Ch 4 - Test

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

An insured has a stop-loss limit of $5000, 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?

$5000 (stop-loss is the insured's ceiling)

Kim has health ins with a deductible of $500 and an 80/20 coinsurance. How much will she pay if she incurs a loss of $1,500?

$700

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

Distributions from an HSA (health savings acct) for qualified medical expenses are: 1. fully taxable 2. tax-free 3. partially taxable 4. tax credits

2. tax-free

Which of the following statements is NOT true regarding a CRITICAL ILLNESS PLAN? 1. Pays a lump sum to the insured upon the diagnosis of a critical illness 2. the insurer may have a list of critical illness they will cover 3. Coverage is limited to a single devastating disease 4. Also known as Specified Disease Plans

3. Coverage is limited to a single devastating disease

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: 1. loss chart 2. benefit summary 3. benefit schedule 4. coverage menu

3. benefit schedule

What type of policy would only provide coverage for specific types of illnesses (cancer, stroke, etc)? 1. MEWA 2. blanket insurance 3. dread disease insurance 4. disability insurance

3. dread disease insurance (provides benefits for ONLY specific types of illnesses such as cancer or stroke)

All of these are characteristics of a major medical expense policy EXCEPT: 1. Large benefit maximums 2. deductibles 3. elimination periods 4. coinsurance

3. elimination periods

All of the following are qualifications for establishing a health savings account (HSA) EXCEPT: 1. enrolled in a high deductible health plan 2. be under the age of 65 (not enrolled in medicare) 3. enrolled in a health plan with a prescription drug benefit 4. enrolled in a health plan that limits out of pocket expenses

3. enrolled in a health plan with a prescription drug benefit

A payment system for health care in which the provider is paid for each service given is called: 1. blanket plan 2. lump sum 3. fee-for-service 4. a prepaid arrangement

3. fee-for-service

Which of the following is NOT included under a health benefit plan? 1. Major medical policy 2. basic hospital policy 3. hospital indemnity plan 4. surgical expense plan

3. hospital indemnity plan

which of the following types of deductibles would apply a single deductible to both medical and dental insurance coverage? 1. standard deductible 2. combined deductible 3. integrated deductible 4. blended deductible

3. integrated deductible

The focus of major medical insurance is providing coverage for: 1. critical illness only 2. preventative care 3. medical and hospital expenses 4. Dr Visits

3. medical and hospital expenses

All of the following plans allow for employee contributions to be taken out on a pre-tax basis EXCEPT: 1. Section 125 Plan 2. Premium only plan 3. Cafeteria Plan 4. Health Reimbursement Arrangement Plan

4. Health Reimbursement Arrangement Plan

Major Medical expense plans provide coverage for each of the following EXCEPT: 1. Medically necessary surgery 2. diagnostic tests 3. blood and urine lab screens 4. work-related injuries

4. work-related injuries

Who is the individual paid on a fee-for-service basis?

Provider

The elimination period under a hospital indemnity plan is:

The specified # of days an insured must wait before becoming eligible to receive benefits for each hospitalization

Medical Expense Insurance would cover

an injury occurring at the insured's residence

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