August 2010 - Monthly Insurance Q&A
Q. How does one get a medical leave of absence?
A. If you're employed for a corporation with 50 or more employees you'll qualify for the Family Medical Leave Act, which allows typically up to 12 weeks for unpaid leave or more if you're within the military. Also, your state may have its own laws that complement FMLA or are additionally to the present leave. ask the dept. of labor in your state.
Q. What are the essential maternity leave laws?
A. this relies on the state, but Family Medical Leave Act typically allows up to 12 weeks for unpaid leave. Also, your state may have its own laws that complement FMLA or are additionally to the present leave. ask the dept. of labor in your state.
Q. what's the difference between claims-made & occurrence malpractice?
A. Claims-made covers you for claims submitted while the policy is effective and if the tort happened from the retro date through the date of the present policy. Occurrence policy covers claims that occurred during the policy period, and therefore the policy doesn't need to be effective .
Q. Do IPAs need medical malpractice insurance?
A. No they have industry specific errors and omissions and directors and omissions insurance that has vicarious malpractice, which covers the IPA's risk for malpractice.
Q. what is the difference between medical malpractice vs errors and omissions?
A. They both cover errors. But Medical Malpractice covers physicians for direct medical aid and Errors and Omission covers a business if it makes a mistake .
Q. What does statutory limits mean on a worker's comp policy?
A. In many nations you can't sue an employer for quite $1 million by law, excepting gross negligence. Therefore it's a law therefore the policy models the statute's limits.
Q. what's an excess worker's comp policy?
A. it's for employers who self insure their workers comp. They buy excess or stop loss insurance. This insurance limits the employer's exposure to unexpected total claims, or the precise claims of 1 person.
Q. what's more than limit losses in workers compensation?
A. this will ask an excess policy, which you'll buy over a totally insured policy. Normally workers compensation is restricted to the statute, but if gross negligence are often proven then a claimant can sue for quite the bounds of statute. If this happens, and therefore the employer has an Umbrella policy, it's going to answer the claim that exceeds the limit of the workers compensation policy.
Q. what's worker's compensation aggregate retention?
A. this is often the entire amount of claims that you simply , the employer, pays till the insurer starts paying.
Q. How does one account for workers compensation aggregate stop loss deductible?
A. once you purchase aggregate stop loss for your self-insured workers compensation, the insurer will define upfront what the mixture is. Your TPA or third party administrator should offer you periodic aggregate reports showing the entire amount of claims paid as they accumulate toward meeting the mixture stop loss deductible.
Q. What are reinsurance triggers in healthcare?
A. It depends. Health insurers can have an outlined dollar amount where they're laying risk off to a reinsurer. Example: A health insurer may buy a $100K of specific reinsurance coverage, thus if one patient hits a $100K, then every dollar above that quantity are going to be reimbursed by the insurer.
Q. What are the 2 sorts of stop loss in hospitals?
A. Specific stop loss covers the hospital for claims that exceed an outlined dollar amount for a patient. Example: The hospital for its self insured health plan, or its capitated members, can purchase a $100K of specific stop loss deductible which suggests the insurer can pay all claims that exceed $100K.
The other is aggregate stop loss which covers the hospital for all the claims it pays call at its self insured plan. Example: The insurer will cover you if your total claims paid within the year exceed $5 million. The insurer will reimburse the amounts that exceed that quantity .
Q. Does a 3rd party FMLA administrator have the proper to contact your healthcare provider?
A. Yes they need the proper to invite a second opinion, and/or have your doctor complete a form. But contacting them directly, I doubt, would be effective since the MD cannot talk with them thanks to HIPAA.
Q. What does it mean if your HMO sent a letter saying you've got reached the catastrophic portion of you policy?
A. Not sure, this will mean that you simply have reached the utmost out of pocket limit.
A. Yes, they have to place you on COBRA. insurance requires that you simply are to be full time and actively at work. once you are out on a workers compensation claim, you can't meet this requirement.
Q. How can a corporation process employees' medical claims?
A. The employer, if it's large enough , can take their claims in house and act as a TPA. Most companies don't do that anymore thanks to HIPAA concerns, most outsource this to an independent TPA.
