Chapter 3 Medical Expenses

Which provision allows a portion of any used medical benefits to be restored following a particualr amount of benefit has been used, or after the policy has been in effect for a particular period of time?

Reimbursement beneefit Restoration of unused benefit Restoration of used benefit Medical offset benefit * Restoration of used benefit

Which of the following medical expenses does Cancer insurance NOT cover?

Chemotherapy Radiation treatment Physicians visit Arthritus * Arthritis

Which of the following is NOT Aa limited benefit plan?

Dental policy Life insurance policy Cricitcal illness policy Cancer policy * Life insurance policy

Which of the following is NOT a limited benefit plan?

Dental policy Life insurance policy Critical illness policy Cancer policy * Life insurance policy

Which of the following statements BEST describes the intent of a Coinsurance clause in a Major Medical policy?

Discourages over utilization of the insurance coverage Minimizes the need for deductibles Discourages adverse selection Minimizes the waiting period * Discourages over utilization of the insurance coverage

A major medical policy typically:

provides benefits for surgical expenses only, subject to policy limits contains more limitaions than a Basic Hospital, Medical, or Surgical policy contains a 60-day Elimination period for losses due to accident provides benefits for reasonable and necessary medical expenses, subject to policy limits *provides benefits for reasonable and necessary medical expenses, subject to policy limits

C was injured while deep sea diving and requires a hospital stay. C has a Major Medical policy with a 80/20 coinsurance clause and a $400 deductible. What is the MAXIMUM C will pay if the covered medical expenses are $2000?

$0 $400 $720 $1,000 *$720

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 $2,020 $2,000 $100 $2.,100

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?

$500 $1,000 $1,500 $2,000 *1,000

All of these are characteristics of a Health Reimbursement Arrangement (HRA) EXCEPT

HRA is entirely funded by the employee HRA is entirely funded by the employer Reimbursement for eligible medical expenses are allowed HRA can be offered with other health plans *HRA is entirely funded by the employee

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

MEWA Blanket insurance Dread disease insurance Disability insurance *Dread disease insurance

The individual Health Insurance policy that offers the broadest protection is a(n) _________ __________ policy

Surgical Benefit Indemnity Medical Major Medical Hospital Expense *Major Medical

Which of these options can an individual use their medical flexible spending account to pay for?

Vitamins and supplements Prescription drugs Household expenditures Cosmetic procedures *Prescription drugs

A comprehensive major medical health insurance policy contains an Eligible Expenses provision with identifies the types of health care services that are covered. All of the following health care services are typically covered, EXCEPT for:

hospital charges physician fees experimental and investigative services nursing services *experimental and investigative services

T was treated for an ailment 2 months prior to applying for a health insurance policy. This condition was noted on the application and the policy was issued shortly afterwards.How will the insurer likely consider this condition?

insurer will require a higher deductible for any claims resulting from this condition Insurer is required to initally cover this pre-exisitng condition Insurer will permanently exclude the condition from the policy Insurer will likely treat as a pre-existing condition which may not be covered for one year * Insurer will likely treat as a pre-existing condition which may not be covered for one year