Medical Expense

Comprehensive Major Medical policies usually combine:

Major Medical with Basic Hospital/surgical coverage

A catastrophic illness would be best covered by which of the following health insurance plans?

Major medical

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

leukemia

In Major Medical Expenses polices, what is the objective of a Stop loss provision ?

limit and insureds out-of-pocket medical expenses

Q is hospitalized for 3 days and receives a bill for $10,100. Q has a Major Medical policy with a $100 deductible and 80/20 coinsurance. How much will Q be responsible for paying on this claim?

$2,100

J's Major Medical policy has a $2,000 deductible and an 80/20 Coinsurance clause. If J is hospitalized and receives a bill for $10,000, J would pay

$3,600

An individual has a major medical policy with a $5,000 deductible and an 80/20 coinsurance clause. How much will the INSURED have to pay if a total of $15,000 in covered medical expenses are incurred?

$5,000 + 20%= $7,000

What type of policy would only provide coverage for specific types of illnesses(cancer, stroke, etc)?

Dread disease

This type of deductible provision wavies the deductible for all after some of them have satisfied individual deductible within the same year:

Family maximum deductible

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

Hospital room and board

Under a basic medical expense policy, what does the hospitalization expense portion cover?

Hospital room and board

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

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 is NOT a limited benefit plan?

Life insurance policy

which of the following is NOT a limited benefit plan?

Life insurance policy

Which of these options can an individual use their medical flexible spending account to pay for?

Prescription drugs

Which of the following statements BEST describes dental care indemnity coverage?

Services are reimbursed after insurer receives the invoice

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 health plan

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

be established by the employer

Major medical policies typically:

contain a deductible and coinsurance

Generally, how long is a benefit period for a major medical expense plan?

one year

Which of the following phrases refers to the fees charged by a healthcare professional?

usual , customary, and reasonable expenses

Deductibles are used in health policies to lower

overuse of medical services

Which of the following services is not included under hospitalization expense coverage?

surgical fees

Which of the following policy features allows an insured to defer current health charges to the following year's deductible instead of the current year's deductible?

Carryover provision

A Major Medical Policy typically contains a provision that requires the insurer to pay only part of a loss, while the balance is paid by the insured. This provision is called

Coinsurance

Which of the following statements BEST describes the intent of a Coinsurance clause in a Major Medical policy?

Discourages overutilization of the insurance coverage

A hospital/surgical expense policy was purchased for a family of four in March of 2013. The policy was issued with $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 deductible amount as well. What would be this family's out-of-pocket medical expenses for 2013?

$1,000

All of these are characteristics of a health reimbursement arrangement(HRA) EXCEPT

HRA is entirely funded by the employee

M is insured under a basic hospital/surgical expense policy. A physician preforms surgery on M. What determines the claims M is eligible for?

Determined by the terms of the policy

A characteristic of preferred provider organizations(PPOs) would be:

Discounted fees for the patient

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.

Common accident deductible

Which of the following BEST describes a Hospital indemnity policy?

Coverage that pays a stated amount per day of a covered hospitalization

The first Portion of a covered major medical insurance expense that the insured is required to pay is called the:

Initial Deductible

Basic Hospital and surgical benefits are:

Lower than the actual expenses incurred

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

Major Medical

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 suffered 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

which of the following types of health coverage frequently uses a deductible?

Major medical policy

A Heath Reimbursement Arrangement MUST be established:

by the employer

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?

$1,600

An insured covered by a group Major Medical plan is hospitalized after sustaining injuries that resulted from an automobile accident. Assuming the plan had a $1,000 deductible and an 80/20 coinsurance clause, how much will the INSURED be responsible to pay with $11,000 in covered medical expenses?

$3,000

C was injured while deep sea diving and requires a hospital stay. C has a Major Medical policy with a 80/20 coinsurance clause and a $400 deductible. What is the MAXIMUM C will pay if the covered medical expenses are $2000?

$720

Which of the following medical expenses does Cancer Insurance NOT cover?

Arthritis

All of the following statements about major medical benefits are true, except:

Benefits have no maximum limit

A comprehensive major medical health insurance policy contains an Eligible Express 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

S wants to open a tax-exempt Health Savings Account. To qualify for this type of account, Federal law dictates that S must be enrolled in a:

High-deductible health plan

T was treated for an ailment 2 months prior to applying for a health insurance policy. This condition was noted on the application and the policy was issued shortly afterwards. How will the insurer likely consider this condition?

Insurer will likely treat as a pre-existing condition and may not be covered for one year.

Which provision allows a portion of any used medical benefits to be restored following a particular amount of benefit has been used, or after the policy has been in effect for a particular period of time?

Restoration of used benefit

Basic Medical Expense Insurance:

has lower benefit limits than Major Medical insurance

A major medical policy typically

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