Life & Health 8 13 transcript

all right you'll kill it now you're gonna kill it now yeah yeah you know when uh when I was a manager for many many years when somebody went and took a test I said if you pass that test take the day off you you deserve it if you don't pass a test I want to see you in this office so it was a little incentive you know hey man if I if I pass this test I can go celebrate that's why I tell him just go celebrate responsibly since we're insurance people all right 8 o00 is what I'm showing here guys so we're going to go ahead and get started um so we are back on health insurance chapter nine uh which is on page 57 so if you guys open up your books and we'll go ahead and get started good morning so yesterday remember we did chapter three and I said there's a lot of questions on the test it's the provisions chapter well this is the health Provisions chapter a lot of similarities uh a few little tweaks some stuff that's not even even in the real world anymore but yet will be on your test um it's also a heavily tested chapter all right so this is policy Provisions for health insurance chapter nine page 57 and and okay here we go uh let's start with brainwashing everybody I everybody I understand what I'm learning so I will pass my test okay so the okay what are we starting off with here entire contract and we used a golf terminology par policy application and writers this is like I told you yesterday this is always on the test always on the test always on the test the contract cannot be modified without the owner's approval you guys producers cannot make changes always on the test par policy application writers make up the entire contract now yesterday we talked about the incontestable period it was how long two years very good here what's it called it's called the time limit on certain defenses it's not called the incontestable Clause like it was yesterday it's close but it's not exactly the same it's time limit but only on certain defenses misrepresentations can be contested within two years so that's the same state statements are incontestable after two years that's the same except fraud if you commit fraud on a health insurance application that twoyear time period does not protect you you commit fraud on life insurance application after two years you were solid gold nothing we could do you commit fraud in health insurance it will always be held against you and they like that on the test because it's different okay fraudulent statements are always held against you in health insurance that's why it's called the time limit on certain defenses okay any questions about that okay right to examine so yesterday how long do you have to to look over your life insurance once you get a policy how long do you have to look at and say I don't want it 10 days okay right to examine free look not less than 10 days for most policies now that's going to be true except for two there's only two policies that we're going to talk about that have a 30-day free look those policies are senior plans Medicare supplements and longterm care so how old do you have to be to be on Medicare 65 so it's for seniors right long-term care what is long-term care what is that where where are you if you're in Long-Term Care Nursing Home type facility so these are the only only two policies that give 30 days because who are we dealing with traditionally older people right okay now listen those are the only two policies that get 30 day all the life insurance policies yesterday 10day all the health policies today 10day except for these two okay everybody with me here all right so because those two are weird then they're going to be on your test 30 days now so let's look at how they do some questions here why is a copy of the application found in the accidental death and dismemberment policy right because it makes it a part of the entire contract the entire contract is policy application writers which of these cannot request or sign to make a change in an turns policy the producer good fraudulent misstatements on a health policy causes claims to be denied because of which of these right the time limit on certain defenses is what they call that instead of the incontestable clause in health insurance okay in a cancer plan for insurance how long does the right to examine free look for a 65 year old 10 just because you're 65 remember the 30 days only applies to two policies long-term care and Medicare supplements so they throw a 65-year-old in there trying to throw you off okay everybody with me here how long's a pre- period for long-term care there's your 30 days all right now grace period so how long yesterday was a grace period for life insurance how long do you have to pay your premiums 31 days well health insurance was stupid and so they didn't keep it so so they said if you pay your premiums weekly you get a s-day grace period now I know that's that's that's not really that hard because how many days are in a week seven okay the weird one 10 days for monthly so if you pay your premiums monthly you only get a 10 day and then the rest of them quarterly semiannual annual are just like life insurance 31 so the weirdo is this one and that's the one you're going to be tested on how long is a grace period for monthly okay now ifay is not made during the grace period the policy what it lapses the coverage is terminated so if there's a claim what's going to happen it's going to be denied if you don't pay and you let your policy lapse okay let's just let's just tell the truth right here insurance if you give an insurance company a way out of paying a claim they're gonna take it absolutely they're going to take it so if you let your health Insurance laps because you didn't pay within your 10-day grace period and you end up in the hospital we are not paying that claim that's going to be on your test I guarantee you everybody with me here any questions about that no okay reinstatement so what do we use for reinstatement yesterday it was food Pi pay back all premiums plus interest and provide evidence of insurability right same thing guys same thing so that's how you reinstate a lapse policy payb all premium plus interest and E evidence of insurability now in health insurance how long is a Grace perer for a person who pays their premiums monthly 10 days a person has a major medical policy with premiums due on the 1 of every month the individual does not pay May or June's payment and goes into the hospital on June 18th what will the insurer do deny it yeah because that thing what do you only if you pay monthly how long is your grace period 10 days and you hadn't they hadn't the the individual does not pay May or Junes that thing lapsed 50 days ago a couple has a major medical policy the wife has a heart attack on July 20th and goes to the hospital on August 5th the husband notices the monthly payment on the policy hasn't been paid since May how will the insurer handled the claim going to deny it once again it's already lapsed what must be done to reinstate a health policy that has lapsed due to non-payment of premiums right Pi make sure you get all of them in there because that's correct correct more correct right okay now now we're going to get into stuff that hasn't been true for like 30 years but they are going to test you on this stuff okay so these are called mandatory uniform Provisions all right so who am I gonna let's see I remember Elizabeth did I pick on you yesterday no can I okay all right so you're going to be my agent okay and you sold me health insurance and this is the oldfashioned way I mean we go back to the dinosaur days all right so now what happens is I go to the a doctor or or the hospital it doesn't matter whichever one and and then I pay the full cost of my doctor visit so I need to file a claim to be reimbursed for your health insurance company share right that your 80% so I go to the doctor after I leave the doctor or the hospital how long do I have to notify you that I need to file a claim 20 days 20 days okay that claim form then must be furnished so now what happens Elizabeth is your company is on the clock because what what the government doesn't want to happen is this oh hey we don't want to pay any claims this month don't send them any forms yet so now you're on the clock how many days do you have to get those forms to me 15 okay that form is called a proof of loss you know everybody calls it a claim form it's not that's not the legal terminology if if David Kerr was here who's been a a claims person for like 40 years uh uh he would tell you the legal terminology for a claim form is it's called a proof of loss they like that on the test you need to know what it's called a proof of loss not claim form now now that proof of loss form then I've got 90 days to what fill it out and submit it for reimbursement okay so you we're going to have all these days 20 days 15 days 90 days a little bit further down to page 60 days so I mean it's a lot to keep up with so I I try to come up with ways of trying to figure out hey how can I remember all these days so um I was thinking okay notice of claim 20 days and so I thought okay Bingo and 20 and then I looked in the 20s in the eye aisle but that helped me forms 15 days for claim forms so I said f115 I like I like airplanes f 15 so forms F15 now this one was easy for me because when when I see 90 days and you see proof of loss I get oh like like a good strong whiskey 90 Proof 90 Proof you go with the good stuff right proof 90 okay now let's see how they ask questions how long does an insured have to notify the insurer of a potential Health claim 20 days in a health policy an insurer is required to furnish a claim form within how many days of notification 15 in a health policy a proof of loss is required to be submitted within 90 what is the form called that must be submitted for payment after a loss notice they're going to have claim form in there but it's it's called the proof of loss okay then time payment of claims so time payment has to do with what time it says the insurer must pay the claim immediately medely that will be on your test must pay the claim when immediately as soon as they get that proof of loss when do they have to pay it immediately okay payment of claims notice that doesn't say time it says time of payment of claims is that one this one is just payment of claims this one says who are we going to pay who are we paying benefits are paid to the insured because this is a reimbursement Style so I paid the full doctor now we're going to pay the insurer or did he assign his payment to the doctor so I could have assigned it so payment of claims is not about when it's about Who Time of payment of claims is when everybody with me so they look very similar very similar change of beneficiary says a policy owner has the right to change the Ben benici as long as it's what not the irrevocable beneficiary the what we called the ace yesterday right so let's look once an insurer receives a health claim the claim must be paid when immediately time payment of claims in health insurance means which of these d right must be paid immediately payment of claims does which of these States re States who receives very good who receives notice this one doesn't say time that one says time time is when immediately this says who okay the owner of a health policy can change the beneficiary for any of these reasons except irrevocable very good all right now some more days legal action says the insured must wait 60 days to sue so we did Sue 60 60 Sue because they sort of rhyme a little bit right but no later than three years after the proof of loss before before legal action can be brought against the insurer why it gives the insurer time to review the claim and any policy coverages so so okay yesterday in life insurance how long could you wait and and sue for for non-payment of a life claim two years but did we have to wait 60 days before we sued the life company no so in health insurance what's the difference here why is it that in life insurance you could have sued immediately after they denied the claim but here you got to say we can't sue for 60 days you got you got what body a body in the Life Insurance someone dead dead so is there a question about that no it's not okay but in health insurance here's the situation so I go to the doctor and the doctor says David there's nothing else we can do for you nothing there's nothing you can do well you know there's this experimental treatment you know I mean if you want to give this a shot and I said I'll I'll do anything so they do the experimental treatment it goes into who it goes into the health insurance to be paid as a claim and the health insurance gets it in the go what the hell is this what is this hey look at this look at this look what they did to this guy for treatment are we going to cover this now now they received the claim for the proof of loss claims must be paid when so you know what they're going to do they're going to go oh just aight it just deny it we've got 60 days to review it otherwise we have to pay this thing so let's deny it it'll give us 60 days we can take this and and talk about this and discuss whether or not this is going to be covered by our policy but in life insurance it's just like you said is there a question is he dead looks dead to me I don't know let's wait 60 days no he's dead in health insurance it could be a question are we going to cover that does that make sense you guys because in health insurance the claim must be paid when immediately so that gives them a way to to hold off and review the claim so the first thing they'll do then is they'll go oh well hey let's just deny it and then within 60 days we'll make up our mind as to whether or not we're actually going to cover this or not now physical exam and autopsy this one says the insurer's rights to have an examination or autopsy done on the insured at their own expense except where it's not prohibited by law so um in Texas it is not prohibited by law but they like that on the test so when you sign a contract for health insurance if if they can't figure out why you died they're if they want to have an autopsy done they're going to do it it doesn't matter about your religious beliefs doesn't matter you're in a contract it doesn't matter if your spouse says no I do not want that doesn't matter doesn't matter now except where it's prohibited by law and it's not in Texas so how long must an insured weight to pursue legal action for non-payment of a health claim 60 days to sue right what does the legal action Provisions in health insurance do to review the claim right because we say hey do we going to cover this or not under what circumstances can an insurer not have an autopsy done in a health insurance policy prohibited by law right right okay so now insuring Clause now remember we talked about that yesterday who's the insured the insurer right and the amount of insurance the policy period the insuring Clause the consideration Clause is the four Ps just like yesterday payment of Premium that's what the insured gets payment of premium for the insurance companies promis to pay the claim change of occupation now this is different because we didn't talk about that yesterday changes to a more hazardous occupation then the benefits are reduced or premiums are increased but if you change to a less hazardous occupation you have to apply for a rate reduction so so let's say that you're you're uh you're working in insurance and a buddy of yours calls and says oh let me see let me pick on somebody here uh I don't know Todd have I picked on you can I so buddy of yours calls Todd and says says uh he taught he taught man I got a great job I'm out here working on the oil rig in the gulf and the pay is fantastic and and he said I can get you on out here and so you're working in the insurance industry and it's GNA it's going to quadruple your pay so you said okay boom I'm gone so you you go to a more hazardous occupation the benefits are going to be reduced or your premiums are going to increase as soon as they find out boom you're your something's going to happen to your policy okay now let's say that you were working out there and like what happens with a lot of people in the oil industry these days uh and and you lost your job so you you go to insurance so you go to a less hazardous occupation now you've got because the occupation working out there on oil rig is very dangerous it's got a high premium insurance companies like big premiums they will automatically increase your premium they will not automatically reduce your premium because they like that big premium so what you have to do if since you're no longer working out there and you're you're selling insurance you have to apply for a rate reduction not exactly fair but that's that's just the real world and besides they like that on the test okay remember what we talked about yesterday about misstatement of age what do they do do we adjust the premium or the benefits benefits same thing same thing if somebody lied about their age or even gender now statements made in application and what else are the applicants consideration consideration what's the applicants huh initial premium very good because remember you're the applicant so what do you give for consideration payment of Premium the insurer their consideration is their promise to pay the claims if an insur changes to a less hazardous occupation in a health policy which of these would apply right you have to apply for a rate reduction okay all right let's look at some optional Provisions here so relations of earnings to insurance and this one is found only in disability income policies which says the benefit benefit from the policy cannot exceed your monthly earnings it prevents somebody from buying multiple policies to be paid more from being disabled than from working so they what do they say we're going to look at at how your earnings relate to the insurance policy we don't want you to go out and and go to five different companies and buy disability income policies and then fake an injury so you so you know when you're working you're making for ,000 bucks a month but if you can fake an injury and you can be making 10,000 bucks a month on disability policies that's pretty unethical so they this the only policy that cares about how much you're earning is a disability income policy because it pays you because you're disabled it pays you income because you're disabled doesn't that make sense so it's the only one that cares about what your earnings are if you were to sell me a cancer plan you don't ask me how much do you make a year if you were going to sell me a heart attack plan or major medical plan or Vision Care plan you my income doesn't matter you're not going to ask me but on disability income you're gonna you're going to want proof of my income level because you're not going to want me to fake an injury okay unpaid premiums allows the insurer to deduct premiums from a claim payment during the grace period to prevent a policy from lapsing so this pervasion says so let's let's assume that that uh I have um a disability income policy okay and and so I pay my premiums monthly which means how long's my grace period 10 days right very good so on the ninth day of of a of the grace period I I get involved in a car accident in and I'm hurt really bad and and so my wife said my wife files a a claim the next day on the 10th day of the grace period sends it off electronically it goes into the company and they go hey hey we got a claim here on David lving okay hold on let's see let's take a look at his policy oh crap this thing lapses tomorrow so they said well maybe there's a payment coming in today's mail we we'll wait and see but but now they receive a claim and claims must be [Music] paid so they wait until the it's turn about to turn five o'clock and they said hey you know what we didn't we never got a payment so go ahead and pay that claim but hold out one month's premium from that payment and apply it to the policy that's what this does it allows them to use the claim money to pay the premium for you illegal occupation and act no coverage is injured if committing a crime so and that's always on the test guys they're going to have some sort of a person committing some sort of crime and they're going to want to know he's injured during the Comm the commission of this crime and want to know what the health insur is going to do that's going to be denied not going to pay so which policy uses relations of earnings to Insurance disability which provision and a disability income policy would prevent paying a person with multiple disability income policies more than they earn on their job perfect if the person pays their health premiums annually for disability income policy on the 31st day of the grace period the person has a disability accident and files a claim immediately how will the insurer handle the claim they're going to pay the claim minus the premium because remember annually how long's the grace period 31 days so they're right there at the end and so they're going to say all right we're going to pay it but we're going to take the premium from the payment if the person pays their health premiums monthly for disability income policy and on the 10th day of the grace period the person has an accident and files the claim immediately how will the insurer handle that one claim paid minus a monthly premium right a person is shot while committing a crime what would they the health insurer do pay none of it a major medical policy will pay for all the following except B stealing of vehicles against the law yes so usually on the test it'll say something like that about like the person being shot and it usually says like in the end like they'll cancel the policy will they do that or'll just deny the claim just deny the claim and he can still keep his polic correct correct yeah yeah yeah we we can't cancel the policy because you've done something but we don't have to pay the claim okay does that make sense you guys okay unless what a felony well we're still we're still not going to we're still not going to cancel the policy well that's for your license that's for your insurance license right good morning okay so well you got here just in time to do the first quiz but we'll see how that goes okay okay all right well go ahead and pull out your your answer sheet guys and let's let's do this first quiz chapter nine quiz all right so 30 seconds begins now seconds pick an answer seconds pick an answer 10 seconds pick an answer 10 seconds pick an answer 10 seconds pick an answer seconds Pi an answer 10 seconds pick an answer all right let's grade them so number one in the cancer plan for insurance how long is the right to examine free look period for a 65 year old 10 days it doesn't matter 65 right only two policies have something other than 10 days what are they does anybody remember long-term care and Medicare supplement very good okay in health insurance how long must the grace period be for a person who pays premiums monthly 10 days 10 days for monthly a person has a major medical policy with premiums due on the first of every month the individual does not pay May or June's payment and goes into the hospital on June 18th so the insurer will do what deny the claim that thing remember you on monthly is you only have 10day grace period and that thing lasts a long time ago anytime you give an insurance company way to deny a claim they will always do that once an insurer receives a health claim the claim must be paid when immediately number five in a health policy a proof of loss is required to be submitted within 90 days did that help 90 Proof does that help anybody to remember that yeah okay six a major medical policy will pay for all the following except right very good number seven how long must an insured wait to pursue legal action for non-payment of a health claim 60 days to sue sue 60 60 Sue okay eight if a person pays their health premiums annually for disability income policy on the 31st day of the grace period the person has a disability accident and files a claim immediately how will the insurer handle that they're going to pay that claim because the claim must be paid when immediately but since it's at the end of the grace period they're going to keep out your ual premium and apply it for you okay anybody need to see any of these again sure so three is D deny the claim okay because that policy had lapsed and number four Once An insur receives a claim all in health insurance all claims must be paid immediately immediately okay sure sure anybody else everybody kill that well considering that you didn't you didn't hear the chapter that's not not bad so David I need to apologize to you for being late today but don't worry I'm leaving super early so that's true sorry guys okay so I'm moving on to chapter 10 medical expense policies so hear you lad him proud one two three okay so let's talk about types of providers so service providers pays directly to uh the provider of care so like an HMO P POS get your mind out of the gutter that's not what it means and Blue Cross Blue Shield pays directly to the provider Indemnity Indemnity providers reimburse the insurance so my dental insurance is indemnity so we go to the dentist we pay the dentist we have to fill out a bunch of forms and then who gets paid the dentist I already paid the dentist does the dentist get paid again who gets paid the insured and it's a pain in the booty so all right so self-insured providers so a lot of the hospital districts will do this so uh the the employer self funds so that the uh employee goes to that hospital district for care so first we're going to talk about a POP po so po providers doctors are paid on a discounted fee for a service basis my my cousin is a primary care physician she went to medical school and she gets real packed off being called a provider because she's like I'm a doctor but anyway providers are paid on a discounted fee for service basis so we had a girl in here and uh Steve she goes I like to Ryme things we're like okay bring it what you got and she goes PP service fee PP service fee and David literally goes it sounds like you have to go to the bathroom but PP service fee so po provide or uh doctors are paid on a discounted fee for service basis PP service fee in network the insured pays their com payment so plus their 8020 Co Insurance out of network their uh their benefits are reduced and the co- insurance is 7030 okay so which of these is not a health care service provider see good job so a reimbursement Health Care pain in the booty kind uh provider pays which of these reimbursement the insured like I go to the dentist I pay the dentist and so if if me and my husband and my kids go I have to pay the dentist $1,500 and then we fill out the paperwork and they eventually get us our $1,500 back it's a pain so but who gets paid back I already paid it so who gets paid back me so so providers of care that are paid on a fee for service basis are part of what arrangement po how are Health Care Providers paid in a PO plan discounted fee for service okay so let's talk about HMO hmos offer medic uh Medical Services to members called subscribers subscribers subscribers who receive evidence of coverage the subscribers get a certificate that shows the coverage the insured is entitled to so this is a weird word and y'all have never heard this word before probably capitation capitation not decapitation capitation has to do with hmos so I have a friend that's a dentist and so they have a DMO they accept dmos he gets paid $7 a month per patient $7 a month per patient that's capitation capitation so if they never come to the dentist you gets seven bucks a month if they come to the dentist all the time he gets seven bucks a month so it's a set amount of money given to the doctor for each patient for each year capitation capitation so it's prepaid so so prepaid so um a health maintenance organization HMO shall provide an enroll e upon request uh what what doctors can I go to whether proposed health services are covered or not what the enrollees personal responsibility for payment is is if a subscriber chooses not to be in the in network nothing's covered nothing's covered so the primary care physician the PCP in HMO is know as the gatekeeper gatekeeper that's going to be on the test so what's the primary care physician known as y'all gatekeeper and so what they're doing so that that doctor is getting let's say 10 bucks a month per patient right so so is that doctor inclined to want to so if you have a a skin problem are they inclined to want to give their $10 a month away and send you to the uh um skin doctor no they want to keep their money right so the primary because physic primary care physician is known as what the gatekeeper so co- payments are low for doctor visits but high for emergency room and what they're trying to do is discourage the the the unnecessary use of medical resources discourage the unnecessary use of medical resources so why are ER visit co-payments High to discourage the unnecessary use of medical resources all right hmos emphasize preventative visits preventative medicine so they they encourage physical exams they want to reduce the time you're in the hospital so non-emergency room uh hospital visits require pre-authorization so this is going to be on the test so let's say we all decide hey we're gonna start an HMO that's what we're going to do we're all GNA go in together we're g to start an HMO so R HMO so who are all certificates of authority approved by do y'all remember from yesterday the com Commissioner of Insurance Commissioner of Insurance so HMO certificates of authority authority authority remember the a word Authority must first be approved by the Managed Care Quality Assurance office Managed Care Quality Assurance office who much who must HMO certificates of authority first be approved by and then secondly all certificates of authority must be approved by the Commissioner of Insurance all right hmos must be in operation for 24 months before they have their first open enrollment why why do they have to be why do they have to be around for 24 months because it's a capitation system so we're trying to enroll doctors right we're trying to enroll doctors so I know I know HMO is no bueno anybody have an HMO no I have a p okay so open enrollment SP last for 31 days 31 days and I don't know if we've said this so far but if you're like gosh I just don't know we've done so many numbers I can't remember what the number is dang it 31 days is probably a good guess probably good guess I mean if 31's a choice there's a lot of 31s so um anyway but if you know it answer the right answer but if you don't know it 31 yeah maybe pretty good chance so um group conversions must be offered no less than 30 days before the end of six months now why didn't they say five months 30 days before the end of six months so David in there is a gun guy so he uses the analogy 30 OD six 30 OD 6 30 OD six so group conversions must be offered uh no less than 30 days before the end of six months so let's do some HMO questions so what type of Health Care offers protection to subscribers on a prepaid basis HMO HMO members are called subscribers providers paid on a capitation system are part of what type of healthcare HMO which of these would be considered the gatekeeper when talking about uh health insurance PCP so why does an HMO have co-payments M which health care provider emphasizes preventive visits HMO certificates of authority must be approved by the commiss HMO certificates of a Authority must first first be approved by manage care quality insurance office okay how long must an HMO be an operation before it may have an open enrollment 24 months what once an HMO has an open enrollment how long must that open enrollment be 31 days so an HMO conversion must offer which of these good job 30 out six 30 out six 30 out six okay and so POS no it doesn't mean that it means point of service point of service so it combines the features of an HMO and a medical exp expense plan at the point of service the subscriber chooses in Network or out of network in network it's an HMO and requires a small payment out of a network requires a deductible in Co Insurance okay so here we're gonna talk about basic so is does does basic sound like it's the Cadillac plan it's the best one we've got no basic basic so basic health insurance plans pay as per the policy schedule or less than the full charge less L than the full charge there's one good thing about basic one good thing no deductible no deductible that's the only good thing because it's not that good it pays less than the full charge so guess who gets to pay the rest so um so basic medical Basic Metal medical pays office visits lab charges scans all that stuff basic Hospital only pays room and board room and board room and board so when we do Medicare later today when David Does Medicare later today because I'll probably not be here um so so Medicare part A Hospital pays Hospital everything basic Hospital only pays what room and board room and board room and board basic surgical pays surgery surgeon fees operating room all that kind of stuff so basic pays less than the full charge as per the policy schedule or less than the full charge okay so basic hospital and medical expense plans pay for benefits how less than the full charge absolutely good job so uh basic medical expense plans pays for benefits how yeah as per the policy schedule which expense would be covered under a basic Hospital plan room and board don't get that messed up when y'all do Medicare it's going to be different okay which expense would would not be covered under a basic Hospital expense plan good job because it's going to be covered under surgical okay so let's talk about major medical so we don't have the sniffles something bad has gone down right we have cancer something like that major major something bad so major medical policies so better than basic better than basic better than basic for a broader range of medical expenses but they do of Lifetime ma uh maximums does not pay for work related injuries y'all anytime on the test if you see anything about somebody getting injured at work workers's comp workers comp workers comp anytime on the test you're injured at work where are you GNA get paid workers comp so major medical has an annual deductible the amount the that's the amount the insured must pay before the insurer pays their share of the cost and co- insurance is the cost sharing feature that applies after the deductible is paid so on the test what what co- Insurance means that the insurer pays 80% and you the insured pays 20% all right so let's do who loves math who doesn't love math early in the morning um so so let's talk about this so a major medical policy so in this case so so when I started the very first thing I told y'all yesterday was you're going to get questions like this how much does the insurer pay and that's a totally different answer than how much does the insured insured pay we had a guy in like I said we had a guy in here uh last week last week he missed one question one question the whole class and he misread insurer insured employer employee so on this one on major medical expense policy there's a $1,200 bill on the test you always pay your deductible first always always always how much does the insurer pay the insured always pays the deductible first so we had a $1,200 Bill what gets paid first so that brings us to $1,100 the insurer pays their share of the co- insurance which is what 80% so take 1,00 times 80% that equals 880 they will give you a calculator in the testing center they'll give you a calculator you can't they will take your phone away so they're gonna put your phone in a locker so if you're I would be like I'm GNA forget my phone I'm worried about it you know so anyway so that's the answer for insurer how much does the insured pay different answer so it's $1,200 Bill what always gets paid first the deductible so that brings us to 1100 what's the insured share of the co- Insurance 20% so 1100 * 20% equals 220 but guess what guys what did they already pay the deductible right so we got to add it back on so how much did the insured pay 320 okay y'all with me on that okay all right so a major medical policy would be best described as better than basic Q has an accident at work and is hospitalized how will the claim be paid workers comp so an insured has a $2,000 and you can use your phone you can use your calculator on your phone and insured has a $2,000 medical bill on a policy with $100 deductible and 8020 Co Insurance how much will the insurer insurer pay how much will the insurer pay the insurer you're right 14 yeah 1520 because you that 1520 1520 y'all all got that do we need to go over it everybody good not good okay you're like no lady let's get a move on come on I got stuff to do I don't want to be here with you so so let's talk about a stop loss so what a stoploss is is the maximum am out of pocket so once the maximum out of pocket dollar limit is reached the insured no longer has to pay their medical expenses per the policy year so let's talk maximum out of pocket stop loss so a major medical policy with a $250 deductible 820 Co insurance for the first 5,000 and after that the policy is going to pay a 100% 100% so let's do the math so the insurer it's a $66,000 bill what always gets paid first the deductible so that brings us down to 5750 so the insurer for the first 5,000 is going to pay 80% which gives you 4,000 after the first 5,000 they're going to pay it at 100% so they'll pay 100% of that 750 which gives you 4750 now y'all can learn how to do that or the answer on the test is 4750 if you get this question on the test the answer is 4750 4750 4750 that's why yall are here 4750 there's a freebie for you if you get the stoploss question what's the answer 4750 4750 4750 okay so let's talk about uh a carryover deductible so have you do you see this ever have you ever do you do medical like billing or just sales done it have you ever seen a carryover deductible yes okay you have okay so they're not real common no okay so a carryover deductible allows medical expenses for the last three months of the year what are the last three months of the year yeah the holidays Halloween they got some Thanksgiving I gotta lose some weight before that Thanksgiving man I I'm pushing maximum capacity I'm going to have to buy new pants if I don't get some of this off so anyway so um anyway so the last three months October November December if they have a bill in October November December and that they didn't meet the deductible for that year they can carry it over till the next year so so what you're going to see on the test so a major medical policy has a $100 deductible 8020 co- insurance and a 90day carryover provision on the deductible in November of 2013 uh he has a $50 medical bill which was his total for the year so he didn't meet his deductible so in March of 2014 he has a $3,000 medical bill so so he had a $100 deductible for 2014 but he got to carry over how much 50 bucks 50 bucks 50 bucks so the insurer how much did the insurer pay it was a $3,000 bill because of the carryover it reduced the deductible to 50 bucks right so that brings us to 2950 the insurer paid 80% Co insurance so that gives you 2360 again you can learn how to do this or the answer on the test is going to be 2360 2360 4750 2360 all right so let's talk about comprehensive major medical so so comprehensive major medical combines both into a single policy it includes reasonable and necessary medical expenses reasonable and necessary so major medical and basic gives you the most complete Hospital coverage so it usually has a deductible co- insurance and a stoploss comprehensive major medical okay so this is g to be weird and I don't even think you probably have seen this one Christina okay so have you ever heard of a corridor deductible okay so basic is it is it Bueno or no bueno no bueno it's not good right the only good thing about it I told y'all it have a deductible that's the only good thing about it so so supplemental major medical has something called a corridor Corridor Corridor deductible have we ever heard a hallway called a corridor so this this hallway this Corridor right here separates our classroom from whatever lab that is I don't even want to know this right there so I don't even want to know I hope it's better than woan so uh anyway so so but this Corridor separates the two so we said a basic medical policy does not have a deductible no deductible no deductible a supplemental major medical policy does have a deductible yes deductible so you get your medical bill right here so your basic policy is going to pay out first does it have a deductible no deductible so then in the middle you're going to have a corridor deductible Corridor deductible and then your supplemental major medical is going to kick in does that make sense so it's deductible in between the two policies y'all with me sort of no yeah um but anyway what y'all need to know is a corridor deductible is is in the middle in between the two policies basic no deductible cordor deductible then your supplemental major medical will pay okay so let's talk about miss pton my little girl so when I was uh pregnant with pton they uh the triple screen po back bad and they said she had Down syndrome which she doesn't she does not but um so I had to go do all this stuff and so they did all these scans and in utero one of her my daughter's kidneys was toast not functional at all and the other one was not looking too hot either and so anyway so I had to they didn't have the Texas Children's Pavilion for women back then so but St Luke's was attached to Texas Children so I have the baby I don't get to hold the baby they immediately rush her to Texas Children's e immediately so when did her medical bills start immediately but the good thing is newborn infant coverage starts when from the moment of birth moment of birth moment of birth moment of birth and it's a good darn thing because that baby had tons of medical bills but it was all covered because the newborn infant coverage started when moment of birth immediately so y'all I'm sitting there I'm I'm sitting there praying for my baby the first thing on my mind is I'm gonna get on the horn with the with the health insurance company right now is that what I was thinking about at that moment no no and it was okay because I had 31 days 31 days 31 days to add that baby to the policy okay so let's talk about something even sadder but she's fine my daughter's fine she's fine she's gifted and talented she's fine she's good so she's good she's unbanned she plays the flute so um anyway so uh so I my friend Kendra um she had a baby right before Payton was born and uh she was vacuuming her house and she went to check on the baby and the baby was dead the baby had died from SIDS the baby had died from SIDS and um anyway it was awful awful awful and and it didn't make me a good mom either because I wouldn't put my baby down the whole year because I paranoid skitso that my baby was going to die of SIDS I mean it was bad but anyway so so um anyway so once the baby has passed away does the baby need health insurance what does the baby need life insurance life insurance so SIDS is not covered under health insurance because the baby's passed the baby's gone all right so let's move on to greener pastures so dependent child care coverage may continue until the child reaches 26 26 26 are you 26 yet Christian oh you're 29 okay well that ship sailed for you baby too bad because you could have stayed on your parents health care until how old 26 26 so so DAV is wife Diana she she loves her little chickies she she like really loves her little chickies and so so David's daughter got married when she was 24 and so so she said hey mom um I married now and my husband has health insurance but I really would like to stay on yours until I turn 26 can I do that and and she was eligible to do that she could have done that because How old could how long could she stay on there till 26 and Diana said I don't think so ttch you're going on your husbands it would shock David and me because we were like all right so which of these policies has a corridor deductible supplemental Major Medical in a medical expense Insurance newborn infants born with congenital defects are covered from the moment of birth in health insurance newborn infant coverage covers all the following except SIDS SIDS so in medical expense policies notification of birth or adoption and payment of Premium must be made within blank days of birth 31 days 31 days 31 days so y'all David David abandoned ship I'm pregnant with Pon they tell me my baby has all these problems and and I got a screamer boss that would scream at me every day every day so so uh accidental not just me I mean everybody so so accidental death and dismemberment so these plans pay principal sum for the accidental death loss of sight of both eyes loss of two limbs pays a lesser amount called the capital sum for loss of sight and one eye or one limb so this kind of creeps me out so as we're sitting there there in our agency selling accidental death and dismemberment there's somebody go somewhere in an office going law subside in one ey is worth $ 5,432 I mean it's funny but anyway so but for the accidental death and dismemberment policy to pay the loss must be above the wrist joint above the wrist joint so if you're mowing the lawn so and then for for uh for loss for the loss to be paid the loss must be above the ankle joint above the ankle joint so if you're mowing the lawn and you cut your toes off be sure to stick your whole leg back in the lawn mower because your policy is not g to pay unless it's where above the ankle and where above the wrist it won't pay it won't pay so an accidental death and dismember policy an accidental death and dism policy will pay which of these car crash that's an accident accident we talked about that yesterday what's an accident drowning in a pool falling off a cliff all those things so a person lost both their legs uh just below the knee in an accident a policy pays 20,000 which policy was it C good job guys good job good job good job so H andq are co-primary beneficiaries oh this one's kind of tricky in an accidental death and dismember policy on their mom for 10 for 100,000 the husband is contingent so H and Q are primary husband is contingent Q dies of cancer the mom dies two months later in an auto accident how much did the policy pay the husband zero nothing nothing because he's he's the contingent right and and yeah so H is Alive and Well she gets she gets paid so a person has their toes accidentally cut off with a mower how much does a $10,000 accidental death and disar policy pay too bad for you baby all right be more careful um so so let's so let's talk about limited policy so we've been talking about health care policies now we're talking about limited limited policies and limited policies only pay one thing one thing so like some of you guys are going to be able to sell a cancer plan and it covers what cancer so it'll cover a cancer plan covers things like imun therapy Physical Therapy chemotherapy that kind of stuff critical illness will cover cancer and like heart attack stuff like that so but it covers only one thing Health Care covers a lot of things limited plans only cover one thing okay so what do y'all think Dental covers dental dental so oral surgery Endodontics that pton has $6,000 worth of braces right now so our dental insurance paid 2500 um so restorative fillings period oncs and prosonic okay so Hospital Indemnity so Hospital Indemnity covers you it'll pay you money while you're in the hospital so maybe you have an accidental death and dismemberment policy with a hospital income benefit added so if you're in the hospital it'll pay you 250 bucks a day for 15 days for every day you're in the hospital uh or you could choose $500 a day for 30 days but it'll pay you money for every day you're in the hospital and it's expensive to be in the hospital so let's talk about short-term medical so so we sold we sold our agency and so um I lost my health insurance and so but hello I knew I was going to get a job selling insurance and I knew I would have health insurance again so I needed temporary temporary coverage so temporary coverage shortterm medical is for three to six months three to six months okay short term okay it covers that one thing so Vision Care so when you think about Vision Care all it covers is Vision but all Vision Care does is glasses and contacts glasses frames lenses contacts so if you have an eye injury that's going to be covered on your medical insurance but is a cataract surgery going to be covered under Vision no it's just for glasses so not disease not eye injury um not glaucoma only uh GL glasses and lenses what do y'all think prescription drug coverage covers that one thing so but there's some common exclusions um intentional when's in any kind of insurance intentional is never covered never covered never covered this next one is a darn shame because yours truly has a lot of things that she would like to have done but elective cosmetic surgery is not covered not covered not covered so military when you're overseas and the military not covered because what are you doing you're working if you're injured at work what's that going to be covered under workers comp so injury sustained in the commission or attempt of a felony or crime so so do youall want to hear this story real quick you want to hear a story or or move on okay so so I had a customer I had a customer and this was like gosh in the late 90s and it comes into the office he PID pay make a payment and he had this like this bandaging on his shoulder and so I was like what what happened to you and he's like well I was shot and I said well you were shot and he said yeah I was I was at Jack In The Box and somebody shot me and I was like I've been to Jack In The Box many times and nobody's ever shot me you know and I was like H H I said well why did they shoot you I don't I have no idea I was minding my own business while was did you they rob you nope okay okay so so the next month his policy is about to cancel because he he didn't pay and so I called the house and uh and I got a hold of the mom and uh the mom said oh oh yeah he's in jail and I said is this related to the gunshot wound and she said yeah he was trying to steal this guy's truck and the guy shot him and so now he's in jail for for grand theft a like you know he's in jail for for try for attempted theft of the vehicle or whatever and I was like okay so the reason I tell you the story what was he doing committing a crime so was that gunshot when covered by his health insurance no no fortunately they have really good quality Care at the Harris County jail so he's all set no problem okay so duplicate or replacement glasses denture not covered okay so a cancer policy C covers all of these except okay appendectomy appendectomy D appendectomy y'all know that getting your appendix out you just didn't read the last answer so Vision Care pays for all the following except a so which of these is not a limited health plan C life insurance so which of these is a limited Health Plan D good job okay pull out your answer sheets and let's do another quiz and then we'll move on to chapter 11 maybe give yall a break if you want one that's what I need right here 10 seconds final jeez 10 seconds ready final seconds h seconds final seconds and final okay so number one a reimbursement health care provider pays which of these a the insured one is a two how are Health Care Providers paid in a PO plan PP service fee two is a number three Q has an accident at work and is hospitalized how will the claim be paid workers's comp three is a four HMO certificates of authority must first be approved by who a a Managed Care Quality insurance office for is a five basic medical expense plans pay for benefit how as per the policy schedule or less than the full charge five is D six an accidental death and dismemberment policy will pay which of these a six is a so seven in a medical expense policy notification of birth or adoption and payment of Premium premium must be made within 31 Days Seven is c number eight a cancer plan covers all of these except B eight is B and number nine which of these is a limited Health Plan B N9 is c number 10 an insured has a $2,000 medical bill on a policy with a $100 deductable in 8020 Co Insurance how much will the insurer insurer pay B good job so 10 is B number 11 what type of Health Care offers protection to subscribers on a prepaid basis a 11 is a capitation 11 is a so 12 which of these would be considered the gatekeeper when talking about health insurance C PCP 12 is c number 13 an insured has a health policy with a $100 deductible 8020 co- insurance and a 90day carryover provision in November 2013 he has a $50 medical bill his total for the year in March of 2014 he has a $3,000 medical bill how much will the insurer pay 2360 2360 4750 4750 2360 okay take a five minute do y'all need a break y'all want a break everybody want a break yeah no yes no maybe so who wants a break y'all you you're like Chris you're just so good I I just want to hang with you um so who needs to see any of these sure so which of these is a limited and limited meaning only pays one thing so vision is a limited plan it only pays Vision so dental vision cancer plans all those are limited see 10 and insured as a $2,000 medical bill on a policy with $100 deductible uh and 8020 Co Insurance the insurer were paid so it's a $2,000 bill what always gets paid first the deductible the deductible the insurer portion of the co- insurance is what oops just kidding is what 80% 80% 80% so what's the answer 1520 15 15 20 15 20 and you'll have a calculator in there so you'll be good anybody else anyone on my online friends anyone online friends David nope Okie doers so you're gonna love chapter 11 because it's the same thing as yesterday pretty much so we're doing a review so chapter 11 is group so let me hear you lad and proud one two three and you will pass your test the first time you will pass your test the first time you will okay so in Group Insurance David talked about this yesterday in group group is weird the policy owner doesn't get the policy who gets the policy employer employer the employer gets the policy the employee gets a Certificate of Insurance Certificate of Insurance that's the same thing as yesterday this is the only difference employee benefits are found in the policy summary in the policy summary that's new employee benefits are found where guys policy summary so who receives a policy in group the policy employer what does the employee receive in group certificate a certificate would be given to which of these in Group Health employee in group health the employee finds their benefits in the policy summary policy summary policy summary all right so just like yesterday eligible groups must be naturally occurring groups so the most common naturally occurring group would be like an employer employee relationship but stockholders Boards of directors my husband has to be in a labor union for his work that's a naturally occurring group and they do offer life and health insurance through that um nonprofit organizations those are all naturally occurring groups but not just a group of neighbors friends families you can't get uh a group together just for the purpose of uh getting group benefits so and you can't just say I really like my sales guys they're amazing I'm only going to have group health for them can't do it not just for the executives they have to offer it for all the employees but you can't just say oh we have a big family let's start a group can't do it all right so in order to be a eligible for Group Health the employee must work 30 hours a week 30 hours so depend an eligibility up to age what 26 26 26 so th this has worked this way so let's talk first about coordination of benefits so so if I have health insurance and I also have health insurance through my spouse's plan my plan is the primary my spouse's plan is the secondary so since dinosaurs roamed the Earth they have been doing children this way so whichever parent birthday comes first in the year that's where the child goes that's the health plan the child goes on so if Mom's birthday is in January and Dad's birthday is in September whose plan are the kiddos gonna go on Mom's plan Mom's plan and they've done it that way I don't know since 70s 80s always okay so let's talk about a conversion privilege if available a group health plan can be converted to an individual plan because the employee quit was fired all that stuff you don't have to prove evidence of insurability the employee is allowed how many days 31 31 31 days to convert uh that policy from their date of separation from the company CRA we talk about cobra in just a second we will talk about Cobra so so that's just if the if the insurer is allowing them to just go to an individual plan okay so small group in Texas is two to 50 2 to 50 2 to 50 employees so our buddy David Kerr that works with us sometimes so he is a small group employer and he does provide he's he's an insurance agent mean duh and he does provide uh health insurance for his employees he has two employees he is a small group provider in Texas but he could have up to 50 hopefully he'll be a mega agent someday and he'll have 50 but he two to 50 small group okay so which of these is eligible which which of these is an eligible group for for Group Health which of these is not an eligible group for Group Health Executives only when an insured is covered under his Group Health Plan and his spouse's Group Health Plan his plan would be called the primary a conver privilege and Group Health allows the allows allows which of the following D good job guys okay so Group Health underwriting so group health insurance requires no evidence of underwriting so so there's no medical underwriting but in group health this is new the employee must sign the enrollment card sign the enrollment card sign the enrollment card sign the enrollment card the employee must do what so but the underwriter must avoid adverse selection and what adverse selection is is the tendency of the older sicker um participants to want to participate in the plan and the younger healthier ones not to want to participate okay so let's talk about the waiting period some of you guys might be in your waiting period right now so you might be a new hire at an insurer and you might be in your waiting period so it's the time the group member must work before they become eligible for coverage under a group plan it's typically 0 to 90 0 to 90 0 to 90 days our former employer our waiting period was Zero days our our group health insurance and group life insurance started the day that we started working but lots of companies do a 30-day 60-day 90day waiting period open enrollment uh after the waiting period they have 30 days to enroll and then annually well it's fall right now some of us might be in their annual enrollment for our employer right now um then you can make changes okay so when we talk about contributory contributory contributory it is the employe contributing employee is contributing contributory who is contributing to the plan the employee noncontributory you work for somewhere good and they pay all your health Insurance great so so non-contributory the employee doesn't have to pay anything it's free so if it's free why would you not take it of course you're going to take it so non-contributory 100% employer employer employer paid 100% participation required it's free you're going to take it right right Christian so taxation so the benit are paid under Group Health arrangements and they're not income taxable under under the employer or employee however the employer can deduct the portion of Premium they paid for their for their business plans so taxation the benefits paid under group uh Health are not income taxable not income taxable to the employer or the employee however just like your employer can deduct your payroll they can deduct if they pay your health insurance as a as a business expense so C goes to work for an employer and wants coverage for his spouse and children C must sign the enrollment card so M switched his job and enrolled on his new employer Group Health Plan three months later M was prescribed a new allergy this is a hard question a new allergy medication the insurer will if he's en enrolled if he's enrolled is he in his waiting period okay so what's what what do you think the answer is a they're gonna pay it so a person not covered for a sickness on a group health policy until after a length of time is expired is in which of these waiting period when an employee pays part of the premium in a group health plan this provision is called contributory contributory contributory okay so let's talk about Federal Regulation here you go Steve Cobra woohoo so the Consolidated Omnibus budget reconciliation act okay y'all if we were in Congress we would not be calling this law the Consolidated Omnibus budget reconciliation act we would call it continuation of employer health care or something like that we would not call it Cobra so employers with at least 20 20 20 employees how many employees 20 must provide uh the option to continue coverage so the ex employee or dependants pay up to 102% of the premium so 100% but 2% to administer the plan and all that's happening with Cobra is you're staying on the same health insurance policy that you've always been on but now you're fired or you've had a parting of the ways or something happened you don't work there anymore you have to pay it but you're staying on the same plan so if you're on the same exact plan that you were always on are you going to have to go through underwriting no no you don't have to you don't have to provide proof of good health nothing like that so I want y'all to what page are y'all on what table what page is that table on 69 so so if you look at that table it's split into two parts one is the employee part and one is the dependent part so the employee the employee so they fired or there's been a parting of the ways you're fured because of covid whatever the the deal um you stay on for 18 months 18 months 18 months uh after the event whatever it is so either you you were working 30 hours a week now you're working 20 hours a week and you're not on the health insurance anymore whatever the deal you're fired you're laid off because of covid 18 months for the employee 18 months for the employee how long for the employee 18 months unless they're they're eligible for Social Security disability in that case they can stay on for 29 29 29 months okay so certain qualifying events permit dependence to stay on for 36 months so the employeee can stay on for 18 months right the dependence so so when I dump my husband and I go marry soncho and I get my divorce I can stay on for how long 30 6 36 36 months because I'm a dependent I'm not the insured my husband's the insured I'm a dependent so I can stand for 36 36 36 months so if the employee dies the dependent can stay on for divorce they can stay on for so the child turns 26 they can stay on for so they that one of the so let's say that the employee turns 65 they go on Medicare but you're not you're the spouse you're not 65 yet they can stay on for how long 36 months so the employee must be informed of cover coverage within 14 days of the qualifying event the employee must notify the employer of their change within 60 days 60 days 60 days so oh oh crud I'm fired so is it Cobra's expensive man so is it better for me to stay on COBRA or is it cheaper for me to go with a private healthcare insurer you have 60 days to make that decision um I call it the Cobra waiting game 60 days so the employer must notify the health insurer within 30 days 30 days 30 days of a qualifying event so so somebody got fured due to co to uh covid they the employer must notify the health insurer within 30 days 30 days 30 days oh they don't work there we had to Furlow them because of Co okay so Cobra recipient requ requirements no evidence of insurability because you're just staying on that same policy that you've always been on all along so it's the exact same policy so it has the exact same benefits you're on the same thing you just get the pleasure of paying it now so um covers pre-existing conditions as long as they were covered before dependents are covered if they were covered before events that will cause termination of Cobra and I promise you on any of the policies if you don't pay your bill what's going to happen it's GNA cancel so same thing with Cobra don't pay your bill no Cobra so if the employer just totally does away with the group plan if the employee becomes eligible for another group or if the employee converts to an individual health plan so you get your own policy okay so what's the minimum number of employees to be eligible for Cobra 20 which of the following is true of Cobra B good job Cobra would cover dependence for how long after the death of an employee 36 months so that's a better deal for the dependent right three years they get three years the employee only gets 18 months unless it's social disability how long after an employee quits does the employer have to notify the health insurer 30 days which of these reasons could be used to cancel Cobra coverage yeah they don't pay their bill they don't pay their bill all right so let's talk about work site plans work site plans are voluntary Plans offered in conjunction with Group Health so things like dental vision critical illness disability typically the employee pays 100% of the premium but you may be able to do it through a um a cafeteria plan okay so there's not much Christian you're very lucky because there's not that much memorization on the test there's just not it's just not but this is kind of one of those that you have to kind of has anybody ever heard of an FSA FSA flexible savings account okay so that is 100% 100% employee employee employee funded so who funds an FSA the employee so uh they they can use their their so they can put up to 2750 bucks they can use it to pay for glasses prescriptions all that stuff it's for unreimbursed unreimbursed unreimbursed medical expenses because if you already got reimbursed by the medical insurer you don't need to pay it again you know they're not going to pay you again so for unreimbursed unreimbursed unreimbursed medical expenses so an FSA is for unreimbursed medical expenses but the problem is it has a fatal flaw you have to use it or lose it and that's why you'll see people at Walgreens on New Year's Eve all dressed up trying to get their prescription oh I got money in my FSA I gotta get rid of it so otherwise you lose it okay so that's FSA employee employee employee funded and HR is 100% employer employer employer funded so probably some of you guys went to go work for a big company for a big old company right and so so you talk to the HR department right and and Steve when you enroll in your employee benefits who you going to who you to talk to HR HR H so an H is employer employer employer funded HR pays the benefit H employer employer or employer funded employer funded okay and then lastly an HSA is for high deductible High deductible High deductible health insurance High deductible so I have a friend who whose husband is a a engineer at one of the oil and gas companies their deductible is $112,500 $122,500 that is a really freaking what high deductible that's a really high deductible High deductible so what plan could help them out HSA HSA health savings account so high deductible Health Plan Plus Health Savings Account equals tax savings HSA High deductible High deductible High High deductible so an FSA pays for which of these which one unreimbursed unreimbursed unreimbursed medical expenses so in HRA is not which of these not employee funded because who funds it HR HR the employer Jay is employed with a company offering a my deductible Health Plan the employer offers a plan HSA so hsas are only available to these people high deductible High deductible okay pull out your answer sheets and let's do another quiz and do another couple chapters and get y'all gone home seconds final that's okay I tell you 10 seconds 10 seconds final I'm back on track I think I think seconds I know seconds final seconds final okay so number one what does an employee receive in group D certificate the certificate the employer receives the policy so C goes to work for an employer and wants uh coverage for his spouse and children C must sign the enrollment card to is a number three Cobra would cover dependence of an employee for how long after the death of the employee 36 months three is B four when an employee pays part of the premium in a group health plan this provision is called contributory a four is a a a a contributory so who is contributing the employee employee so for is a five M switched his job and enrolled on his new employer Group Health Plan three months later M was prescribed a new allergy medication the health insurer will they'll pay it right five is C six a person not covered for sickness on a group health policy until after a length of time is passed is in which of these waiting period six is a okay anybody need to see any of those do yall need a break y need y'all got some strong bladders man I mean y'all y'all good y'all are good okay so let's jump right into chapter 12 which is disability income hey David how can you tell a good dad joke it's a it's a parent all right so chapter 12 disability come let me hear you ride them proud one two three okay so disability income disability income policy pays lost earnings when the insured is disabled due to an illness or injury their benefits are paid monthly but it's not designed to pay your full income because then we'd all I'm feeling a little I'm feeling a little sick today David you know we'd all be out on disability so taxation so so this is going to be one of the tax ta ation questions that you will probably see so premiums are not tax deductible for the individual but the good news is benefits are received income taxfree so when they get their disability benefit it's income taxfree money taxfree money as long as they pay their own premiums so if the individual pays their own premiums then when they go out on disability even though they're only to get 50% or 66 and 23% it's income tax free money so disability income if they pay their own income tax free Okay so let's talk about occupational occupational occupational covers for on the job or off the job this is for a person did y'all know you companies do not have to have workers comp in Texas they don't have to have it so if your company does not have workers comp which kind of disability do you want occupation and it's more expensive of course so occupational occupational your company does not have workers comp you're going to get occupational so if your company does have workers comp or you don't work um well I mean you wouldn't need it if you didn't work but um but if your company does not have n uh workers comp then you would want nonoccupational it only covers off the job off the job off the job injuries because most of us if we work for a big employer we're hurt at work where is it going to be covered workers comp okay so Kay pays premiums on her own disability income policy the policy pays F $1,500 a month and she is disabled for 12 months how much will she have to pay in taxes zero nothing so R has an individual disability income policy R was injured at work and is disabled ours policy didn't pay any benefit because it was nonoccupational nonoccupational in other words it does not cover on the job injuries so an employee has workers comp benefits available to them at work which of these disability income policies should they buy non nonoccupational does that make sense y'all with me on that kind of not kind of not sure so if they're injured at work where where on the test where are they most likely going to get paid your heard at work where you gonna get paid so occupational occupational this one is R has an individual disability income policy R was injured at work R's policy did not pay it didn't pay which kind of policy is it nonoccupational let's go back okay occupational covers on the job and off the job injuries nonoccupational only covers off the job off the job off the job so like afflac you you work for an employer they have a workers comp at work you buy disability income policy through through afflac or something it's nonoccupational because you have workers comp at work you don't need disability income at work because you already have it it's called workers Cal but you need it for when you're water skiing and you break your leg that's what you need it for nonoccupational so non-occupational only off the job only off the job I'm in a car accident I am um base jumping and I break both my legs that's nonoccupational occupational one you need for on the job and off the job because in Texas they do not have to have workers Cal they don't have to have it this one's more rare harder to find but occupational is on the job company's not gonna pay it yeah they're not gonna pay it because they don't have workers Comm okay so a person not are we all we're all good everybody's good okay so a person not concerned about becoming disabled on the job should purchase they're not concerned about it because they have workers comp on their job so which of these disability income policies should they buy nonoccupational nonoccupational nonoccupational occupational on the job or off the job on the job or off the job nonoccupational is only off the job only off the job because why you have workers comp at work you don't need disability income uh because they're not going they're not gonna two policies aren't going to pay out so you don't need it right okay so let's talk about definitions let's talk about total disability so there was a time that I was totally disabled I could not do my own job I could not do any job and that pton that Payton she stressed me out so so so when I was pregnant with her I got put on full bed dress I wasn't even allowed to check emails I wasn't allowed to do anything so I couldn't do anything I couldn't do my own job I couldn't do any job I could not do any job so I was totally disabled now a partial disability so my husband works for the airline and so what he does it's so so he sits underneath the airport in a little cubby and if something bad happens he goes to whatever it is so if the aircraft won't start or if there's a truck stuck on the airplane or whatever it is he goes rushing to figure out what the problem is so so if he broke his leg you know he probably couldn't do some of his job but he probably could do he could for sure answer the phone and say hey Steve you need to go to e14 and start that airplane right so he could do that he could talk on the phone so would he be totally disabled partially disabled so he wouldn't be able to perform all of his job duties he probably still probably still could do some some okay so let's talk about temporary disabled so when I was on bedr with my daughter was I permanently disabled or what temporarily disabled thank God I didn't have to be pregnant for the rest of my life oh my God so I was it was temporary temporary so I was expected to recover and I did right I was fine so I I recovered that's a temporary disability permanent disability there's no expectation of recovery so you're paraplegic or quadriplegic or something like that you're never gonna you're never going to recover okay so let's talk about a residual disability pays benefit when the insured returns to work after a total disability but their earnings are reduced because they're unable to perform the entirety of their job uh duties so so real common residual disability is a cancer patient on chemo okay so because they go get the chemo treatment it kicks their butt the first week man they're they're fine the first day because they're hopped up on steroids then man it kicks their butt and so they can't work for like about a week and a half and then they slowly get to go back to work but are they doing all of their job duties no no but the one on the test is going to be about um the a a doctor is really sick and so he returns to work with something like cancer he returns to work he's able to see some patients but he can't do his whole workload so what happens if he can't see more all the patients that he normally sees does he get paid the same no he gets paid less so that's residual residual so a recurrent disability is a disability that happens again after the insured is presumed to have recovered but sustains the same injury so maybe I work for a moving company and I'm moving a piano and I throw my back out and so I go out on disability for a little bit but my back eventually gets all better right then I go back and I've got to move a safe and uh oh hurt my back again same darn back injury that's recurring have y'all ever had it like a recurring dream recurring it's the same dream over and over and over and over same thing with the disability recurring disability same thing over and over and over okay so prevent presumptive disability so the the loss is presumed to be for a a loss of sight hearing speech or limbs that's a presumptive disability so what they're saying is like you're in a car accident you lose both your legs do you have to go to the doctor every six months to make sure the legs didn't grow back no it's presumed that that disability is going to be forever right you don't have to go check it again all right so let's talk about mingering we all have that Uncle or that cousin or that friend that is this guy they're faking a disability so they don't have to go to work right so so my husband works with one and he eventually got fired but he worked with him for 20 years and he all the time all the time he would had a field day with covid he would have been exposed to covid every every two weeks he would have been exposed to so he was a mingering faking who's faking his injury or illness to get out of work he was a master so so AR is disabled and finds that she is temporarily unable to perform her own job Duty or uh or anything that she's reasonably trained this would be total a doctor has a disability income policy he becomes disabled and after a Time returns to work however he can only work part-time which provision pays for that residual so which of these provisions in a Disability Policy pays for loss of income after recovering from a total disability and still unable to do all of their job requirements residual so Jay injures his lower back loading Furniture into a moving van after recovering he later re-injures the same uh injury what's that one recurring okay so let's talk about the elimination period so it's basically like a time deductible deductible of time so it's a period of time after the onset before the benefits are paid like a Time deductible elimination period so the benefit period is the amount of time the benefits are payable Under Disability sometimes it can be up to age 65 the benefit amount is the amount the policy will pay upon becoming disabled it's not taxable as long as the insured paid the premium themselves so it could be 50% of your income 66 in 30% of your income whatever you choose all right so in this policy they have a disability benefit amount of $3,000 a month their benefit period is up to 10 years so look at this so the longer the elimination period the cheaper the cost of the insurance right so if we have a 30-day elimination period then it's $127 a month for the policy if we have if we save up we have savings we don't need the disability income policy to kick in right away 150-day elimination period it's only $65 a month so the longer the elimination period the cheaper the cost of the insurance so you're going to get a bunch of these a bunch of these you I promise you're going to get one of these on the test so this Disability Policy has a benefit amount of $500 that's not much um an elimination period of 30 days so X is disabled for three and a half months how much did the policy pay so the policy is going to pay out for 3 and a half months how long was the elimination period so we're going to subtract one month so the policy's going to pay out for two and a half months $500 a month how much did the policy pay 12250 12250 y'all with me on that good okay so this one you are going to get the this in some form or fashion on the test you are going to get this so so how much is the benefit amount how much is the elimination period x is disabled on May 1 and returns to work on May 15 this is what's what you're going to get and I promise you're going to get it so we don't care we don't care why is that even in there it doesn't matter it doesn't matter how long are they disabled 15 days how how long is our elimination period 30 days do we care we don't care I promise you you're going to get it May 1st to May 15th on your one of your questions don't worry about it we don't care so what you need to know is X becomes disabled again on June 1st and returns to work in December so July August September October November December so six months how long is their elimination period 30 days so they're disabled for six months we're going to subtract one so they're there how much is the policy going to pay out five months of disability times 500 bucks is what 2500 bucks okay and I promise you're going to get that May 1st through May 15th don't worry about it don't worry about it okay so the time an insured must wait while sick or disabled before a Disability Policy pays is known as the elimination period v has a disability income policy with a 30-day elimination period v becomes disabled on May 1st and returns to work on May 15 do we care no so V becomes disabled again on June 1st and returns to work on September 1st how long did the disability income policy pay 60 days 60 days because there's a 30day elimination period so V has a disability income policy paying $500 a month with a 30-day elimination period v becomes disabled on May 1st and returns to work on May May 15th without a recurring disability benefit V becomes disabled again on June 1st and returns to work on December 1st when do the payments begin July good job good job good job okay so let's talk about individual disability under writing um so these are the ways that we determine the premium amount on a Disability Policy so your income because if you make $100,000 a month your premium is going to be way higher than somebody that makes $2,000 a month right because the insurer has to pay out more money so the higher the income the higher the premium the benefit is typically going to be 66 and 2/3 it's never going to be the whole amount it's going to be 66 and two3 perent of your income so occupation How likely are you to become disabled on the job the more hazardous the job the higher the premium so I am a a base jumper instructor I do those jumps all day every day my premium going to be cheap it's going to be high right what if I just work in an office it's cheaper right okay so let's talk about an advocation so an avocation becoming disabled from a job a side job the more dangerous the higher the premium the lower the benefit so and I do y'all are not gonna believe this I was I've worked in Insurance my whole life I was an interior design major in college so so anyway so but I decorate Christmas trees and I do I decorate commercial Christmas trees at Christmas time so when I work here am I safe unless I make y'all real mad probably pretty safe um but when I decorate those Christmas trees some of them are in two like twostory entry halls in houses so what do I have to do climb a ladder that's my avocation avocation avocation that's my avocation I have a system don't worry um so so anyway but that's my avocation so my avocation is more dangerous than my occupation my occupation is I could trip over my own two feet probably so the more hazardous the hobby the higher the premium so things like scuba diving mountain climbing uh whatever the more hazardous the uh the hobby the higher the premium the age the older you get the more likely you are to go out on disability gender so men are more likely to become disabled women have a higher premium because they're more likely to file a claim now I think I think it's because I think it's because pregnancy right that's what I think that's why I think more women go out on disability um but anyway um David won't go to the doctor my husband won't go to the doctor men won't go to the doctor in my world so health history David do you like to go to the doctor so poor health how you go to the doctor he won't go to the doctor so health history poor health results and higher premiums so if you if you have cancer you're way more likely to go out on disability all right so individual disability underwriting once we've gotten all the information about you the underwriter will decide if the applicant is insurable if the applicant is considered substandard then the underwriter can adjust the requested coverage to make them insurable by increasing uh the premium uh extending the elimination period shortening the benefit period reducing the benefit amount or excluding certain conditions so oh I have a back injury so the underwriter will say okay we we'll write the policy and we'll cover you for anything except the back right so which of these is not used to determine premium and a disability income policy see spouse's occupation what difference does it make okay so oh and I didn't tell y'all this so I have a plan I H I have a plan y'all and and let let me see if y'all are with me on this one so so I've been lobbying David for a long time on my cards I want to change my title from instructor to Queen of insurance School of Texas what do y'all think y'all with me yes no so would it matter would it matter if it's said that on my card am I going to do a different job so does my job title matter my job title doesn't matter okay so all of these would you still haven't done it have you David so all of these would be used to determine premium for an individual Disability Policy except good job so what is not used to determine benefit level in a disability income po I think Steve's with me I I really do da David I really do I think he's a so what is not used to determine benefit level and disability income policy gender we don't care we don't care well like so so David Kerr does it matter if he's here or I'm here would do we do the same thing okay so gender doesn't matter okay so he's a guy David Curr is a guy so uh underwriting so no proof of insurability each for each employee in group group group never has you never have to prove insurability so on the job injuries in group if you have Group Insurance are covered by workers comp workers comp workers comp on the test y'all are always going to know if they're injured on the job where's it going to be covered workers comp always workers comp okay so taxation so we talked about this before if the uh if the premiums are employe paid so in other words they pay for their own Disability Policy if they pay for their own and they go out on disability it's income tax free zero tax zero tax if it's a group and your employer is really nice and they pay for your for your disability then you do have to pay taxes on the benefit but if it's employe paid zero taxes zero taxes okay so let's talk about short-term short-term disability pays 80 to 100% it's usually for six months but never more than two years at our former employer the group Insurance started after I mean the the short-term disability started after five days five days it was really good so and then long-term disability pays 66 and 23% on group and begins after the shortterm uh has expired and goes till age 65 so short-term disability so when I went out I was totally uh uh temporarily temporarily disabled I went out on shortterm disability short-term disability right but if you're disabled for six months to two years where are you g to go long term long term so it's for injury or disability that lasts a long time so which of these would not be true for group disability insurance see each employee employe must prove good health no on group if you're in the group you're covered there's no individual underwriting in group on any of the group stuff on the test so an employee has short-term disability benefits available through their employer an injury on the job causes the employee to to be disabled which of these applies anytime you see the employee is injured on the job where is it always going to be covered on the test workers comp workers comp workers comp which of these would be true of a disability income [Music] plan good job good job Christian good job good job good job all right so David talked to you yesterday in life insurance about Buy sell agreements right Buy sell agreements so a disability buyout agreement the person didn't die they just became disabled so it's used in a partnership arrangement to buy out a totally disabled partner's interest in the business benefits are paid to the disabled partner taxfree taxfree taxfree so you didn't die you became totally disabled your partners buy you out so if a partner in a business becomes disabled the disability buyout does which of these pays the disabled partner okay so same thing so here at Insurance School of Texas I am absolutely critical to the operations folks right I we would shut the place down so I am a key employee and David really would have a struggle he'd have to find somebody else and be a pain so so anyway so I'm a key employee on the test it's going to say like a vice president or something like that so the same thing so if the key employ they don't die they don't die but they become totally disabled insurers uh benefits are paid to the employer employer employer taxfree so if David had a key employee Disability Policy on me I become disabled who gets paid David okay so business overhead so so y'all probably get this one on the test so business overhead ensures the business owner pays the actual cost actual cost actual cost y'all do y'all have y'all heard that word before overhead what's what's an give me an example of of overhead for a business rent utilities uh employee payroll those kind of stuff so what does this say pays for actual cost actual cost so what if they sold the business before they become disabled what's their actual cost of of of overhead nothing they sold the business so how much are they going to get paid nothing so the policy pays a monthly benefit paid on the actual not anticipated but the actual overhead expenses so whatever you paid your so if it's a doctor the doctor becomes disabled he um he he still Pays His nurses uh their their salary that's actual overhead he still Pays His lease on his office office he still Pays His utilities he still Pays His payroll those are actual costs okay so disability return reducing term pays a loan for a business should the owner become disabled okay so a corporation hires a new president concerned about losing him in an accident or due to an illness all of these would be true except is B BBB okay so the corporation hires the president the key person so let's let's let's table this for one second let's go back to keyman life insurance so I am a key man here at Insurance School Texas if David buys a key person life insurance policy on me is my husband GNA get paid no who's GNA get paid David David same thing the corporation buys the policy the president becomes disabled who's going to get paid the corporation right so so the the employee because I would and I do love you man but I would not pick you as my beneficiary David so anyway but but so the employee can't pick the beneficiary he is the policy owner he's the king of the policy he picks the beneficiary and the beneficiary is going to be him so a lawyer has a disability income policy used to pay uh office rent employee labor it is called overhead a nurse works for a doctor the doctor becomes disabled the nurse will still receive her pay due to which of these policies overhead her payroll is what overhead so G has a business overhead expense policy with a benefit of 5,000 per month uh G pays the annual premium January 1st and sells the business on July 1st two weeks later he becomes disabled how much will the insurer pay zero because they'll only pay the actual okay so change of occupation if we are going to change our occupation uh if the insurer is not informed of the change to a more hazardous occupation that the benefits will be reduced if you want to um if you're going to move to a less hazardous occupation you're going to have to apply uh to get uh to get that discount okay so cost of living Rider automatically increases the month ly benefit after the onset of a disability as the Consumer Price Index increases so let's talk about this one the guaranteed purchase option writer so on certain dates ages occurrences additional Insurance may be purchased without having proof of insurability so maybe maybe some of you all are starting an agency okay and it's it's a tough road the first two years it's you don't make as much as as as you will so so you you're starting your agency you're only making like 50 Grand the first year you know and and maybe not even that maybe you're struggling a little bit wor worse than that so can you afford but you know if you do this in in three years you're gonna be making $250,000 a year and you know you will so so and you will so so anyway so you're going to buy the disability income policy because if you become disabled you still need to get paid right so you buy the policy you don't have much money right now you're only making 50,000 right now so in the policy only going to pay 66 and 23% of that so you buy your policy now what are you going to want to do later on buy more insurance right you're going to want to buy more Insurance to replace your income that $250,000 income so so you can add this the guaranteed purchase option writer just like on a life insurance policy the guaranteed purchase option writer allows you guarantees that on certain dates ages occurrences additional Insurance can be purchased and you don't have to go through underwriting again again there's no proof of insurability okay impairment writer also known as an exclusion writer this El uh eliminates coverage for conditions that would otherwise make the insurance unobtainable for the insured so allows the insurer to offer a policy that they would normally not offer by covering uh by not covering a specific impairment so so we buy the disability income policy we have a back injury we're going the insurer says hey we can't write it unless we add this impairment writer which excludes what the back we'll write it we'll cover you for anything else cancer whatever happens but not for that back injury okay waiver of premium Rider so so just like Tony the roofer in life insurance and a waiver of premium if the insured becomes totally disabled the insurer waves the premiums for the duration of the disability okay so a person bought a disability income policy while working at a low risk job later the insured changes to a more hazardous job but fails to notify the insurer six months later the insured incurs a disability injury how will the insurer handle this they'll pay it they'll pay it they'll pay it but they will see good job they'll just you'll just get less you'll you'll get whatever uh the amount of Premium that you paid would have paid if class ified at the correct job code so a business owner buys a disability income policy for 2,000 a month which of these writers could be used to increase the benefits as his business grows without having to prove insurability an insurer wants to offer a person with a disability income policy a person wants to offer a person with a disability an insurer wants to offer a person with the disability income policy however they want to offer them a disability income policy sorry however the applicant has been disabled from a back injury in the recent past what would the insurer use to offer coverage without covering the pre-existing back injury impairment writer um B is disabled and receives payments from his disability income policy which of these Pays His premiums for him during the disability waiver of premium okay good job pull out your answer sheets and let's do one more next chapter is your jam Christina 10 seconds final seconds I know seconds final seconds fin seconds how'd y'all do good all right so so number one a person not concerned about becoming disabled on the job this is y'all struggled with this one a little bit person not concerned about becoming disabled on the job should buy which of these policies nonoccupational one is a two R is disabled and finds that she is temporary unable to perform her own job nor any job she is reasonably trained for this would be total two is B three a dentist has a disability income policy he becomes disabled and after a Time returns to work however he can only work part-time which provision pays this residual three is B four V has a disability income policy with a 30-day elimination period v becomes disabled on May 1st and returns to work on May 15 do we care no V becomes disabled again on June 1st and returns to work on September 1st how long did the disability income policy pay 60 days 60 days that period I never change it so so y'all there's if you put if you if if it's in your heart it's like 67% chance you you picked the right answer the first time uh four is C which of these is not used to determine premium in a disability income policy spouse's occupation five is b six G has a business overhead policy with a benefit of 5,000 a month G pays the annual premium on June 1st and sells the business on July 1st two weeks later he becomes disabled how much will the insure pay zero six is c number seven a business owner buys a disability income policy paying $2,000 a month which of these writers could be used to increase the benefits as his business grows without having to prove insurability D seven is D number eight an insurer wants to offer a person with a disability income po golly y'all an insurer wants to offer a person a disability income policy period however the applicant has been disabled from a back injury in the recent passed what would the insurer use to offer coverage without covering the pre-existing back injury impairment writer good job so who needs to see any of those y'all want a break y want five okay so uh be back at 10:24 y'all are making record time y'all are making record time sure so G has a business overhead expense policy with a with of 5,000 so overhead C covers the actual overhead actual overhead so with a $5,000 per month benefit G pays the annual premium on juli on January 1 and sells the business on July 1 two weeks after he sells it uh he becomes disabled so how much is his actual overhead if he already sold the business got you got got it so a a a business owner buys a disability income policy paying two grand a month which of these writers could be used to increase the benefits as his business grows without having to prove insurability guaranteed purchase so they'll be guaranteed to P purchase more insurance and you if you're starting a farmers agency I mean that you're the classic example of that right because you you probably used to work for a corporation and you probably used to have disability at work right now you got to buy your own and so you're not GNA be making that much your first couple years but as time goes on you're going to be making a ton right so so you might want you might need to but you don't W to you don't W to risk what if you get cancer next year you don't want to risk not being able to buy more insurance right anybody else online friends anyone anyone are you doing 13 okay you mind ifes out that time taking a r this is the last diet C hey I saw a mark just yesterday on on when we were leaving and I said what's going on over there on the other side of the building and I said what what company is moving in there and he said that's that that BNI company that does all the for the immigrants that oh is it really I said really he said yeah they're they're expanding and he said now they're going to have their own entrance they're going to have their own restrooms there's not going to be a bunch of people waiting around outside I said wow yeah yeah right now they certainly don't need that great big area he said I said they don't need that much area since the there's hardly anybody there anymore he said yeah but they had already signed that contract to get that done so they're stuck in it they've already those two they they've taken the test how many times have you guys tested I tce twice oh you're gold now oh yeah they've got it 68 and a 66 and you taken the test three times more four times you're you're GNA kill it now you guys got it if you to come here first you would been fine okay have a good one all right guys what' she say 24 is 24 just one more and we'll start last chapter so when are you testing Christian today at six today just go knock it out get it done well you'll have time to you know relax and before you go looking like time to take PR yeah even if you wanted you bet you could if you're not within 48 Hours of your test time yet it's oh it's in the morning can you change the test so did you look it up did you so yeah yeah you just need to call them you can't do that online yeah yeah just just call them and tell them I you know that you've double checked it and it's the wrong test I've never seen that on there no life accident in hell yes just like it says in your book where's our friend there he comes to save the day okay here we go guys let's do this last chapter and you guys can uh will be done and no more torture with me David and Chris all right so here we are in our last chapter this is the senior needs and government plans chapter 13 and for the last time we will do brainwashing I understand what I'm learning so I will pass my test yeah all right now chapter 13 so the first thing we're starting off with here is social security Now Social Security offers medical through what's called Medicare which is what what age did we say 65 it also offers retirement benefits it also offers disability benefits called the old age Survivor disability in uh income so so these are the benefits found in in Social Security medical retirement disability medical that's what's that's what you have available to you through your uh your Social Security because it's being taken out of your paycheck right now let's look at the Social Security Disability part of it Social Security Disability is available to people of any age who qualify by having worked and paid into social security for a certain amount of time to be fully insured you have to have 40 credits now a credit is a quarter it's three months 20 of those must have been in the last 10 years and so then you would be you would get the full Social Security disability benefits available to you currently insured is based upon your age starting with six credits in the last 13 quarters both now now both must wait five full months before the benefits are triggered to pay so should you become disabled you're going to have to wait how long five months the the what triggers this thing to pay is you have to be disabled five months if you're disabled four months and then you can go back to work you're not going to get paid you have to be disabled five months and that's what triggers it to say okay now we're going to start paying you okay that will probably be on your test what triggers it to pay the length of time you're disabled five months okay now what did they use to determine how much am I going to get paid David that's called your primary Insurance amount this is the amount of Social Security disability benefit available to a person who's disabled and it's based on your average index monthly earnings so how do what what uses primary Insurance amount is Social Security disability because they use this to determine how much we'll pay you or Social Security will pay you for being disabled so the only thing that uses this is your disability Social Security Now Medicare what is Medicare Medicare is what we call care for the elderly and why do we do that because pretty soon we're going to talk about Medicaid and Medicare and you got to know the difference so this is Medicare care for the people what 65 and older Elder now so eligibility you have to be age 65 or older or kidney failure or you could be uh lug Gars ALS others of any age who receive Social Security disability for at least 24 months so you could be you could be on Social Security Disability be 30 years old and be on Medicare for your hospital hospitalization now what if somebody turns 65 and continues to work in remains on their employer Group Health Plan then the group health plan would pay primary and Medicare wouldn't pay until secondary they would be a secondary insurer now the group health plan must have 20 employees for that rule to apply but they like that on the test okay does that make sense to everybody okay so Social Security offers all of these except what dismemberment right the OASDI the old age Survivor Health disability insurance is part of what that's part of Social Security in Social Security Disability what triggers the benefits to pay length of time because how long do you have to be disabled five months right okay what program pays benefits based on primary Insurance amount right a 50 year old on Social Security Disability has a hospital bill which policy would pay disability pays hospital bills Medicare how come not the group health because he's disabled how could he have Group Health right and you can't have workers Cal if you're on Social Security Disability because you're not employed right and that doesn't pay hospital bills but you could be any age and be on Medicare as long as you've been on soci security disability huh A and B you get both huh oh no a pays the hospital right right but they would be eligible for both parts A and B now if if an employee turns 65 and stays on his group health plan of an employer with 50 employees which policy is primary for him Group Health okay speaking of Medicare Parts Here We Go part A is the hospital part part A is the hospital it's the building related stuff so part A is called inpatient and it's provided by the federal government and free for those who 65 and over who've been put into Social Security for at least 10 years 40 quarters those who did not have to pay a premium or or I mean if you want it you have to pay a premium to get it now what does it pay for hospitalization a semi-private room miscellaneous Hospital expenses drugs while they're legal drugs not illegal post Hospital Skilled Nursing Facility care must have been in the hospital for three days so if you go into a a nursing home Medicare will uh uh yeah medic care will pay for that as long as you were in the hospital 3 days before which is sort of weird but they do they do force that home health care that is medically necessary skilled care nurses visits supplies hospice care that's hospice is pain relief or terminally ill Chris's dad and my dad both died of cancer and so what hospice did was they they came and jacked my dad up on warping so he wasn't in pain anymore but he was seeing things we didn't see there was an elephant in his bedroom he swore up and down no dad there's no elephant in here the the room's not big enough to hold an elephant so but he he said there was blood covered as an impatient except the first three pints annually Medicare pays after now that's another weird thing so you have a three pint deductible that's true most health insurance typically pays for like the first two or three pints and then after that you're responsible Medicare says uh nope we're going to say you pay the first three pints and maybe that's how they pick Social Security because honestly I don't know how many pints you can be low and be over 65 and still be alive well we're gonna get rid of this one I'd like to give you blood Mr lurvig but you know what the first three pints are on you and if you can't afford it oh well helps our social security all right so three pints three pints you're responsible for now yeah and we're going to get to that now Part B is the people related the people related stuff so it's a medical part the doctors nurses Etc and you pay a premium for that it provides benefits for 80% of what's called Medicare approved charges and what does it paay for medical expenses like Physician Services physical therapy diagnostic test Clinical Laboratory services like blood test and biopsies Home Health Care medically necessary skilled care and supplies outpatient hospital treatment