Medical Expense Insurance

comprehensive

Chris has a single major medical contract which covers all medical expenses. His plan is considered to be

the cost of each service is scheduled

Fee-for-service is a method of administering health insurance benefit payments in which

Custodial care

Major medical plans typically exclude coverage for which of the following benefits?

Flexible Savings Accounts

The "Use it or Lose it" rule applies to

deductible amount

The amount of a covered loss to be paid by the insured before a major medical expense policy begins to pay is called the

20%

Mary has a Health Savings Account (HSA). Distributions that she has made for anything other than qualified medical expenses are considered taxable and subject to a penalty of

by the employer

A Health Reimbursement Arrangement MUST be established

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

General nursing care

A major medical expense plan typically includes coverage for hospital room and board. Which of the following is normally covered under the category "room and board"?

pay surgeon fees on a first-dollar basis

A major medical expense policy typically does NOT

highest amount payable

A medical fee schedule shows the amount an insurer will pay for a given procedure. This amount is considered to be the

Claim must be paid after proof of loss is received

A policyowner suffers a covered accident and health insurance loss on June 30 and submits the proof of loss to the insurer July 10. If the policyowner cancelled the coverage on July 2, how will the insurance company handle the claim?

prior health matters

A pre-existing condition exclusion in an accident and health insurance policy pertains to

Both pay on a fee-for-service basis

A preferred provider plan and an indemnity plan are similar in what way?

$960,000

An individual is insured under a major medical plan with a $1,000,000 lifetime benefit. The plan has a $500 deductible and an 80% coinsurance. If the insured suffers a $50,500 medical expense during the calendar year, what is the remaining lifetime benefit?

$240

Dan has a major medical expense policy with a $200 deductible and an 80/20 coinsurance provision. He incurs covered medical expenses of $100 in November and $400 in January. Under the carryover provision, what will the insurer pay?

1 year

How long is individual medical expense insurance normally written for?

the applicant must be enrolled in a High Deductible Health Plan (HDHP)

In order to contribute to a Health Savings Account (HSA),

May reduce her benefits

Karen is considering replacing her individual accident and health insurance policy with another individual policy. She has had issues in the past with her gall bladder that would be considered a pre-existing condition. How will a pre-existing conditions exclusion affect Karen's new insurance contract?

$800

Larry has a Major Medical Expense policy for his family with a $1,000 per family/per year deductible and an 80/20 coinsurance provision. If Larry's family files four claims of $400, $800, $100, and $700 in one year, how much will the insurance company pay?

Flat deductible

Major Medical policies are typically characterized by which of the following?

three

The major medical deductible carryover period normally applies to expenses incurred during the last ___ months of the plan year.

Average charges within a geographic region

What are reasonable and customary charges for health insurance primarily based on?

A specific illness or event

What do Limited accident and health policies normally cover?

Limited perils and amounts

What is covered under a limited accident and health insurance policy?

50 employees

What is the MAXIMUM number of employees an employer may have for qualified medical savings accounts?

Treatment in a government facility

Which of the following does medical expense insurance NOT typically cover?

Rehabilitation

Which of the following is NOT included as a hospice benefit under a major medical plan?

Cancer plan

Which of the following is considered a Limited accident and health plan?

Claims can be sent directly to the insured

Which of the following statements is true regarding accident and health insurance claims that reimburse on an indemnity basis?

Major medical policy

Which of these policies is considered to be a comprehensive health policy?

Benefits are paid on a capitation basis

Which of these statements regarding Major Medical Expense insurance is NOT true?

Only persons under the age of 65 are eligible

Which statement is NOT true regarding health insurance policies that provide limited benefits?

Per-cause

Which type of deductible must be satisfied again for each illness or accident in a major medical plan?