Medical Expense Insurance

All of the following statements about major medical benefits are true, EXCEPT?

Benefits have not maximum limit

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 covered medical expenses are incurred?

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

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 (In this situation, $2,200 - $200 deductible X %80 = $1,600

An insured covered by a group major medical plan is hospitalized after sustaining injuries that resulted from an automobile accident. Assuming the plan had $1,000 deductible and an 80/20 coinsurance clause, how much will the INSURED be responsible to pay with $11,000 in covered medical expenses?

$3,000 (the insured is responsible for $1,000 deductible + 20% of the remaining bill = $3,000)

Which of the following BEST describes a hospital indemnity policy?

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

This type of deductible provision waives the deductible for all family members after some of them have satisfied individual deductibles within the same year?

Family maximum deductible

All of these are characteristics of a health reimbursement arrangement (HRA) EXCEPT?

HRA are entirely funded by the employee (HRA plans are employer funded medical reimbursement plans)

The first portion of a covered major medical insurance expense that the insured is required to pay is called the?

Initial deductible

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

Hospital room and board

Generally, how long is a benefit period for a major medical expense plan?

One year

A major medical policy typically?

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

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

Restoration of used benefit

Which of the following cost would a basic hospital, surgical policy likely cover?

Surgically removing a facial birthmark

Which of the following statements BEST defines usual, customary, and reasonable (UCR) charges?

The maximum amount considered eligible for reimbursement by an insurance company under a health plan

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

Usual, customary, and reasonable expenses