Ch.3 Exam - Health Insurance Policies: Medical Expense

a phrase that refers to the fees charged by a healthcare professional

usual, customary, and reasonable expenses

a major medical policy typically contains a provision that required the insured to pay only part of a loss, while the balance is paid by the insured. this provision is called?

coinsurance

major medical policies typically :

contain a deductible and coinsurance

Comprehensive Major medical policies usually combine

Major Medical with Basic Hospital/Surgical coverage

States that should more than one family member be involved in a common accident, or suffer the same illness, only one individual deductible amount shall be applied

Common Accident deductible

Are the maximum amount the insurer will consider eligible for reimbursement under a health plan

UCR (usual, customer, reasonable) charges

carryover provision

allows an insured to defer current health charges (incurred in the last 3 months) to the following years deductible instead of the current years

surgically removing a facial birthmark would be covered by a

basic hospital/surgical policy

a characteristic of a Preferred Provider Organization (PPO's) would be?

discounted fees for the patient

S wants to open a tax-exempt Health Savings Account. To qualify for this type of account, Federal law dictates that S must be enrolled in a

high deductible health plan

under a basic medical policy, what does the hospitalization expense portion cover?

hospital room and board

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 a year

J was reviewing her Health Insurance policy and noticed the phrase "This policy will only pay for a semi-private" room. This phrase is considered to be a(n)?

internal limit

Hospital indemnity policy

is coverage that pays a stated amount per day of a covered hospitalization

what's the objective for a stop loss provision

limits an insured out of pocket medical expenses

Basic Hospital and Surgical policy benefits are:

lower than the actual expenses incurred

An individual health policy that offer the broadest protection is a _______ policy

major medical

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

what is indemnity coverage?

services that are reimbursed AFTER the insurer receives the invoice