3 - Medical Expense Insurance (Test only has 10 Questions)

The first portion of a covered Major Medical insurance expense that the insured is required to pay is called the

initial deductible (Correct.) A provision that requires the insured to pay the first portion of covered expenses before Major Medical coverage applies is called an initial deductible.

All of the following statements about Major Medical benefits are true EXCEPT

Benefits have no maximum limit (Correct.) Major Medical benefits normally have a maximum limit.

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

Discourages overutilization of the insurance coverage (Correct.) A purpose of the Coinsurance clause in a Major Medical Policy is to discourage overutilization of the insurance coverage.

A Health Reimbursement Arrangement MUST be established

by the employer (Correct.) HRAs are employer-established benefit plans that must be funded by the employer.

Q is hospitalized for 3 days and receives a bill for $10,100. Q has a Major Medical policy with a $100 deductible and 80/20 coinsurance. How much will Q be responsible for paying on this claim?

$2,100 (Correct.) In this situation, $10,000 x 20% coinsurance + $100 deductible = $2,100.

J's Major Medical policy has a $2,000 deductible and an 80/20 Coinsurance clause. If J is hospitalized and receives a bill for $10,000, J would pay

$3,600 $2,000 + 20% of the remaining bill = $3,600.

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 (Correct.) In this situation, $5,000 + 20% of the remaining bill would = $7,000

C was injured while deep sea diving and requires a hospital stay. C has a Major Medical policy with a 80/20 coinsurance clause and a $400 deductible. What is the MAXIMUM C will pay if the covered medical expenses are $2000?

$720

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 (Correct.) This condition would likely be considered a pre-existing condition and may not be covered for one year.

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

Leukemia (Correct.) Leukemia is a type of cancer and would be covered under a Critical Illness plan.

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

Major Medical policy (Correct.) Most major medical benefits begin to be paid after the deductible is satisfied.

Major Medical policies typically

contain a deductible and coinsurance (Correct.) Major Medical policies typically contain a deductible and coinsurance.