Chapter 3 (Health) Chapter Exam

a characteristic of preferred provider organizations (PPO) would be

Discounted fees for the patient

which of the following statements best describes the intent of a coinsurance clause in a major medical policy?

Discourages overutilization of the insurance coverage

what type of policy would only provide coverage for specific types of illnesses (cancer, stroke, etc)?

Dread disease insurance

The first portion of a covered Major Medical insurance expense that the insured is required to pay is called the

initial deductible

Which of the following phrases refers to the fees charged by a healthcare professional?

usual, customary and reasonable expenses

all of the following statements about major medical benefits are true, except

benefits have no maximum limit

which of the following policy features allows an insured to defer current health charges to the following year's deductible instead of the current year's deductible?

carryover provision

a major medical policy typically contains a provision that requires the insurer to pay only part of a loss, while the balance is paid by the insured. This provision is called

coinsurance

a major medical policy typically contains a provision that requires the insurer to pay only part of a loss, while the balance is paid by the insured. this provision is called

coinsurance

major medical policies typically

contain a deductible and coinsurance

A Hospital/Surgical Expense policy was purchased for a family of four in March of 2013. The policy was issued with a $500 deductible and a limit of four deductibles per calendar year. Two claims were paid in September 2013, each incurring medical expenses in excess of the deductible. Two additional claims were filed in 2014, each in excess of the deductible amount as well. What would be this family's out-of-pocket medical expenses for 2013?

$1,000

M has a Major Medical insurance policy with a $200 flat deductible and an 80% Coinsurance clause. If M incurs a $2,200 claim for an eligible medical expense, how much will M receive in payment for this claim?

$1,600

M has a major medical insurance policy with a $200 flat deductible and an 80% coinsurance clause. If M incurs a $2,200 claim for an eligible medical expense, how much will M receive in payment for this claim?

$1,600

Q is hospitalized for 3 days and receives a bill for $10,100. Q has a Major Medical policy with a $100 deductible and 80/20 coinsurance. How much will Q be responsible for paying on this claim?

$2,100

J's major medical policy has a $2,000 deductible and an 80/20 coinsurance clause. if J is hospitalized and receives a bill for $10,000, J would pay:

$3,600 ($2,000 + 20% of the remaining bill = $3,600)

an individual has a major medical policy with a $5,000 deductible and an 80/20 coinsurance clause. how much will the insured have to pay i of a total of $15,000 in covered medical expenses are inccured?

$7,000 ($5,000 + 20% of the remaining bill)

B's policy provides coverage on an in-hospital basis only and contains a limited daily room and board benefit. Which of these policies does B have?

Basic hospital

all of these characteristics of a health reimbursement arrangement (HRA) except

HRA is entirely funded by the employee

S wants to open a tax-exempt Health savings account. To qualify for this type of account, federal law dictates that S must be enrolled in a

High Deductible Health Plan

which of the following statements about health reimbursement arrangements (HRA) is correct?

If the employee paid for qualified medical expenses, the reimbursements may be tax-free

in major medical expense policies, what is the objective of a stop loss provision?

Limits an insured's out-of-pocket medical expenses

in order to establish a health reimbursement arrangement (HRA), it must:

be established by the employer

which of the following best describes a hospital indemnity policy?

coverage that pays a stated amount per day of a covered hospitalization

which of the following statements best describes the intent of a con insurance clause in a major medical policy?

discourages over-utilization of the insurance company

A comprehensive major medical health insurance policy contains an eligible expenses provision which identifies the types of health care services that are covered. All of the following health care services are typically covered, except for

experimental and investigative services

a comprehensive major medical health insurance policy contains an eligible expenses provision which identifies the types of health care services that are covered. all of the following health care services are typically covered, except for

experimental and investigative services

basic medical expense insurance

has lower benefit limits than Major Medical insurance

for which of the following expenses does a basic hospital policy pay?

hospital room and board

under a basic medical expense policy, what does the hospitalization expense portion cover?

hospital room and board

J was reviewing her health insurance policy and noticed the phrase "this policy will only pay for a semi-private room". this phrase is considered to be a(n)

internal limit

which of the following situations does a critical illness plan cover?

leukemia

which of the following is not a limited benefit plan?

life insurance policies

in Major Medical Expense policies, what is the objective of a stop loss provision?

limits an insured's out-of-pocket medical expenses

a catastrophic illness would be best covered by which of the following health insurance plans?

major medical

the individual health insurance policy that offers the broadest protection is a(n) ______ policy

major medical

deductibles are used in health policies to lower

overuse of medical services

a major medical policy typically

provides benefits for reasonable and necessary medical expenses, subject to policy limits

which of the following services is not included under hospitalization expense coverage?

surgical fees