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AZ Senior Citizens

Insurance for Senior Citizens and Special Needs Individuals AZ

QuestionAnswer
What is Medicare? A Federal medical expense insurance program for people 65+ or those who have been on Social Security for over 2 years.
Name the eligibility requirements for Medicare? 65 years old and older or have been on SS for 24 months, or have End Stage Renal Disease
What are the 3 Enrollment Periods for Medicare? 1- initial: 3 months before your birthday, the month of, and 3 months after. 2- general: January 1 to March 31. 3- special: any time of the year as as long as the individual or their spouse is still employed and covered under a group plan.
Describe what Medicare Part A covers It covers In-Patient Hospital Care, Skilled Nursing, Home Health Care, and Hospice Care.
What does Medicare Part B cover? Doctor services, Surgical Services, Diagnostic Tests & X-Rays, Medical Supplies, and Out-Patient Hospital Services.
What is Medicare Advantage (Also known as Part C)? Allows people to receive their health care through HMO/PPO providers. (Part A&B enrollment required)
What Medicare Part covers Prescription Drugs? Part D.
Describe the Donut Hole effect. Once the limit of Medicare Part D is reached, the beneficiary becomes responsible for a portion of the Drug Costs.
Supplemental Coverage under Medicare is also known as... Medigap
Name the Plans in the Medicare Supplement Program? A-N
Who oversees the Medicare Supplement Policies? The NAIC
What are the "core benefits" in Medicare Supplements? Part A co-insurance and copay, Part A hospital costs up to an additional 365 days, Part A hospice co-insurance and copay, Part B co-insurance and copay, and the first 3 pints of blood,
How many days is the Free-Look Period for Medicare? 30 days.
What is Medicare Select? A Medicare Supplement containing restricted network provisions, and condition the payment of benefits based on providers seen.
OBRA covers.... Disabled employees, employees with kidney failure, individuals 65+
How many consecutive months must a LTC policy provide coverage? 2 years?
What is a return of premium? An optional nonforfeiture type benefit that is offered in the even the insured dies, or the policy has lapsed. The insurer returns a certain percentage of premiums paid.
What must the insurer obtain if they issue a policy to an insured 80 or older? Physical Exam report, Assessment of functional capacity, attending Physicians statement, and copies of medical records
What size print must the Outline of Coverage be in and when must it be provided to the insured? 10pt font, and before the application process.
How many days notice must be given in a Replacement situation? 5 days.
Under what conditions may a insurer terminate a LTC policy? Due to lapse of coverage from nonpayment of premium.
On what basis may premiums be increased? Class Basis.
What is a contestable period? 6 months to 2 years.
What are ADL's? Mobility, Eating, Bathing, Continence, Dressing, and Toileting.
How many ADL's must you be unable to do to qualify for LTC? At least 3.
What is Medicaid? State and Federally funded Health Insurance for those in financial need.
What is the Arizona equivalent for Medicaid? ACCHS
How do you become eligible for Medicaid? Low income.
What is Respite Care? Relief for a major care giver.
How long must insurance companies retain their advertisements? 3 years.
When must an Agent provide a Prospective Insured with a shoppers guide? Prior to completing the application.
What must be in an Outline of Coverage? Information about the Insurance Company, the policy number, and important features of the policy.
If a LTC application is approved, when must the policy be delivered? 30 days.
When must an insurer notify the insured of their right to change the person they have designated to receive notice of unintentional lapse? Every 2 years.
Created by: jgray2015
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