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