Ch. 14 Medical Expense Insurance

fee-for-service

A payment system for health care in which the provider is paid for each service given is called a blanket plan lump sum fee-for-service a prepaid arrangement

provides the insured a specific dollar amount for services

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

benefit schedule

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

$5000

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

$700

Kim has health insurance with a deductible of $500 and an 80/20 coinsurance. How much will she pay if she incurs a loss of $1,500? $200 $500 $700 $1,300

medical and hospitalization expenses

The focus of major medical insurance is providing coverage for critical illnesses only preventative care medical and hospitalization expenses doctor's visits

Dread disease insurance

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

Hospital indemnity plan

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

Coverage is limited to a single devastating disease

Which of the following statements is NOT true regarding a Critical Illness Plan? Pays a lump sum to the insured upon the diagnosis of a critical illness The insurer may have a list of critical illnesses they will cover Coverage is limited to a single devastating disease Also known as Specified Disease Plans

Integrated Deductible

Which of the following types of deductibles would apply a single deductible to both medical and dental insurance coverage? Standard deductible Combined deductible Integrated deductible Blended deductible