Chapter 15
What does the term coinsurance refer to?
After the deductible is satisfied, the percentage paid by the insured for the remaining covered expenses
What is considered the most common type of specified disease insurance policy?
Cancer
Which of the following terms is NOT associated with a Major Medical policy?
Capitation
Health insurance policies typically contain a provision stating that insureds and their insurer will share covered losses in an agreed proportion. Which provision does this refer to?
Coinsurance
All of the these are examples of cost sharing in a health insurance policy EXCEPT
Coordination
Which of the following is NOT included in comprehensive major medical plans?
First-dollar coverage
Which of the following types of policies pays a stated amount for each day an individual is hospitalized?
Hospital confinement indemnity
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 is the tax liability for employer contributions in Health Savings Accounts (HSA's)?
No tax payment needed
What does a Hospital Confinement indemnity policy pay for?
Pays a specified daily amount while the insured is confined to a hospital
An insured is protected from the expense of a catastrophic illness by which of the following health insurance provisions?
Stop-loss
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
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
Which of the following does specified disease insurance NOT cover?
costs covered by medical expense insurance
Major medical expense plans typically use a cost containment measure for emergency hospital care. This is referred to as a(n)
deductible
The elimination period in a disability income policy serves the same purpose as a(n) ______ in a medical expense policy.
deductible
A proposed insured for a health insurance policy was treated for heart disease within the past year. When applying for health insurance, the heart disease treatment
indicates a preexisting condition
A policyholder has a major medical plan with a 80%/20% coinsurance and a deductible of $75. If the insured has previously met her deductible and receives a bill for $175, how much will the insurer pay?
$140
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
