Chapter 13: Exam Questions

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

The individual health insurance policy that offers the broadest protection is a(n) ____________ policy

major medical

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

$1,000

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?

$7,000". In this situation, $5,000 + 20% of the remaining bill = $7,000

B's 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?

Basic hospital

Which of the following policy features allows an insured to defer current health charges to the following years deductible instead of the current years 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. Is provision is called

Coinsurance

Which of the following BEST describes the hospital indemnity policy?

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

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

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 situations is a critical illness plan cover?

Leukemia

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

Major Medical policy

Comprehensive major medical policy is usually combine:

Major Medical with Basic Hospital/Surgical coverage

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

Services are reimbursed after insurer receives the invoice

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 exclude the heart condition