Medical Plans - PSI

Sole proprietors are permitted tax deductions for health costs paid from their earnings in the amount of

100% of costs

HIPAA considers which of the following as "individually identifiable health information"?

A person's health claim information

Ted has a health insurance plan that requires him to pay a specific sum out of pocket before any benefits are paid in a calendar year. Which of these does his health plan have?

Calendar-year deductible

Which of the following statements is NOT true regarding a Critical Illness Plan?

Coverage is limited to a single devastating disease

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

Dread disease insurance

All of the following are qualifications for establishing a health savings account (HSA) EXCEPT

Enrolled in a health plan with a prescription drug benefit

Which type of coverage pays an amount per day for hospitalization directly to the insured regardless of the insured's other health insurance?

Hospital indemnity

Which of the following is NOT included under a health benefit plan?

Hospital indemnity plan

Which of the following types of deductibles would apply a single deductible to both medical and dental insurance coverage?

Integrated deductible

Without a Section 125 Plan in place, what would happen to an employee's payroll contribution to an HSA?

It would be considered taxable income to the employee

Low frequency diseases can be exclusively covered by what kind of health insurance policies?

Limited policies

When an insured has a major medical plan with first dollar coverage, how does this impact the benefits paid?

No deductible payment is required

What is the tax liability for employer contributions in Health Savings Accounts (HSA's)?

No tax payment needed

Coordination of Benefits regulation applies to all of the following plans EXCEPT

Preferred Provider Organization plan

Who is the individual paid on a fee-for-service basis?

Provider

Which of the following decisions would a Health Savings Account (HSA) owner NOT be able to make?

The amount contributed by the employer

How is a health provider reimbursed if they do NOT have an agreement in place with the insurance company?

With a usual, customary, and reasonable fee

Major Medical expense plans provide coverage for each of the following EXCEPT

Work-related injuries

A fee for service health insurance plan will normally cover

a disease

Major medical insurance will typically cover medical expenses that result from

a negative reaction to prescribed medication

Medical Expense Insurance would cover

an injury occurring at the insured's residence

An insured has a health plan that pays established amounts in accordance with a list of injuries, surgical procedures, or other losses. This list is called a

benefit schedule

Jennifer is required to pay a specific sum out of pocket before any benefits are paid in a year. Her health policy most likely contains a(n)

deductible

A pharmacy benefit covers prescription drugs derived from a list called a(n)

drug formulary

All of these are characteristics of a major medical expense policy EXCEPT

elimination periods

A payment system for health care in which the provider is paid for each service given is called

fee-for-service

A proposed insured for a health insurance policy was treated for heart disease within the past year. When applying for health insurance, the heart disease treatment

indicates a preexisting condition

A dread disease policy is considered to be a type of

limited health insurance policy

A health insurance policy will typically cover

preventative health services

An example of elective cosmetic surgery would be

removing excess fat from an insured's waistline

The elimination period under a hospital indemnity plan is

the specified number of days an insured must wait before becoming eligible to receive benefits for each hospitalization

A policyholder has a major medical plan with a 80%/20% coinsurance and a deductible of $75. If the insured has previously met her deductible and receives a bill for $175, how much will the insurer pay?

$140

An insured under a Major Medical expense plan with a zero deductible and 80/20 coinsurance provision files a $1,000 claim. How much of this claim is the insured responsible for?

$200

An insured has a stop-loss limit of $5,000, a deductible of $500, and an 80/20 coinsurance. The insured incurs $25,000 of covered losses. How much will the insured have to pay?

$5,000

Kate has a Major Medical Plan with a 75/25 coinsurance and a deductible of $25. How much will she have to pay if she, not having met any of her deductible, visits the doctor and receives a bill for $125?

$50

K has a Major Medical Plan with a 75/25 coinsurance and a deductible of $25. How much will she have to pay if she, not having met any of her deductible, visits the doctor and receives a bill for $125?

$50.00

Kim has health insurance with a deductible of $500 and an 80/20 coinsurance. How much will she pay if she incurs a loss of $1,500?

$700

Amy has a group medical policy through her employer with a $500 deductible and a 90% coinsurance provision. She incurs $1,500 in covered health care services. How much will her group insurance carrier pay?

$900