Chapter Exam - Medical Expense Insurance

Which provision allows a portion of any used medical benefits to be restored following a particular amount of 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

A Hospital/Surgical Expense policy was purchased for a family of four in Mach 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?

$1,000

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

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 expense are incurred?

$7,000

A Major Medical policy typically contains a provision that requires the insurer to pay only part of a loss, while the balance is paid by the insured. This provision is called

Coinsurance

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

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.

In Major Medical Expense policies, what is the intent of a Stop Loss provision?

Limits an insured's out-of-picket medical expenses

The individual Health Insurance policy that offers the broadest protection is a(n)

Major Medical

Comprehensive Major Medical policies usually combine:

Major Medical with Basic Hospital/Surgical coverage

Which of the following Statements BEST describes dental care indemnity coverage?

Services are reimbursed after insurer receives the invoice

Which of the following phrases refers to the fees charged by a healthcare professional?

Usual, customary, and reasonable expenses

A comprehensive major medical health insurance policy contains an Eligible Expenses provision which identifies the types of health care services that are covered. All of the following health care services are typically covered, EXCEPT for:

experimental and investigative services

Basic Medical Expense insurance:

has lower benefit limits than Major Medical Insurance

Under a Basic Medical Expense policy, What does the hospitalization expense portion cover?

hospital room and board