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? $500 $900 $1,000 $1,350

$900

Medical Expense Insurance would cover an injury occurring at the insured's residence an injury occurring at work an injury caused by war elective surgeries

an injury occurring at the insured's residence

Kate has a Major Medical Plan with a 75/25 coinsurance and a deductible of $25. How much will she have to pay if she, not having met any of her deductible, visits the doctor and receives a bill for $125? $25.00 $50.00 $75.00 $100.00

$50.00

What type of policy would only provide coverage for specific types of illnesses (cancer, stroke, etc)? MEWA Blanket insurance Dread disease insurance Disability insurance

Dread disease insurance

All of the following are qualifications for establishing a health savings account (HSA) EXCEPT Enrolled in a high deductible health plan Be under the age of 65 (not enrolled in Medicare) Enrolled in a health plan with a prescription drug benefit Enrolled in a health plan that limits out of pocket exprenses

Enrolled in a health plan with a prescription drug benefit

All of the following plans allow for employee contributions to be taken on a pre-tax basis EXCEPT Section 125 Plan Premium Only Plan Cafeteria Plan Health Reimbursement Arrangement plan

Health Reimbursement Arrangement plan

A dread disease policy is considered to be a type of hospital expense policy group health insurance policy major medical insurance policy limited health insurance policy

Limited health insurance policy

Low frequency diseases can be exclusively covered by what kind of health insurance policies? Limited policies Blanket policies Employer policies Restricted policies

Limited policies

How is a health provider reimbursed if they do NOT have an agreement in place with the insurance company? With a contingent fee With a scheduled fee With a usual, customary, and reasonable fee With a reasonably appropriate fee

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 loss chart benefit summary benefit schedule coverage menu

benefit schedule

Jennifer is required to pay a specific sum out of pocket before any benefits are paid in a year. Her health policy most likely contains a stop-loss provision deductible copayment out of pocket provision

deductible

All of these are characteristics of a major medical expense policy EXCEPT large benefit maximums deductibles elimination periods coinsurance

elimination periods

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 does not count as a preexisting condition is not required to be reported on the application indicates a preexisting condition is irrelevant to underwriting

indicates a preexisting condition

An indemnity plan: pays both the insured and health care provider provides the insured a specific dollar amount for services pays the health care provider directly for services rendered is typically issued as a group plan

provides the insured a specific dollar amount for services

Who is the individual paid on a fee-for-service basis? Subscriber Administrator Insured Provider

Provider

A policyholder has a major medical plan wit 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? $35 $75 $100 $140

$140

An insured under a Major Medical expense plan with a zero deductible and 80/20 coinsurance provision files a $1,000 claim. How much of this claim is the insured responsible for? $160 $200 $600 $800

$200

An insured has a stop-loss limit of $5,000, a deductible of $500, and an 80/20 coinsurance. The insured incurs $25,000 of covered losses. How much will the insured have to pay? $500 $5,000 $5,400 $5,600

5,000

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 Coinsurance provision Stop-loss feature Integrated deductible

Calendar- year deductible

Which type of coverage pays an amount per day for hospitalization directly to the insured regardless of the insured's other health insurance? MEWA Mutual Group Hospital indemnity

Hospital indemnity

Which of the following is NOT included under a health benefit plan? Major medical policy Basic hospital policy hospital indemnity plan Surgical expense policy

Hospital indemnity plan

Low frequency diseases can be exclusively covered by what kind of health insurance policies? Limited policies Blanket policies Employer policies Restricted polices

Limited policies

When an insured has a major medical plan with first dollar coverage, how does this impact the benefits paid? No deductible payment is required Deductible specified in the contract is payable by the insured Insured must pay a percentage of coverage losses An initial deductible plus a percentage of the remaining covered loss is owed by the insured

No deductible payment is required

A fee for service health insurance plans will normally cover vitamins and natural remedies cosmetic procedures gym memberships a disease

a disease

The elimination period under a hospital indemnity plan is the period in which pre-existing conditions are not taken into consideration the period in which all deductibles are eliminated the specified number of days after an insurance policy's issue date during which coverage is not afforded for sickness the specified number of days an insured must wait before becoming eligible to receive benefits for each hospitalization

the specified number of days an insured must wait before becoming eligible to receive benefits for each hospitalization

"Maximum benefits" refers to the upper limit of the total lifetime benefits the insurance company will pay Upper limit percentage of what the insurance company will pay for coinsurance Upper limits of what the insured will pay in out-of-pocket expenses Upper limits of what an insurance company will pay for any particular claim

upper limit of the total lifetime benefits the insurance company will pay