Health & Accident Insurance Chp 3

$2,100

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? a) $2,100 b) $2,020 c) $2,000 d) $100

coinsurance

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: a) Assignment of Benefits b) Coinsurance c) Indemnity d) Co-deductible

experimental and investigative services

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: a) hospital charges b) physician fees c) experimental and investigative services d) nursing services

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

A major medical policy typically: a) provides benefits for surgical expenses only, subject to policy limits b) contains more limitations than a Basic Hospital, Medical, or Surgical policy c) contains a 60-day Elimination period for losses due to accident d) provides benefits for reasonable and necessary medical expenses, subject to policy limits

Continue coverage but exclude the heart condition

A prospective insured completes and signs an application for health insurance but intentionally conceals information about a pre-existing heart condition. The company issues the policy. Two months later, the insured suffers a heart attack and submits a claim. While processing the claim, the company discovers the pre-existing condition. In this situation, the company will: a) continue coverage but request a corrected application b) deny coverage and increase premiums c) continue coverage but exclude the heart condition d) rescind the coverage and return the premiums

Benefits have no maximum limit

All of the following statements about Major Medical benefits are true, EXCEPT: a) the deductible can be expressed as a fixed dollar amount b) the benefit period begins only after a specified amount of expenses have accured c) benefits are generally expressed as a percentage of eligible expenses d) benefits have no maximum limit

internal limit

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): a) hidden deductible b) internal limit c) restricted provision d) stop loss

contain a deductible and coinsurance

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

insurer will likely treat as a pre-existing condition which may not be covered for one year

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? a) insurer will require a higher deductible for any claims resulting from this condition b) insurer is required to initially cover the pre-existing condition c) insurer will permanently exclude the condition from the policy d) insurer will likely treat as a pre-existing condition which may not be covered for one year

life insurance policy

Which of the following is NOT a limited benefit plan? a) dental policy b) life insurance policy c) critical illness policy d) cancer policy

Leukemia

Which of the following situations does a Critical Illness cover? a) asthma b) leukemia c) alcohol rehabilitation d) severe car accident

the maximum amount considered eligible for reimbursement by an insurance company under a health plan

Which of the following statements BEST defines usual, customary, and reasonable (UCR) charges? a) the maximum premium an insurer can charge for their health insurance based on geography b) the maximum amount an employer can contribute to a contributory health plan c) the maximum deductible an insured can be charged d) the maximum amount considered eligible for reimbursement by an insurance company under a health plan

services are reimbursed after insurer receives the invoice

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

Major Medical policy

Which of the following types of health coverage frequently uses a deductible? a) Major Medical policy b) Basic Surgical policy c) Basic Hospital policy d) Worker's Compensation

prescription drugs

Which of these options can an individual use their medical flexible spending account to pay for? a) vitamins and supplements b) prescription drugs c) household expenditures d) cosmetic procedures