Medical expense insurance

A health reimbursement arrangement must be established With an employee funding With other employee sponsored benefit plans By the employer Only during specific open enrollment periods

By the employer

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

Dread disease insurance

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

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

Major Medical policy

Comprehensive major medical policies usually combine

Major Medical with Basic Hospital/Surgical coverage

Which of the following individual health insurance policies will provide the broadest protection Hospital expense Surgical expense Major medical Limited sickness

Major medical

Which of the following health insurance coverages is best suited for meeting the expenses of catastrophic illness

major medical

Which of the following individual health insurance policies will provide the broadest protection

major medical

All of the following statements about major medical benefits are true except

Benefits have no maximum limit

J's major medical policy has a $2,000 deductible and an 80/20 coinsurance clause if J is hospitalized an receives a bill of 10,000, J would pay

3,600

J's major medical policy has a 2,000 deductible and a 80/20 coinsurance clause. If j is hospitalized and receives a bill for 10,000 j would pay

3,600

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?

$1,600

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

An insured covered by a group Major Medical plan is hospitalized after sustaining injuries that resulted from an automobile accident. Assuming the plan had a $1,000 deductible and an 80/20 Coinsurance clause, how much will the INSURED be responsible to pay with $11,000 in covered medical expenses?

$3,000

C was injured while deep sea diving and requires a hospital stay. C has a Major Medical policy with a 80/20 coinsurance clause and a $400 deductible. What is the MAXIMUM C will pay if the covered medical expenses are $2000?

$720

How long is a benefit period For a major medical expense plan 1 year 2 year 3 year

1 year

Which of the following medical expenses does cancer not cover

Arthritis

Comprehensive major medical combines the features of

Basic expense coverage in major medical coverage sold as one policy Covers practically all medical expenses hospital for scission surgical nursing drugs lavatories test etc.

Basics physicians expense coverage Often referred to as basic physicians non-surgical Expense coverage

Because it provides coverage for nonsurgical services as physicians provides

Which of the following policy features allows an insured to defer current health charges to the following years deductible instead of the current years deductible

Carryover provision

Comprehensive major medical

Combines the features a basic expense coverage And major medical coverage sold as one policy

This type of deductible provisional state that should more than one family member be involved in a common accident or some of the same illness only one individual deductible amount should be applied

Common accident deductible

Which of the following best describes a hospital indemnity policy

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

Basic surgical expense coverage

Covers costs of surgeons' services, whether the surgery is performed in or out of the hospital

Corridor Deductible

Covers the gap between basic coverage and major medical when a major medical policy is supplementing basic coverage that contains no deductible directable is not applied as the basic coverage has been exhausted

Per Cause Deductible

Deductible for each accident or illness

M is insured under a basic Hospital/Surgical Expense policy. A physician performs surgery on M. What determines the claim M is eligible for?

Determined by the terms of the policy

A characteristic of preferred provider organizations (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 Minimizes the need for deductible's Discourage adverse selection Minimizes the waiting period Discourages overrutilization of the insurance policy

Discourages overrutilization of the insurance policy

Basic medical expense coverage can be purchased to cover

Emergency accident benefits maternity benefits mental nervous disorders hospice care home health care outpatient care and nurses expenses

Which of these is not a characteristic of a health reimbursement arrangement (hra)

Employee funds the HRA entirely

A comprehensive major medical health insurance policy contains an eligible expense provision which identifies the types of health care services that are covered all the following health care services are typically covered except for

Experimental and investigation services

This type of deductible provision waives the deductible for all family members after some of them have satisfied individual deductibles in the same year

Family maximum deductible

Medical expense insurance provides

Financial protection against the cost of medical care for accidents and illness

Basic medical expense insurance is sometimes called

First dollar insurance

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

Hospital expense policies cover

Hospital room and board, miscellaneous, hospital expenses such as lab and x-ray charges medicines use of operating room and supplies

Which of the following statements about health reimbursement arrangements (HRA) is correct

If the employee paid for qualified medical expenses, the reimbursements may be tax-free

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

Initial deductible

Flat initial deductible

Is a state dollar amount that applies to a covered loss. This deductible is applies to a covered loss

All of the following are limited benefit plans except

Life insurance policies

Which of the following is not a limited benefit plan

Life insurance policies

Most major medical plans contain a

Lifetime maximum benefit that limits the insurance total exposure under contract well if you contain a per cause maximum benefit which limits the medical expenses covered for each cause

In major medical expense policy, what is the intent of a stop loss provision

Limits an insureds out of pocket medical expense

Benefits provided by basic medical expense insurance are

Lower than actual expenses incurred

Basic hospital and surgical policy benefits are

Lower than the actual expenses incurred

Usual customary and reasonable (UCR) Chargers are the

Maximum amount then sure will consider eligible for reimbursement under health insurance plan it is based primarily on average charges within a geographic area

Hospital room and board benefits cover expenses for

Occupancy of the room and bed general nursing care food and beverages and personal hygiene items

Generally how long is a benefit period for a major medical expense plan

One year

The phrase "This policy will only pay for a semi-private room" is an example of a(n)

internal limit

Hospice benefits under a Major medical expense plan normally includes coverage for

Pain management, home-based services and counseling

Nurse expense benefits

Pay only for private duty nursing care arranged according to a doctors order while the insured is a hospital patient

Convalescent care facility benefits

Provide a daily benefit for confinement and a skilled nursing facility for a limited recovery. Following discharge from the hospital

Which provision allows a portion of any used medical benefits to be restored following a particular amount of benefits has been in effect for a particular period of time?

Restoration of unused benefits

Which describes dental care indemnity coverage Services are reimbursed before the insured received invoice Services are reimbursed after insured received the invoice In network dentist must always be used Very limited list of providers

Services are reimbursed after insured revives invoice

Which of following statements best describes dental care indemnity coverage

Services are reimbursed after insurer receives the invoice

Which of the following situations does a critical illness plan cover

leukemia

Supplementary major medical policies are used to

Supplement The coverage payable under a basic medical expense policy after the basic policy pays supplemental major medical will provide coverage for expenses that were not covered by the basic policy and expenses that exceed the maximum

Basic surgical expense coverage includes

Surgeons fees anesthesiologist in the operating room

All-cause deductible

The insured only has to meet the deductible for each accident or illness

Which of the statements best defines usual customary and reasonable (UCR) charges

The maximum amount considered elegibal for reimbursement

Which of the following best defines. Usual customary and reasonable UCR charges The maximum premium and insurance can charge for their health insurance based on geography The max amount employer can contribute to a contributary health plan The maximum deductible and insured can be charged The maximum amount considered eligible for reimbursement by an insurance company under a health plan

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

Coinsurance

The sharing of expenses by the insured and the insurer The insurance company pays a high percentage of the additional expenses ( usually 75% or 80%) and the insured pays the remaining

Hey particular fee charged by physician or other health professionals is called

Usual, customary and reasonable expense

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

Usual, customary, and reasonable expenses

Pre - existing conditions

When considering the replacement of an individual accident and health insurance policy a pre-existing condition exclusions and the new contract they reduce their insurance benefit

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

initial deductible

In order to establish a health reimbursement arrangement (hra) it must

be established by the employer

A health reimbursement arrangement must be established

by the employer

N has a Major Medical policy that only pays a portion of N's medical expenses. N is responsible for paying the remaining balance. This provision is known as

coinsurance

Major medical policies typically

contain a deductible and coinsurance

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

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

hospital room and board

Deductibles are used in health policies to lower

overuse of medical services

A major medical policy typically

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

Which of the following services is not covered under a hospitalization expense policy

surgeon's fees

Integrated Deductible

the amount of the deductible may be satisfied by the amount paid under basic medical expense coverage

Unlike major medical expense insurance basic medical expense insurance provides

upfront without having to satisfy a deductible