XCEL ch. 3

Amy has a group medical policy through her employer with a $500 deductible and a 90% coinsurance provision. She incurs $1,500 in covered health care services. How much will her group insurance carrier pay?

900

A dread disease policy is considered to be a type of

A limited health insurance policy

What does the term coinsurance refer to?

After the deductible is satisfied, the percentage paid by the insured for the remaining covered expenses

All of the following plans allow for employee contributions to be taken on a pre-tax basis EXCEPT

Health Reimbursement Arrangement Plan

What does a Hospital Confinement indemnity policy pay for?

Pays a specified daily amount while the insured is confined to a hospital

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?

The correct answer is "$140". Because the insured has previously met her deductible, the eligible expenses for a claim is the entire $175. The insurance company pays 80% of $175, or $140.

At what point does a self-insured group qualify for stop-loss coverage?

after claims exceed a specified limit in a set period of time.

Medical Expense Insurance would cover

an injury occurring at the insured's residence

Which of the following terms is NOT associated with a Major Medical policy?

capitation

Which of the following does specified disease insurance NOT cover?

costs covered by medical expense insurance

All of these are characteristics of a major medical expense policy EXCEPT

elimination periods

All of the following are qualifications for establishing a health savings account (HSA) EXCEPT

enrolled in a health plan with a prescription drug benefit

Which of the following is NOT included in comprehensive major medical plans?

first dollar coverage

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.

Medical expense policies will typically cover which of the following?

injuries caused by accident