Chp. 3 Medical Expense Insurance

Basic Hospital and Surgical policy benefits are:

lower than the actual expenses incurred

A major medical policy typically:

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

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

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 if a total of $15,000 in covered medical expenses are incurred?

$7,000

Which of the following statements BEST describes the intent of a Coinsurance clause in a Major Medical policy? A.) Discourages overutilization of the insurance coverage B.) Minimizes the need for deductibles C.) Discourages adverse selection D.) Minimizes the waiting period

A.) Discourages overutilization of the insurance coverage

Which of the following health insurance coverages is BEST suited for meeting the expenses of catastrophic illness? A.) Major Medical B.) Hospital Expense C.) Surgical Expense D.) Hospital Income

A.) Major Medical

Which of the following statements BEST describes dental care indemnity coverage? A.) Services are reimbursed before the insurer receives the invoice B.) Services are reimbursed after insurer receives the invoice C.) In-network dentists must always be used D.) Very limited list of providers

B.) Services are reimbursed after insurer receives the invoice

All of the following are limited benefit plans, EXCEPT: A.) cancer policies B.) life insurance policies C.) dental policies D.) critical illness policies

B.) life insurance policies

What type of policy would only provide coverage for specific types of illnesses (cancer, stroke, etc)? A.) MEWA B.) Blanket insurance C.) Dread disease insurance D.) Disability insurance

C.) Dread disease insurance

Which of the following individual health insurance policies will provide the broadest protection? A.) Hospital Expense B.) Surgical Expense C.) Major Medical D.) Limited Sickness

C.) Major Medical

A characteristic of Preferred Provider Organizations (PPOs) would be:

Discounted fees for the patient

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 likely treat as a pre-existing condition which may not be covered for one year

Which of the following types of health coverage frequently uses a deductible? A.) Major Medical policy B.) Basic Surgical policy C.) Basic Hospital policy D.) Worker's Compensation

Major Medical policy

For which of the following expenses does a Basic Hospital policy pay?

hospital room and board

With a Basic Medical Expense policy, what does the hospitalization expense cover?

hospital room and board