question

Requirements

answer

Enrollment in a gov't program such as Medicare, TRICARE, Medicaid, etc. Purchasing insurance offered by employer. Purchasing insurance through state exchange. Purchasing insurance directly from an insurer in the individual market.

question

Eligibility

answer

Members of a religion opposed to acceptance of health care benefits. Undocumented immigrants. Those who are incarcerated Members of a federal recognized Indian tribe. Those whose household income doesn't require the filing of a tax return. Those who pay more than 9.5% of income for health insurance. Those eligible for hardship exemption, such as homeless and victims of eviction.

question

Essential Health Benefits Package

answer

Ambulatory patient services Behavioral health treatment Emergency services Hospitalization Lab services Maternity Mental health services Newborn care Pediatric services Prescriptions Preventive, wellness, etc. Rehab Substance use disorder services

question

Bronze Plan

answer

Covers 60%

question

Silver Plan

answer

Covers 70%

question

Gold Plan

answer

Covers 80%

question

Platinum Plan

answer

Covers 90%

question

Guaranteed Issue

answer

Designed to eliminate discrimination based on health status by insurers. Mandates that insurers provide health insurance to any person, regardless of med. history.

question

Pre-existing Conditions

answer

Required to cover children under 19 with preexisting conditions and are prevented from dropping policyholders if they get sick.

question

Termination of Coverage Notice Req.

answer

Within at least 30 days prior to the last day of coverage, insurers must provide notice of termination/cancellation of coverage and include reason.

question

Appeal Rights

answer

Health Plans must have an internal appeals process for beneficiaries to challenge "adverse benefits decisions" such as a denial, reduction, termination, or failure to provide or make a payment for a benefit.

question

Prohibit Restrictions

answer

Coverage may only be restricted for fraud or intentional misrepresentation of material fact.

question

Guaranteed Issue

answer

By eliminating an insurer's right to refuse to insure anyone under the Affordable Care Act, health insurance in America can essentially be referred to as ___________________.

question

Dependent Continuation

answer

Covers adult children up to age 26.

question

Lifetime and Annual Limits

answer

Insurers offering group or individual health insurance coverage are prohibited from imposing lifetime or annual limits on the dollar value of health benefits.

question

Emergency Care

answer

Must provide coverage without need for prior authorization regardless of the participating status of the provider.

question

Preventive Services

answer

Well-child care from birth to age 19.

question

26

answer

One of the changes to take effect following passage of the PPACA was to allow children to remain covered under a parent's policy to age:

question

CONSUMER-DRIVE HEALTH PLANS (CDHPs)

answer

Allows individuals to use a 3-tiered approach to funding the costs of medical services and treatment.

question

Tier 1:

answer

Pretax account, such as a Health Savings Account (HSA), Archer Medical Saving Account (MSA), Health Reimbursement Account (HRA), and Flexible Spending Account (FSA).

question

Tier 2:

answer

The amount the individual chooses to pay, out-of-pocket, after the funds in the pretax account have been exhausted and before the health insurance plan's deductible is met.

question

Tier 3:

answer

A high deductible plan (HDHP), which is designed to coordinate with pretax accounts to help consumers manage their spending for health care and insurance.

question

High Deductible Health Plan (HDHP)

answer

Contain restrictions pertaining to the individual and family deductibles, as well as annual out of pocket limits.

question

Health Savings Accounts (HSAs)

answer

Available to any employer or individual for an account beneficiary who has high deductible health insurance coverage.

question

Medical Savings Account (MSAs)

answer

Have different contributions limits, min. annual deductibles, and max. out of pocket limits.

question

Health Reimbursement Arrangements (HRAs)

answer

Reimburses employees for qualified medical expenses.

question

Flexible Spending Accounts (FSAs)

answer

Employer established plan that permits the employee to defer up to $2,550 on a pre-tax basis into a designated account from with the employee may withdraw funds to pay for unreimbursed med. expenses such as eyeglasses, deductibles, copayments, etc.

question

TRICARE

answer

Primarily for active duty and retirees, plus dependents.

question

Disability Income Insurance

answer

Premiums paid for individual disability income insurance are not tax deductible.

question

Medical Expense Insurance

answer

Premiums and unreimbursed med. expenses that exceed 10% of the individual's adjusted gross income may be tax deductible.

question

Long-Term Care Insurance

answer

Premiums paid for individual LTC policies that exceed 10% of adjusted gross income may be tax deductible.

question

Disability Income Insurance

answer

Premiums paid by employer are tax deductible. Premiums paid by employee are made with after-tax dollars.

question

Medical and Dental Insurance

answer

Group medical and dental premiums paid by employer are tax deductible.

question

Long-Term Care Insurance

answer

Premiums paid by employer are tax deductible.

question

Accidental Death and Dismemberment

answer

Premiums paid by employer are deductible

question

Medical Expense Coverage for Sole Proprietors and Partners

answer

Qualify for deduction that lets them write off the entire amount of insurance premiums without worrying about an adjusted gross income threshold.

question

Business Overhead Expense

answer

Premiums paid by business are tax deductible.

question

Key Person Disability Insurance

answer

Premiums are not tax deductible to the business.

question

Disability Buy-Sell Agreement

answer

Premiums not tax deductible.

question

A personal disability income insurance policy benefit.

answer

Which of the following disability income benefits would be received free of federal income tax?

question

Zero

answer

Victor, age 59, calculated last year's gross income to be $100,000. When he analyzed the cost of his various personal insurance policies, he found that his Disability Insurance annual premium is $3,500, his Long-term Care insurance annual premium is $4,000, and the annual cost of his individual Medical insurance and out-of-pocket medical expenses came to $5,500. This meant he could deduct ______ from his taxable income.

question

Long Term Care insurance only

answer

For which policy type is the threshold for deductibility lower after one reaches the age of 65?

question

HRAs

answer

Ashley wanted to establish her company benefit plan so that it could cover her individual health insurance premiums and out-of-pocket expenses without group insurance or loss of unused benefits. After some research, she established a:

question

Any time premiums for employee policies are paid by the employer.

answer

When are LTC premiums deductible for an employer:

question

The LTC policy is tax-qualified.

answer

Long-Term Care insurance (LTC) benefits are not taxable to the recipient if:

question

Medical expense insurance, long term care insurance, disability income insurance.

answer

The benefits received from which of the following personal policies are received tax-free?

question

Universal use of Consumer Driven Health Plans (CDHPs)

answer

In order to achieve its goals, the Affordable Care Act instituted a variety of measures, including all of the following, except:

question

A $12 co-pay for office visits and 25% co-pay for procedures

answer

The cost sharing provisions of TRICARE Standard include:

question

Business Overhead Expense

answer

Under which of the following business-related plans are benefits taxable as income to the owner?

question

Premiums are never deductible if benefits are received tax-free.

answer

Which of the following statements regarding the taxation of personally owned health insurance is false?

question

$2,550

answer

What is the max. annual contribution to an FSA, which is allowed by law?

question

Annual or lifetime dollar limits on essential services.

answer

Under the ACA, Insurer's provided group or individual health plan insurance coverage are prohibited from:

question

$1,200 was subject to income tax.

answer

After Robert signed up for Medicare, he withdrew $2,000 from his HSA. He used $600 for his Medicare Supplement premium, $200 for out-of-pocket medical expenses, and the remaining $1,200 on a trip to celebrate his retirement. Later on, when he paid his taxes for the year, he discovered that:

question

Plans must do so regardless of network affiliation without requiring prior approval.

answer

Which of the following statements regarding coverage for emergency care under the Affordable Care Act is correct?

question

The premiums are tax deductible.

answer

Harry and Sally were equal partners in a catering business worth $400,000. They entered into a buy-sell agreement that provided funding whether one of them died or was disabled. The annual premium for each of the disability insurance policies was $2,000. All of the following statements are correct, except:

question

Business Overhead Expense Coverage.

answer

Under which business-related use of Disability Income Insurance would the premiums be tax-deductible?

question

The $1,000 is taxed as ordinary income, with an additional $200 penalty tax applied.

answer

Karen, age 50, withdraws $1,000 from her Health Savings Account (HSA) for a purpose other than a qualified medical expense. As a result of this action:

question

No tax.

answer

What taxes apply to the benefits under an individual Disability Income Policy on which the insured has paid the premiums?

question

All of the premiums paid.

answer

Under the ACA, Stephen purchased a Silver plan that covered him, his wife, and his 2 children, ages 17 and 24. Since he is a sole proprietor with no employees, what portion of his premiums is he able to deduct?

question

A business overhead expense policy.

answer

Which of the following disability policies would be considered a deductible business expense?

question

Needed an HDHP to coordinate with the HSA they intended to offer its 700 FT employees.

answer

Michelle's corporation chose a high-deductible health plan because it:

question

Policies may be terminated for nonpayment after 90 days with 30 days notice.

answer

Which of the following statements regarding termination of coverage under the ACA is true?

question

Eyeglasses

answer

Which of the following expenses might be covered by an FSA but not an HRA?

question

Flexible Spending Account

answer

For which of the following may any funds remaining at year-end not be rolled over to the next year?

question

0%

answer

Gary participates in a group long-term care insurance program through his employer. The employer pays for a standard level of coverage for all employees, and Gary pays for an additional voluntary amount of coverage. In all, Gary's employer pays two thirds of the cost and Gary pays the remaining one third of the cost. If Gary makes a claim under this policy, what percentage of his benefits would be taxable based on the premium structure?

question

$12,000

answer

Evelyn paid a $700 annual premium for a business overhead expense policy that paid a monthly benefit of up to $4,000 for a benefit period of 6 months. When Evelyn became disabled she used the entire benefit for 3 months, which covered $11,000 in employee salary and rent and utilities, which meant that the amount of the benefits which was reported as income equaled:

question

$4,000

answer

Nathan is insured under a group disability plan which requires that he pay 1/3 of the premium. Nathan is currently drawing a $6,000 monthly benefit from the plan. How much of the $6,000 is subject to income tax?

question

Any benefits received are not taxable to the recipient.

answer

All of the following statements regarding a group Accidental Death and Dismemberment policy are incorrect, EXCEPT:

question

It is by definition tax-free since the employer buys it for his or her own benefit.

answer

If an employer purchases a Key Person disability policy on an employee, when would the disability benefit be received income tax free?

question

Denial or reduction of benefits to insureds for specific claims.

answer

The 'Appeal Rights' required by the ACA apply to:

question

The sole proprietor of a small firm buys an overhead expense policy.

answer

In which of the following circumstances was the small business owner able to deduct the premiums she paid for insurance?

question

$1,500

answer

Victoria, age 62, calculated last year's gross income to be $60,000. When she totaled up the cost of individual Medical and Long-term Care insurance, as well as her various out-of-pocket medical costs, she discovered the total was $7,500, which meant she could deduct _______ from her taxable income.

question

Anne, who is covered through a traditional HMO.

answer

Which of the following individuals is not eligible to establish a Health Savings Account?

question

They must be under age 26.

answer

Group health insurance plans apply which of the following restrictions to dependent coverage on children of the primary insured up to age 26?

question

$300 was lost.

answer

Barry deposited $1,800 in his FSA, and used $1,500 of that amount during the course of the benefit period. As a result:

question

Flexible Spending Account

answer

For which of the following may any funds remaining at year-end not be rolled over to the next year?

question

The $1,000 is taxed as ordinary income, with an additional $200 penalty tax applied.

answer

Karen, age 50, withdraws $1,000 from her HSA for a purpose other than a qualified medical expense. As a result:

question

Annual or lifetime dollar amounts on essential services.

answer

Under the ACA, insurer's provided group or individual health insurance coverage are prohibited from:

question

The LTC policy is tax-qualified.

answer

LTC insurance benefits are not taxable to the recipient if:

Life- Chapter 14 – Flashcards

Unlock all answers in this set

Haven't found what you were looking for?

Search for samples, answers to your questions and flashcards