Personal Finance Chapter 9

Health insurance coverage is only available from private insurance companies.

False

Most private insurance companies do not provide group policies.

False

The hospital indemnity policy is a major medical protection.

False

Managed care is offered by which of the following?

Health maintenance organizations Point-of-service plans Preferred provider organizations

expense coverage pays for some or all of the daily costs of room and board during a hospital sta

Hospital

Which type of insurance pays part or all of hospital bills for room, board, and other charges?

Hospital expense insurance

Which type of policy pays benefits when you are hospitalized that are in cash that you can spend as you choose?

Hospital indemnity policy

What are some questions to ask or things to consideration when evaluating a long-term care insurance policy?

How much does the policy pay each day? Is the policy guaranteed renewable? Does the policy have a maximum lifetime benefit?

Which type of limit sets specific levels of repayment for certain services?

Internal

Physician expense insurance provides benefits for which of the following?

Lab tests Doctors' fees for nonsurgical care X rays

Which type of insurance pays the larger expenses of a serious injury or long illness, including those covered by the hospital, surgical, and physician expense policies, beyond those paid by basic health insurance?

Major medical expense insurance

Which type of insurance covers only doctors' fees for nonsurgical care, X rays, and lab tests?

Physician expense insurance

Which policy provides benefits based on the actual expense incurred?

Reimbursement

health services for an HMO include vision and prescription services.

Supplemental

Which type of insurance pays part or all of the surgeon's fees for an operation?

Surgical expense insurance

Copayment is the provision under which the insured pays a flat dollar amount each time a covered medical service is received.

True

Federal laws have provided federal standards to ensure that workers will not lose their health insurance if they change jobs.

True

Health insurance is one way people protect themselves against economic losses due to illness, accident, or disability.

True

Which of the following statements is NOT true?

You have 30 days from the date coverage ends to elect COBRA.

Coordination of benefits prevents you from collecting benefits from two or more group policies that would in total ______ the actual charges

exceed

A health maintenance organization (HMO) is a health insurance plan that provides a wide range of health care services for a(n) ________ monthly premium.

fixed prepaid

Most private insurance companies are providers of

group

The the deductible, the less expensive the policy.

higher

Blue Cross is an independent, nonprofit membership corporation that provides protection against the cost of

hospital

expense coverage pays for some or all of the daily costs of room and board during a hospital stay.

hospital

Preventive care for an HMO includes checkups, screening, testing, and routine

immunizations

HMO preventive care services cover periodic checkups as well as:

immunizations. screening programs. diagnostic testing.

Fill in the blank question. A(n) policy provides specified benefits regardless of whether the actual expenses are greater or less than the benefits. A(n) policy provides benefits based on the actual expense. This is taken directly from the text.

indemnity reimbursement

A health insurance plan should be coordinated to the needs of the:

individual

The deductible is an amount the policyholder must pay before benefits become payable by the

insurance

Comprehensive major medical insurance policies are complete insurance policies offering a very _____ deductible.

low

medical expense insurance pays the large costs involved in long hospital stays and multiple surgeries, and it covers every type of care and treatment prescribed by a physician, in and out of a hospital.

major

Blue Shield is an independent, nonprofit membership corporation that provides benefits for

sugery

The two factors that greatly affect the cost of health insurance are:

the amount of coinsurance the size of deductible

In terms of dollar amount or a number of days in the hospital, what determines the maximum amount paid?

Benefits limits

Name an independent, nonprofit membership corporation that provides protection against the cost of surgical and medical care (not hospital care).

Blue Shield

A "good" health insurance plan pays what percentage of out-of-hospital expenses once a yearly deductible for the individual and family have been met?

80%

What might a person who is uninsured experience during times of illness and injury?

A financial burden

A "good" health insurance policy provides which of the following?

Pay at least 80 percent of out-of-hospital expenses after a yearly deductible of $1,000 per person or $2,000 per family Offer basic coverage for hospital and doctor bills

An insurance policy with exclusions and limitations provision may deny coverage for preexisting conditions, cosmetic surgery, or routine checkups.

True

Name an independent, nonprofit membership corporation that provides protection against the cost of hospital care.

blue crsss

A provision under which the insurer and insured share the covered losses (for example, you pay 25 percent) is called:

coinsurance.

A provision under which the insured pays a flat dollar amount each time a covered medical service is received is called:

copayment

Long-term care insurance provides coverage for:

daily help

An amount the insured must pay before benefits become payable by the insurance company is called a:

deductible

Group policies:

do not always cover the needs of every employee

The exclusions and limitations provision specifies the conditions or circumstances for which the policy:

does not provide benefits

The benefit limits provision defines the maximum benefits possible in terms of either a(n)

dollar days

Age, marital status, and dependency requirements are usually specified in the ______ provision of an insurance policy.

eligibility

Not all group policies cover the needs of all _____. Additional coverage may be needed.

employees

In a group health insurance plan arrangement, ______ and ______ are most likely to pay for the cost of health care.

employees employers

In most group health insurance plans, the employees pay part of the premium and the

employer

in most group health insurance plans, the employees pay part of the premium and the pays ______ the remainder.

employer

Health insurance coverage is available from:

government programs hospital service plans private insurance health maintenance organizations

Employers typically provide health insurance called ____ health insurance. (Enter one word per blank.)

group

With a(n) ______ policy provision, the insurance company cannot cancel unless you fail to pay premiums when due.

guaranteed renewable

_____ is the process of paying a premium in exchange for financial protection.

insurance

Coinsurance is a provision under which the ______ share the covered losses.

insurer and the insured

The eligibility provision defines who:

is entitled to benefits under the policy

-term care insurance provides day-in day-out care for extended illness or disability. (Enter one word per blank.)

long

Prepaid health plans that provide comprehensive health care to members are called

managed care.

Aggregate limits are limits on the

maximum

Most insurance policies set a _____ amount they will pay for each day you are in the hospital and may limit the _____ they will cover.

maximum; number of days

Most insurance policies set a _____ amount they will pay for each day you are in the hospital and may limit the _____ they will cover. Multiple choice question.

maximum; number of days

Surgical expense insurance pays part or all of surgeons' fees for a(n)

operation

Basic health insurance coverage is a combination of:

physician expense insurance surgical expense insurance hospital expense insurance

Fill in the blank question. Under the guaranteed renewable policy provision, the insurance company cannot raise premiums unless it raises premiums for all members of your

plan

A policy that limits the total of the coinsurance and deductibles you must pay will limit your financial burden, but also increase your:

premiums

Fill in the blank question. Out-of-pocket limit is a provision in an insurance policy that limits the amount one must pay, but this causes the

premiums

Supplemental health services for an HMO include

prescription services vision care

Fill in the blank question. Dental expense insurance provides reimbursement for the expense of services and supplies and encourages

preventive

A provision under which an insured pays all costs up to a certain amount, after which the insurance company pays 100% of the remaining covered expenses, is called a:

stop-loss

Fill in the blank question. Aggregate limits are limits on the

total

Stop-loss is a provision under which an insured pays a certain amount, after which the insurance company pays _____ percent of the remaining covered expenses.

100

cuts down on paperwork and time by allowing your insurance company to pay the hospital or doctor before you receive the bill from them. Multiple choice question.

Assigning benefits

Which of the following provides temporary continued coverage under your employer's health plan if you lose your job?

COBRA

Choosing a health insurance plan requires which of the following?

Comparison shopping Study

Which type of insurance is complete major medical insurance that has a very low deductible?

Comprehensive

What provision allows you to collect benefits from two or more group policies that could not exceed the actual charges?

Coordination of benefits

Which type of insurance provides reimbursement for the expense of services and supplies and encourages preventive care for teeth?

Dental expense insurance

Which of the following insurance policies is considered to have a poor value?

Dread disease insurance

Which of the following is not true about hospital expense coverage?

These policies pay all costs of being hospitalized with no limits

Before buying a long-term care insurance policy, which of the following is least important?

To closely examine marketing pitches from the company

The Health Insurance Portability and Accountability Act of 1996 provides:

a parent with a sick child can move from one health plan to another without paying more for coverage than other employees do. standards so workers would not lose health insurance if they change jobs.

When you benefits, you sign a paper allowing your insurance company to make payments directly to your doctor or hospital.

assign

A combination of hospital expense insurance, physician expense insurance, and surgical expense insurance is called:

basic health insurance

Group health insurance provided by employers is often part of an employee's:

benefit package