Chapter 5 - Medical Expense Insurance

Which of the following services is NOT covered under a hospitalization expense policy? daily room & board surgeon's fees intensive care miscellaneous expenses

surgeon's fees

A Hospital/Surgical Expense policy was purchased for a family of four in March of 2013. The policy was issued with a $500 deductible and a limit of four deductibles per calendar year. Two claims were paid in September 2013, each incurring medical expenses in excess of the deductible. Two additional claims were filed in 2014, each in excess of the deductible amount as well. What would be this family's out-of-pocket medical expenses for 2013? $500 $1000 $1500 $2000

$1000 - 2 deductibles In 2013

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? $2100 $2020 $2000 $100

$2100 [($10,000 x 20% coinsurance) + $100 deductible]

In order to establish a Health Reimbursement Arrangement (HRA), it MUST... - be offered in conjunction with other employer provided health benefits - limit the benefits to prescription drugs only - be established by the employer - limit the amount of money the employee can contribute toward the account

- be established by the employer

All of the following statements about Major Medical Benefits are true, EXCEPT: - the deductible can be expressed as a fixed dollar amount - the benefit period begins only after a specified amount of expenses have accrued - benefits are generally expressed as a % of eligible expenses - benefits have no maximum limit

- benefits have no maximum limit

A health reimbursement arrangement MUST be established... - with employee funding - with other employer sponsored benefit plans - by the employer - only during specific open enrollment periods

- by the employer

Major Medical policies typically: - pay 100% of covered expenses - contain a deductible and coinsurance - require use of in-network facilities only - do not contain a deductible and coinsurance

- contain a deductible and coinsurance

Which of the following BEST describes a Hospital indemnity policy? - coverage that reimburses an insured for surgeon expenses - coverage that pays a stated amount per say of a cover hospitalization - coverage that replaces lost income due to hospitalization - coverage that pays for hospital room and board

- coverage that pays a stated amount per say of a cover hospitalization

M is insured under a basic Hospital/Surgical Expense policy. A physician performs surgery on M. What determines the claim M is eligible for? - Claim payment is equal to physician's actual charges - claim payment is negotiated between physician and client - determined by the schedule of benefits from the hospital - determined by the terms of the policy

- determined by the terms of the policy

Which of the following statements BEST describes the intent of a coinsurance clause in a Major Medical Policy? - discourages over-utilization of insurance coverage - minimizes the need for deductibles - discourages adverse selection - minimizes the waiting period

- discourages over-utilization of insurance coverage

A comprehensive major medical health insurance policy contains an Eligible Expenses provision which identifies the types pf health care services that are covered. All of the following health care services are typically covered EXCEPT: - hospital charges - physician fees - experimental and investigative services - nursing services

- experimental and investigative services

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... - low deductible health plan - medicare supplement - high deductible health plan - flexible savings plan

- high deductible health plan

Which of the following is NOT a limited benefit plan? - cancer policies - life insurance policies - dental policies - critical illness policies

- life insurance policies

In Major medical expense policies, what is the intent of stop-loss provision? - limits an insurer's premium increases - limits an insurer's liability - limits an insured's out of pocket medical expenses - limits an insured's coverage for pre-existing conditions

- limits an insured's out of pocket medical expenses

Basic hospital and surgical policy benefits are... - lower than the actual expenses incurred - higher than the actual expenses incurred - normally subject to deductibles - normally subject to coinsurance

- lower than the actual expenses incurred

Comprehensive Major Medical policies usually combine: - major medical with disability income coverage - major medical with basic hospital/surgical coverage - basic hospital.surgical with accidental coverage - basic hospital/surgical with disability income coverage

- major medical with basic hospital/surgical coverage

Deductibles are used in health policies to lower: - the incidents of fraud - the coinsurance amount - overuse of medical services - adverse selection

- overuse of medical services

A major medical policy typically... - provides benefits for surgical expenses only, subject to policy limits - contains more limitations than a Basic Hospital, Medical, or Surgical Policy - contains a 60 day elimination period for losses due to accident - provides benefits for reasonable and necessary medical expenses, subject to policy limits

- provides benefits for reasonable and necessary medical expenses, subject to policy limits

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? - reimbursement benefit - restoration of unused benefit - restoration of used benefit - medical offset benefit

- restoration of used benefit

Which of the following statements BEST describes dental care indemnity coverage? - services are reimbursed before the insurer receives the invoice - services are reimbursed after insurer receives the invoice - in network dentists must always be used - very limited list of providers

- services are reimbursed after insurer receives the invoice

Which of the following phrases refers to the fees charged by a healthcare professional? - deductible - coinsurance - usual, customary, and reasonable expenses - hospital expense

- usual, customary, and reasonable expenses

Which of the following health insurance coverages is BEST suited for meeting the expenses of catastrophic illness? Major Medical Hospital Expense Surgical Expense Hospital Income

Major Medical

Which of the following types of health coverage frequently uses a deductible? Major Medical Policy Basic Surgical Policy Basic Hospital Policy Worker's compensation

Major Medical Policy

Which of the following medical expenses does cancer insurance NOT cover? chemotherapy radiation treatment physician's visit arthritis

arthritis

This type of deductible provision states that should more than 1 family member be involved in a common accident, or suffer the same illness, only 1 individual deductible amount shall be applied. individual deductible corridor deductible Family Maximum deductible common accident deductible

common accident deductible

This type of deductible provision waives the deductible for all family members after some of them have satisfied individual deductibles within the same year: Individual deductible corridor deductible family maximum deductible common accident deductible

family maximum deductible

The phrase "This policy will only pay for a semi-private room" is an example of a(n)... maximum policy limit internal limit stop loss participation %

internal limit