medical expense insurance

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

Which of the following terms is NOT associated with a Major Medical policy?

Capitation

All of the following are qualifications for establishing a health savings account (HSA) EXCEPT

Enrolled in a health plan with a prescription drug benefit

Which of the following is NOT included in comprehensive major medical plans?

First-dollar coverage

Medical expense policies will typically cover which of the following?

Injuries caused by accidents

Low frequency diseases can be exclusively covered by what kind of health insurance policies?

Limited policies

What does a Hospital Confinement indemnity policy pay for?

Pays a specified daily amount while the insured is confined to a hospital

At what point does a self-insured group qualify for stop-loss coverage?

When claims exceed a specified limit in a set period of time

What does the term coinsurance refer to?

After the deductible is satisfied, the percentage paid by the insured for the remaining covered expenses

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

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

Dread disease insurance

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

No deductible payment is required

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

Provider

How is a health provider reimbursed if they do NOT have an agreement in place with the insurance company?

With a usual, customary, and reasonable 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 a

benefit schedule

Which of the following does specified disease insurance NOT cover?

costs covered by medical expense insurance

A pharmacy benefit covers prescription drugs derived from a list called a(n)

drug formulary

A dread disease policy is considered to be a type of

limited health insurance policy

The focus of major medical insurance is providing coverage for

medical and hospitalization expenses

An indemnity plan

provides the insured a specific dollar amount for services

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