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Detail Outline for Exam 7 – 2007 Part C - page 2 / 28





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Wiening, Personal Insurance (First Edition) – SK

Chapter 12. Health and Disability Insurance

Disability Income Insurance

Social Security Disability Income Benefits

Eligibility Requirements – must earn a certain # of credits (in 2002, 1 credit = $870 capped at 4 credits a year); must satisfy a 5-mth waiting period; must satisfy: “a physical or mental condition that prevents him or her from doing any subtantial gainful work, and the condition must be expected to last at least 12 mths or result in death.”

31 or older: workers must earn credits according to schedule (31 through 42 = 20; then linear to 62 = 40; then 62+ = 40); plus 20 credits must have been earned 10 yrs immediately before worker becomes disabled.

24 to 30: worker must have worked 1/2 the time between age 21 and time of disability.

Before 24: worker must have earned 6 credits in 3-yr period ending w/ disability.

Benefits – these can go to disabled beneficiaries or unmarried children under 18; unmarried children 18 or older who are disabled before 22 and are eligible for benefits according to disabled worker’s earnings; a spouse caring for a child under 16; and a spouse 62 or older.

Government Health Insurance and Healthcare Programs

Medicare – can be paid to most individuals 65 and older, and to disabled individuals under 65 who are entitled to SS disability benefits for 24 mths, or persons under 65 who need long-term kidney dialysis treatment or a kidney transplant.

Hospital Insurance (Part A)

Inpatient Hospital Care

Skilled Nursing Facility Care

Home Healthcare Services

Hospice Care

Blood Transfusions – except for the first 3 pints.

Additional Benefits

Supplementary Medical Insurance (Part B) – includes physicians’ services in a hospital, office, elsewhere; medical supplies & durable medical equipment; clinical lab services, home healthcare visits if beneficiary is not covered in Part A; outpatient hospital services for diagnosis/treatment of illness/injury; blood, except for 1st 3 pints; ambulatory surgical services.

Financing Medicare – part A is financed by a payroll tax %-age, paid by employee and employer (goes beyond the SS max).  Part B is financed by a monthly premium paid by insured persons and by general revenues of fed govt.

Medicare + Choice (Part C) – 1997.

Original Medicare Plan

Original Medicare Plan with Supplemental Policy

Medicare Managed Care Plan

Private Fee-for-Service Plan

Medicare Medical Savings Account (MSA)

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