Freiberg and Peck

Freiberg and Peck, Public Health Benefits for the Injured or Disabled

A permanent injury or disability may require long-term medical care. The expense of medical treatment combined with not being able to work can be financially devastating for people who do not have private insurance, depleting their savings and even leading to bankruptcy. Two government programs, Medicare and Medicaid, may be able to help with the cost of medical care for people who are not able to work because of an injury or disability.

Medicare Benefits

Medicare is a health insurance program for people over the age of 65, or for people with disabilities under the age of 65. Medicare has two programs, Medicare Part A and Medicare Part B. Medicare Part A is hospital insurance. It is usually provided free to people who meet the age or disability requirements because most people pay Medicare taxes while they are working. Medicare Part A benefits help pay for stays in a hospital, nursing facility, or hospice, and some home health services.

Medicare Part B is a medical insurance program that people can choose to enroll in at the age of 65. In 2006, Part B insurance costs $88.50 per month. Medicare Part B helps pay for medically necessary doctor’s care, home health services, outpatient hospital care and physical therapists.

Medicare Eligibility Requirements

People under the age of 65 with an injury or disability are eligible for Medicare Part A insurance if they have been collecting Social Security or Railroad Retirement Board disability payments for 24 months, or if they are a kidney dialysis or kidney transplant patient. People who meet the conditions to get Part A insurance can also choose to buy Part B insurance. (For more specific information on what Medicare covers, visit www.medicare.gov/Coverage/Home.asp.)

Social Security disability payments are only available to people with a long-term, total disability. A disability is based on whether or not you are able to work. If you cannot do the work you did before or adjust to new work because of an injury or medical condition, and the condition has lasted or is expected to last for at least a year or result in death, then it meets the standard for a long-term, total disability. The Railroad Retirement Board disability payments also require a “permanent disability” that results in an inability to work. Because Medicare eligibility for people under age 65 requires a serious and long-term disability, it is not usually revoked once granted.

To find out if you are eligible for Medicare, visit www.medicare.gov . Under the “Search Tools,” follow the link that says “Find out if you are eligible for Medicare and when you can enroll.” The website will take you through a series of questions to determine your eligibility, and if you are eligible will instruct you on how to enroll in the program. You may also do this over the phone by contacting the Social Security Administration between 7 a.m. and 7 p.m. Monday through Friday at 1-800-772-1213.

Medicaid Benefits and Eligibility Requirements

Medicaid is a program designed to assist people and families with low incomes. It pays money directly to health care providers and may require a co-pay. Medicaid benefits vary from state to state, but must include hospital services, vaccinations, prenatal care, family planning services, rural clinics, pediatric service and screenings, and laboratory and x-ray services. Unlike Medicare benefits, Medicaid benefits end within a month if the recipient’s financial situation improves.

Medicaid varies from state to state, and each state defines what makes a person eligible for Medicaid. In general, families that qualify for Aid to Families with Dependent Children, children under the age of 6 and pregnant women in low-income families (at or below 133 percent of the Federal Poverty Level; roughly $26,600 for a family of four) qualify for Medicaid. To find out about elegibility requirements and to apply for Medicaid, contact your county Social Security office. To find the office nearest you, visit the Social Security Office Locator.

Freiberg and Peck, China and Hong Kong: Insurance Law Update

Foreign insurers are currently permitted to provide services in 15 major Chinese cities; all geographical restrictions should be removed by the end of the year. Domestic insurers are now permitted to establish sales and distribution outlets in all locations where they have branches.

Since the end of 2003 foreign non-life insurers may conduct short-term health and casualty insurance business, and a number of applications to carry on this business are being reviewed by the China Insurance Regulatory Commission (CIRC).

It is expected that the group insurance and annuities markets for life insurers will be opened by the end of the year. The requirement on property liability insurers in China to reinsure 20% of their primary risk with China Re was reduced to 10% on December 11, 2003 and will be reduced to 5% by December 11, 2004.

Flexibility has been given to insurers to develop and launch new insurance products for accident, home, liability, commercial and cargo insurance without first seeking CIRC approval, although insurers will continue to be required to notify the CIRC of new products within seven days after they are introduced to the market.

The CIRC has also relaxed its control over the premium that may be charged for insurance products other than vehicle, health and statutory liability insurance.

On January 15 the CIRC issued the Administrative Measures on Foreign Insurance Institutions’ Representative Offices, which came into effect on March 1. The main changes introduced by the administrative measures include the following:

• References to foreign-invested insurance institutions have been changed to foreign insurance institutions (ie those registered overseas);

• There are new provisions for representative offices regulated by local branches of the CIRC;

• There is a 20-day deadline for the CIRC to approve the establishment of or changes to representative offices (extendable by 10 days with permission of the CIRC chairman);

• Government approval is no longer necessary for changes of address or the number of representatives, vice-representatives or foreign employees, though such changes must be reported to the CIRC;

• There is repeal of provisions for examination and extension of the representative office term; and

• Penalties for infringement of Chinese insurance laws are set out.

The administrative measures specify the minimum work experience and qualifications of the general representative and chief representative of a representative office and prohibit representative offices from participating in any revenue-generating business activities. Foreign insurers with representative offices must report any changes to their articles, registered capital or business address to the CIRC. Termination of any representative office and any change to the general or chief representative must be approved by the CIRC before the change is implemented and the CIRC may conduct regular inspections of representative offices.

With effect from June 1, insurers will be permitted to invest their premium income with asset management companies. Insurers seeking to establish asset management companies must satisfy certain specified minimum capital and investment requirements.

On January 15 the CIRC issued a notice requesting all insurers to alter their insurance policies and rates for motor credit insurance. The existing policies and rates were repealed on March 31. Insurers are required to separate their motor credit insurance business from other motor insurance businesses, and local branches may not undertake insurance business for policyholders based in other locations.

A new rule to permit domestic insurers to invest up to 5% of their assets in domestic stock markets (providing access to non-tradable and freely-traded shares and convertible bonds from listed companies) is anticipated, although no timetable for implementation has yet been indicated.

The proposed terms and premiums of relevant insurance policies are being reviewed by the CIRC to implement a new rule requiring all motorists to purchase third-party liability insurance coverage (at present, only certain municipalities, provinces and autonomous regions require third-party liability insurance).

The Closer Economic Partnership Arrangement (Cepa) between China and Hong Kong was entered into on June 29, 2003 and implemented on January 1.

It provides accelerated access for insurers in Hong Kong to enter the China insurance market and allows Hong Kong insurance agents and brokers to practise in China without prior approval from the CIRC, though the remaining criteria for establishment in China still apply.

To take advantage of Cepa, insurers and brokers carrying on insurance business in Hong Kong must be incorporated in Hong Kong (registered overseas companies will not be eligible) and satisfy other criteria regarding their businesses in Hong Kong. An investment of up to 24.9% of the capital in a China insurer (up from 10%) is also now permitted.

Licensed corporations that participate in the Hong Kong Futures Exchange and the Stock Exchange of Hong Kong are required to take out and maintain insurance if they participate in dealing in securities, futures contracts or securities margin financing. Aon Hong Kong has been appointed to source the relevant master policy.

The public consultation on the feasibility of establishing insurance policyholders’ protection funds in Hong Kong designed to provide a safety net to policyholders if an insurer faced financial difficulties ended on March 31. A report following that consultation is expected shortly.

Following an interim report, a consultation paper on establishing a supervisory framework of the assets of long-term insurers will be published for public comment shortly.

The Employees Compensation Insurer Insolvency Scheme (ECIIS) is scheduled to come into effect on August 1 to cover employee compensation claims arising from the insolvency of employee compensation insurers.

The ECIIS will replace the existing Employees Compensation Assistance Scheme. The ECIIS will be financed by contributions from employee compensation insurers and a levy.

The Office of the Commissioner of Insurance (OCI) is structured as a governmental regulatory agency.

It is proposed that the OCI be converted into an independent, non-governmental regulatory agency and relevant stakeholders are being consulted to determine the most effective structure for the OCI.

Various minor amendments have been made to the Code of Practice for the Administration of Insurance Agents, which will take effect on June 1.

A study on the desirability and feasibility of operating a Central Employees’ Compensation Scheme has commenced. The study will focus on the operation and financial arrangements of comparable schemes in overseas jurisdictions.

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