Chapter 7

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 under a Major Medical expense plan with a zero deductible and 80/20 coinsurance provision files a $1,000 claim. How much of this claim is the insured responsible for?

$200

An insured has a stop loss limited of $5,00 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

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

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 In this situation, the insured will pay $500 deductible plus $200 coinsurance = $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

How is a healthy provider reimbursed if they do not have an agreement in place with the insurance company

A usual customary and responsible fee

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

Benefit schedule

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

Which of the following statement is not true regarding a critical illness plan

Coverage is limited to a single devastating disability

Which type of policy would only provide coverage for specific types of illnesses

Dead diseases insurance

A pharmacy benefit coves prescription drugs derived from a list called

Drug formulary

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

Eliminating periods

All of the following are qualifications for establishing a health savings account except

Enrolled in a health plan with a prescription drug benefit

All of the following plans allow for employees contributions to be taken on a pre tax basis expect

Health reimbursement arrangement plan

Which of the following is not included under the health benefit plan

Hospital indemnity plan

A dread disease policy is considered to be a type of

Limited health insurance policy

When an insured has a major medical plan with first dollar coverage how does this impact the benefits paid

No deductible payment is required

What is the tax liability for employer contributions in Health Savings Accounts (HSA's)?

No tax payment needed

Distributions from a health savings account for qualified medical expenses are

Tax free

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

Major medical expense plans provide coverage for each for the following except

Work related injury

Major medical insurance will typically cover medical expenses that result from

a negative reaction to prescribed medication

Medical expense insurance would cover

an injury occurring at the insured's residence

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 fee for service health insurance plan will normally cover

disease

A payment system for health care in which the provider is paid for each service given is called

fee for service

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

provider

An indemnity plan

provides the insured a specific dollar amount for services

An example of elective cosmetic surgery would be

removing excess fat from an insured's waistline