Medical Expense Insurance (health)

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

Discourages overutilization of the insurance coverage

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

Dread disease insurance

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

Prescription drugs

Basic Hospital and Surgical policy benefits are

lower than the actual expenses incurred

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

one year

Comprehensive Major Medical policies usually combine:

Major Medical with Basic hospital/surgical coverage

In Major Medical Expense policies, what is the objective of a Stop Loss provision?

limit an insured's out-of-pocket medical expenses

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

Which of the following bEST describes a Hospital Indemnity policy?

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?

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 waives the deductible for all family members after some of them have satisfied individual deductibles within the same year:

Family maximum deductible

All of these are characteristics of a Health Reimbursement Arrangement (HRA) EXCEPT:

HRA is entirely funded by the employee - this is inaccurate. HRA plans are employer-funded medical reimbursement plans

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

Which of the following situations does a Critical Illness plan cover?

Leukemia

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

Services are reimbursed after insurer receives the invoice

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

be established by the employer

Which of the following is NOT included under hospitalization expense coverage?

surgical fees

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

Coinsurance

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

For which of the following expenses does a Basic Hospital policy pay?

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 reimbursement may be tax-free

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 which may not be covered for one year

Which of the following is NOT a limited benefit plan?

Life insurance policy

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

Major Medical Policy

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

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

Surgically removing a facial birthmark

Basic Medical Expense Insurance

has lower benefit limits than Major Medical insurance

Under a Basic Medical Expense policy, what does the hospitalization expense portion cover?

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 phrases refers to the fees charged by a healthcare professional?

usual, customary, and reasonable expenses

A Health Reimbursement Agreement (HRAs) MUST be established:

by the employer