Medical Expense Insurance
An insured has a stop-loss limit of $5,000, a deductible of $500, and an 80/20 coinsurance. The insured incurs $25,000 of covered losses. How much will the insured have to pay?
$5,000
Kim has health insurance with a deductible of $500 and an 80/20 coinsurance. How much will she pay if she incurs a loss of $1,500?
$700
Ted has a health insurance plan that requires him to pay a specific sum out of pocket before any benefits are paid in a calendar year. Which of these does his health plan have?
Calendar-year deductible
What type of policy would only provide coverage for specific types of illnesses (cancer, stroke, etc)?
Dread disease insurance
Which type of coverage pays an amount per day for hospitalization directly to the insured regardless of the insured's other health insurance?
Hospital indemnity
Which of the following is NOT included under a health benefit plan?
Hospital indemnity plan
Which of the following types of deductibles would apply a single deductible to both medical and dental insurance coverage?
Integrated deductible
Low frequency diseases can be exclusively covered by what kind of health insurance policies?
Limited policies
What is the tax liability for employer contributions in Health Savings Accounts (HSA's)?
No tax payment needed
Who is the individual paid on a fee-for-service basis?
Provider
How is a health provider reimbursed if they do NOT have an agreement in place with the insurance company?
With a usual, customary, and reasonable fee
Major Medical expense plans provide coverage for each of the following EXCEPT
Work-related injuries
An insured has a health plan that pays established amounts in accordance with a list of injuries, surgical procedures, or other losses. This list is called a
benefit schedule
Jennifer is required to pay a specific sum out of pocket before any benefits are paid in a year. Her health policy most likely contains a(n)
deductible
A pharmacy benefit covers prescription drugs derived from a list called a(n)
drug formulary
All of these are characteristics of a major medical expense policy EXCEPT
elimination periods
A payment system for health care in which the provider is paid for each service given is called
fee-for-service
A proposed insured for a health insurance policy was treated for heart disease within the past year. When applying for health insurance, the heart disease treatment
indicates a preexisting condition
A dread disease policy is considered to be a type of
limited health insurance policy
An indemnity plan
provides the insured a specific dollar amount for services
"Maximum benefits" refers to the
upper limit of the total lifetime benefits the insurance company will pay
A policyholder has a major medical plan with a 80%/20% coinsurance and a deductible of $75. If the insured has previously met her deductible and receives a bill for $175, how much will the insurer pay?
$140
Kate has a Major Medical Plan with a 75/25 coinsurance and a deductible of $25. How much will she have to pay if she, not having met any of her deductible, visits the doctor and receives a bill for $125?
$50.00
All of the following are qualifications for establishing a health savings account (HSA) EXCEPT
Enrolled in a health plan with a prescription drug benefit
All of the following plans allow for employee contributions to be taken on a pre-tax basis EXCEPT
Health Reimbursement Arrangement Plan
The focus of major medical insurance is providing coverage for
medical and hospitalization expenses
The elimination period under a hospital indemnity plan is
the specified number of days an insured must wait before becoming eligible to receive benefits for each hospitalization