4 - Medical Expense Insurance

An insured has a stop-loss limit of $10,000, a deductible of $500, and an 80/20 coinsurance. The insured incurs $50,000 of covered losses in an accident. How much will the insured have to pay?

$10,000

An insured has a deductible of $100 and an 80/20 coinsurance. How much will the insured pay if he or she incurs a loss of $1,100 immediately after enrolling in the plan?

$300

An insured has a Major Medical Plan with a 75/25 coinsurance and a deductible of $50. How much will the insured have to pay if, not having met any of his deductible, the insured visits the doctor and receives a bill for $150?

$75.00

Harold has a group medical policy through his employer with a $200 deductible and a 90% coinsurance provision. Harold incurs $1,200 in covered health care services. How much will his group insurance carrier pay?

$900

Which of the following BEST describes an indemnity plan?

An insured is provided a specific dollar amount for services

Some health plans pay benefits on a "usual, customary, and reasonable" (UCR) basis while other plans may pay established amounts in accordance with a list of injuries, surgical procedures, or other losses. What is this list known as?

Benefit schedule

Which of the following would an insured MOST likely have if the insured MUST pay a specific sum out of pocket before any benefits are paid in a calendar year?

Calendar-year deductible

Which of the following provides benefits for ONLY specific types of illnesses such as cancer or heart disease?

Dread disease insurance

Which is a payment system for health care wherein the provider is paid for each service given?

Fee-for-service

What type of policy pays an amount per day for hospitalization directly to the insured regardless of the insured's other health insurance?

Hospital indemnity

An insured individual has major medical insurance with first dollar coverage. How does the first dollar coverage impact benefits paid?

No deductible payment is required before expenses are reimbursed

Which of the following would be covered under a health insurance policy?

Preventative health services

Which of the following would be considered elective cosmetic surgery?

Surgery to remove excess fat from an insured's hips

Which of the following would be covered under Medical Expense Insurance?

a cut wrist caused by a saw at the insured's residence

The person who is paid on a fee-for-service basis is also known as

a provider

In a hospital indemnity plan, an elimination period refers to the number of days

an insured must wait before becoming eligible to receive benefits for each hospital stay

A single deductible applying to both medical and dental insurance coverages is referred to as

an integrated deductible

A proposed insured for a health insurance policy was treated for cancer in the past 12 months. When applying for health insurance coverage, the cancer treatment

indicates a preexisting condition

Health insurance policies that can be purchased to cover specific low frequency diseases are

limited policies