • Neither premiums nor deductibles are affected.
  • Require a Health Reimbursement Account for eligibility.
  • Higher premiums but lower deductibles.
  • What does an Individual Disability Income Policy provide?

  • Coverage for business expenses during the owner's disability
  • Income replacement if the insured is disabled and unable to work (correct)
  • Funds for purchasing a disabled partner's share in a business
  • Payment for medical expenses incurred due to disability
  • Which statement is true regarding Health Savings Accounts (HSAs)?

  • HSAs must be used within the same year or funds are lost.
  • HSAs are employer-funded only.
  • HSAs have no minimum deductible requirements.
  • HSAs allow pre-tax savings that roll over year-to-year. (correct)
  • Which type of policy covers ongoing business expenses if the owner becomes disabled?

    <p>Business Overhead Expense Policy (B)</p> Signup and view all the answers

    What are Health Reimbursement Accounts (HRAs) primarily funded by?

    <p>Employer funds. (B)</p> Signup and view all the answers

    What is a common feature of Group Disability Income Policies?

    <p>They may offer both short-term and long-term disability options (D)</p> Signup and view all the answers

    Which of the following best describes Medigap policies?

    <p>Insurance policies that cover additional costs excluding Original Medicare. (A)</p> Signup and view all the answers

    Which type of policy pays a lump sum for accidental death or specific injuries?

    <p>Accidental Death and Dismemberment (AD&amp;D) Policy (D)</p> Signup and view all the answers

    What is a primary advantage of group insurance policies compared to individual policies?

    <p>Lower premiums due to risk spreading among individuals. (C)</p> Signup and view all the answers

    In terms of medical expense insurance, what is true about Major Medical Policies?

    <p>They provide broad coverage for extensive medical costs (D)</p> Signup and view all the answers

    What is the most accurate feature of COBRA coverage?

    <p>Employees pay the full premium plus fees. (D)</p> Signup and view all the answers

    What does a Key Employee Policy primarily address?

    <p>Covers replacement costs for a key employee if they become disabled (D)</p> Signup and view all the answers

    What is the primary purpose of Cancer insurance policies?

    <p>To offer a lump-sum benefit or periodic payments for treatments. (B)</p> Signup and view all the answers

    Which health insurance model requires using a network of providers and PCP referrals?

    <p>Health Maintenance Organization (HMO) (B)</p> Signup and view all the answers

    Which type of care falls under Intermediate Care in long-term care insurance?

    <p>Periodic medical assistance. (B)</p> Signup and view all the answers

    What do Flexible Spending Accounts (FSAs) allow employees to do?

    <p>Use pre-tax dollars for medical expenses (C)</p> Signup and view all the answers

    Flashcards

    Individual Disability Income Policy

    Provides income replacement if the insured becomes disabled and unable to work. Coverage typically based on a percentage of pre-disability income (e.g., 60-70%). Benefits may be short-term or long-term.

    Business Overhead Expense Policy

    Covers ongoing business expenses if the owner becomes disabled. Expenses covered: rent, utilities, employee salaries (but not owner’s income). Premiums are tax-deductible; benefits are taxable.

    Business Disability Buyout Policy

    Provides funds for business partners to buy out a disabled partner’s share. Benefits typically paid as a lump sum or installment. Helps maintain business continuity.

    Group Disability Income Policy

    Offered by employers as part of employee benefits. Typically more affordable than individual policies. Options for short-term and long-term disability. Premiums paid by employers may result in taxable benefits for employees.

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    Accidental Death and Dismemberment (AD&D)

    Pays a lump sum for accidental death or specific injuries (e.g., loss of limbs, vision). Coverage is often supplemental to other insurance policies. Benefits may be partial (e.g., loss of one limb) or full (e.g., death).

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    Basic Hospital, Medical, and Surgical Policy

    Covers specific medical expenses, such as hospital stays or surgeries. Limited in scope and benefits compared to major medical policies.

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    Major Medical Policy

    Broad coverage for extensive medical costs. Includes high limits, deductibles, and coinsurance. Covers catastrophic events and comprehensive care.

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    Health Maintenance Organizations (HMOs)

    Requires using a network of providers. Primary Care Physician (PCP) referrals required for specialists. Emphasis on preventive care.

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    What are HDHPs and what do they come with?

    High Deductible Health Plans (HDHPs) have lower premiums but require you to pay more out-of-pocket before insurance kicks in. These plans often come with Health Savings Accounts (HSAs).

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    What are HSAs and why are they beneficial?

    Health Savings Accounts (HSAs) allow you to save pre-tax money for medical expenses. This money can be used anytime, even in retirement, and any unused funds roll over year-to-year.

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    What are Health Reimbursement Accounts (HRAs)?

    Employer-funded accounts that help employees pay medical expenses. Funds can carry over at the employer's discretion.

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    What are Medicare Supplement Policies and what do they cover?

    Medicare Supplement Policies (Medigap) fill gaps in Original Medicare coverage, like copayments, coinsurance, and deductibles. They are standardized plans with labels A through N.

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    What is group insurance?

    Group insurance policies cover multiple individuals under one contract, typically employees, and often result in lower premiums due to risk spreading.

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    What is COBRA?

    COBRA allows employees to continue their group health insurance after leaving their job, but they pay the full premium plus administrative fees.

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    What is Long-Term Care Insurance and what does it cover?

    Long-Term Care (LTC) insurance covers individuals needing assistance with daily activities. It requires meeting specific medical or functional criteria and offers various levels of care, from skilled nursing care to custodial care.

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    What does dental insurance cover?

    Dental insurance covers routine dental care, cleanings, and procedures. It might also include orthodontic and cosmetic options.

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    Study Notes

    Disability Income Insurance

    • Individual Disability Income Policy: Replaces income if the insured is disabled and unable to work, typically covering a percentage (60-70%) of pre-disability income. Benefits can be short-term or long-term.
    • Business Overhead Expense Policy: Covers business expenses like rent, utilities, and employee salaries if the owner is disabled, but does NOT cover the owner's income. Premiums are tax-deductible, benefits are taxable.
    • Business Disability Buyout Policy: Provides funds for partners to buy out a disabled partner's share of the business, commonly paid as a lump sum or installments.
    • Group Disability Income Policy: Offered by employers as employee benefits, generally more affordable than individual policies, offers short-term and long-term disability options. Premiums paid by employers may lead to taxable benefits for employees.
    • Key Employee Policy: Provides benefits to a business if a key employee is disabled, covering costs of replacement and training. Benefits are paid to the business, not the employee.

    Accidental Death and Dismemberment (AD&D)

    • Pays a lump sum for accidental death or specific bodily injuries (e.g., limb loss, vision loss). Often supplemental coverage. Benefits range from partial (loss of a limb) to full (death).

    Medical Expense Insurance

    • Basic Hospital, Medical, and Surgical Policies: Primarily cover specified medical expenses like hospital stays or surgeries; limited compared to major medical.
    • Major Medical Policies: Cover extensive medical costs, offering broader coverage, high limits, deductibles, and coinsurance; covers catastrophic events and comprehensive care.
    • Health Maintenance Organizations (HMOs): Require using a network of providers; need a Primary Care Physician (PCP) referral for specialists; emphasize preventive care.
    • Preferred Provider Organizations (PPOs): Allow flexibility to use in-network or out-of-network providers; no referrals needed for specialists; out-of-network care is typically more expensive.
    • Point of Service (POS) Plans: Combine features of HMOs and PPOs; PCP referrals required for in-network care; out-of-network care allowed at a higher cost.
    • Flexible Spending Accounts (FSAs): Allow pre-tax savings for medical expenses; unused funds are generally lost.
    • High Deductible Health Plans (HDHPs) and Health Savings Accounts (HSAs): HDHPs have low premiums, high deductibles; HSAs allow pre-tax savings for medical expenses, and funds roll over yearly.
    • Health Reimbursement Accounts (HRAs): Employer-funded accounts for employee medical expenses; funds may carry over at the employer's discretion.

    Medicare Supplement Policies (Medigap)

    • Supplement Original Medicare by covering costs not included, like copayments, coinsurance, and deductibles.
    • Standardized plans (A through N).

    Group Insurance

    • Differences Between Individual and Group Contracts: Group policies cover multiple individuals under one contract (e.g., employees). Lower premiums are due to risk pooling.
    • General Characteristics: Employers often subsidize premiums; portability may be limited if employment ends.
    • COBRA (Consolidated Omnibus Budget Reconciliation Act): Allows employees to continue group coverage after employment ends, but employees must pay the full premium plus admin fees.

    Individual/Group Long-Term Care (LTC)

    • Eligibility: Covers individuals needing help with daily activities, requiring specific medical or functional criteria.
    • Levels of Care:
      • Skilled Nursing Care: Provided by licensed medical professionals.
      • Intermediate Care: Periodic medical assistance.
      • Custodial Care: Assistance with daily living activities.

    Other Policies

    • Dental: Covers routine dental care, cleanings, procedures, potentially orthodontics and cosmetic options.
    • Vision: Covers eye exams, glasses, and contact lenses, occasionally with discounts for corrective surgery.
    • Cancer: Provides lump-sum or periodic payments for cancer treatments.
    • Critical Illness or Specified Disease: Pays a lump sum upon diagnosis of specific illnesses (e.g., heart attack, stroke).
    • Worksite (Employer-Sponsored): Voluntary benefits (accident, critical illness, hospital indemnity) deducted from paychecks.
    • Hospital Indemnity: Provides fixed payments for hospital stays, supplementing other coverage.
    • Short-Term Medical: Temporary coverage for gaps in insurance, limited duration and scope.
    • Accident: Covers medical costs and lost income due to accidents, often includes AD&D benefits.

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    Description

    Explore the various types of disability income insurance policies that can protect both individuals and businesses. Learn about individual plans, group policies, and coverage specifics like business overhead and key employee insurance. Understand how these policies can provide essential financial support during disabling events.

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