Chapter exam-medical expense insurance

A Hospital/Surgical Expense policy was purchased for a family of four in March of 2013. The policy was issued with a $500 deductible and a limit of four deductibles per calendar year. Two claims were paid in September 2013, each incurring medical expenses in excess of the deductible. Two additional claims were filed in 2014, each in excess of the deductible amount as well. What would be this family's out-of-pocket medical expenses for 2013?

$1,000

J's major medical policy has a $2,000 deductible and an 80/20 coinsurance clause. If J is hospitalized and relieves a bill for $10,000, J would pay:

$3,600

M is insured under a basic Hospital/Surgical Expense policy. A physician performs surgery on M. What determines the claim M is eligible for?

Determined by the terms of the policy

Which of the following statements about health reimbursement arrangements (HRA) is CORRECT?

If the employee paid for qualified medical expenses, the reimbursements may be tax-free

Which of the following costs would a basic hospital/surgical policy likely cover?

Surgically removing a facial birthmark

Which of the following statements BEST defines usual, customary, and reasonable (UCR) charges?

The maximum amount considered eligible for reimbursement by an insurance company under a health plan

In order to establish a Health Reimbursement Arrangement (HRA), it MUST

be established by the employer

A prospective insured completes and signs an application for health insurance but intentionally conceals information about a pre-existing heart condition. The company issues the policy. Two months later, the insured suffers a heart attack and submits a claim. While processing the claim, the company discovers the pre-existing condition. In this situation, the company will

continue coverage but exclude the heart condition

A comprehensive major medical health insurance policy contains an Eligible Expenses provision which identifies the types of health care services that are covered. All of the following health care services are typically covered, EXCEPT for:

experimental and investigative services

For which of the following expenses does a basic hospital policy pay?

hospital room and board

J was reviewing her Health Insurance policy and noticed the phrase "This policy will only pay for a semi-private room". This phrase is considered to be a(n)

internal limit

Which of the following situations does a critical illness plan cover?

leukemia

Which of the following is NOT a limited benefit plan?

life insurance policy

The individual health insurance policy that offers the broadest protection is a(n) _______ _________ policy

major medical

Generally, how long is a benefit period for a Major Medical Expense Plan?

one year