Medical Expense Exam

Which of the following best describes a hospital indemnity policy?

Coverage that pays a stated amount per day of a covered hospitalization

The individual health insurance policy that offers the broadest protection is an _______ ___________ policy

major medical

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?

$1000

M has a Major Medical insurance policy with a $200 flat deductible and an 80% Coinsurance clause. If M incurs a $2,200 claim for an eligible medical expense, how much will M receive in payment for this claim?

$1600; 2200-200 X .80

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?

$2,100; 10000 X 20% +100

B's policy provides coverage on an in-hospital basis only and contains a limited daily room and board benefit. Which of these policies does B have?

Basic hospital

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

Type of deductible provision 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

A characteristic of PPO would be

Discounted fees for the patient

Which of the following statements BEST describes the intent of a coinsurance clause in a major medical policy?

Discourages overutilization of the insurance coverage

What type of policy would only provide coverage for specific types of illnesses (cancer, stroke, etc)?

Dread disease insurance

Comprehensive major medical policies usually combine:

Major Medical w/ Basic Hospital/Surgical coverage

For which of the following expenses does a basic hospital pay?

Hospital Room and Board

The first portion of a covered major medical insurance expense that the insured is required to pay is called the:

Initial deductible

In Major Medical Expense policies, what is the objective of a stop loss provision?

Limits an insured's out of pocket medical expenses

Which of the following types of health coverage frequently uses a deductible?

Major Medical Policy

Which of these options can an individual use their medical flexible spending account to pay for?

Prescription Drugs

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

Which of the following statements best describes dental care indemnity coverage?

Services are reimbursed after insurer receives the invoice

Which of the following services is NOT included under hospitalization expense coverage?

Surgical fees

Which of the following costs would a basic hospital/surgical policy likely cover?

Surgically removing a facial birthmark

Which of the following statements BEST defines usual, customary, reasonable charges?

The max amount considered eligible for reimbursement by an insurance company under a health plan

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

Usual, customary, and reasonable expenses

In order to establish a health reimbursement arrangement, it must:

be established by the employer

A Health Reimbursement Arrangement MUST be established:

by the employer

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:

continue coverage but exclude the heart condition

Basic Medical Expense Insurance

has lower benefit limits than Major Medical insurance

A major medical policy typically:

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