Health Insurance - Medical Expense insurance

Which of the following situations does a critical illness plan cover? - asthma - leukemia - alcohol rehabilitation - severe car accident

leukemia

M has a Major Medical insurance policy with a $200 flat deductible and an 80% Coinsurance clause. If M incurs a $2,200 claim for an eligible medical expense, how much will M receive in payment for this claim? - $2000 - $1760 - $1600 - $400

- $1600

And insured covered by a group major medical plan is hospitalized after sustaining injuries that resulted from an automobile accident. Assuming the plan had a $1000 deductible and 80/20 coinsurance clause, how much will the insured be responsible to pay with $11,000 in covered medical expenses? - zero - $3000 - $8000 - $11,000

- $3000

Jay's major medical policy has $2000 deductible and a 80/20 coinsurance clause. If Jay is hospitalized and receives a bill for $10,000, Jay would pay: - $1600 - $2000 - $3600 - $8000

- $3600

Bees policy provides coverage on an in hospital basis only and contains a limited daily room and board benefit. Which of these policies does B have? - comprehensive major medical - Basic hospital - critical illness - Basic surgical

- Basic hospital

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 request a corrected application - deny coverage and increase premiums - Continue coverage but exclude the heart condition - resend the coverage and return the premiums

- Continue coverage but exclude the heart condition

This type of deductible provision waive the deductible for all family members after some of them have satisfied individual deductibles within the same year: - individual deductible - corridor deductible - Family maximum deductible - common accident deductible

- Family maximum deductible

All of these are characteristics of a health reimbursement arrangement (HRA) EXCEPT: - HRA is entirely funded by the employee - HRA is entirely funded by the employer - reimbursement for eligible medical expenses are allowed - HRA can be offered with other health plans

- HRA is entirely funded by the employee

Which of the following is not a limited plan benefit? - dental policy - Life insurance policy - critical illness policy - cancel policy

- Life insurance policy

This type of deductible provision states that should more than one family member be involved in a common accident, or suffer the same illness, only one individual deductible amount shall be applied. - individual deductible -m corridor deductible - Family maximum deductible - common accident deductible

- common accident deductible

Major medical policy typically: - pay 100% of covered expenses - contain a deductible and coinsurance - require use of in network facilities only - do not contain a deductible and coinsurance

- contain a deductible and coinsurance

Which of the following best describes a hospital indemnity policy? - coverage that reimbursed and insured for surgeon expenses - coverage that pays a stated amount per day of a covered hospitalization - coverage that replaces lost income due to hospitalization - coverage that pays for hospital room and board

- coverage that pays a stated amount per day of a covered hospitalization

M is insured under a basic hospital/surgical expense policy. A physician performs surgery on M. What determines the claim M is eligible for? - claim payment is equal to physicians actual charges - claim payment is negotiated between physician and patient - determined by the schedule of benefits from the hospital - determined by the terms of policy

- determined by the terms of policy

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

- dread disease insurance

T was treated for an ailment two months prior to applying for a health insurance policy. This condition was noted on the application and the policy was issued shortly afterward. How likely will the insurer consider this condition? - ensure will require a higher deductible for any claims resulting from this condition - ensure is required to initially cover this pre-existing condition - ensure will permanently exclude the condition from the policy - ensure will likely treat as a pre-existing condition which may not be covered for one year

- ensure will likely treat as a pre-existing condition which may not be covered for one year

A comprehensive major medical health insurance policy contains an eligible expenses provision which identifies the type of healthcare services that are covered. All of the following healthcare services are typically covered, except for: - hospital changes - physician fees - experimental and investigative services - nursing services

- experimental and investigative services

Basic medical expense insurance: - normally has a deductible and coinsurance - covers an illness but not an accident - pays for lost wages while hospitalized - has lower benefit limits than major medical insurance

- has lower benefit limits than major medical insurance

For which of the following expenses does a basic hospital policy pay? - hospital room and board - prescription medication - surgical fees - physician fees

- hospital room and board

Under a basic medical expense policy, what does hospitalization expense portion cover? - hospital room and board - hospital administration expenses - surgeon fees - physician fees

- hospital room and board

The first portion of a covered major medical insurance expense that the insured is required to pay is called the: - corridor deductible - initial deductible - step loss deductible - coinsurance deductible

- initial deductible

Jay 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 - Hidden deductible - internal limit - restricted provision - stop loss

- internal limit

Basic hospital and surgical policy benefits are: - lower than the actual expenses incurred - higher than the actual expenses incurred - normally subjected to deductibles - normally subjected to coinsurance

- lower than the actual expenses incurred

The individual health insurance policy that offers the broadest protection is a(n) ______________ policy - surgical benefit - indemnity medical - major medical - hospital expense

- major medical

Comprehensive major medical policies usually combine: - major medical with disability income coverage - major medical with basic hospital/surgical coverage - Basic hospital/surgical with accidental coverage - basic/hospital/surgical with disability income coverage

- major medical with basic hospital/surgical coverage

Generally how long is a benefit period For a major medical expense plan? - one year - two year - three year - four year

- one year

Deductibles are used in health policies to lower: - the incidence of fraud - the coinsurance amount - overuse of medical services - adverse selection

- overuse of medical services

A major medical policy typically: - provides health benefits for surgical expenses only, subject to policy limits - contains more limitations than a basic hospital, medical, or surgical policy - contains a 60 day elimination period For losses due to accident - provides benefits for reasonable and necessary medical expenses, subject to policy limit

- provides benefits for reasonable and necessary medical expenses, subject to policy limit

Which of the following services is not included under hospitalization expense coverage? - daily room and board - surgical fees - intensive care - miscellaneous expenses

- surgical fees

A major medical policy typically contain a provision that requires the insurer to pay only part of a loss while the balance is paid by the insured. The provision is called - assignment of benefits - coinsurance - indemnity - co-deductible

coinsurance