Ch 9 personal financial

The typical out-of-pocket payment for a stop-loss provision ranges from:

$5,000 to $8,000

Which of the following is part of the Patient Protection and Affordable Care Act?

-Bans insurance companies from dropping people when they get sick -Tax credits for small business -Prohibits denying coverage to children with preexisting medical conditions

Which of the following statements is NOT true? 1 COBRA covers group health plans of employers with 20 or more employees 2 COBRA allows employees who are laid off to continue temporary coverage under the employer's plan at group rates. 3 You have 30 days from the date coverage ends to elect COBRA

3 You have 30 days from the date coverage ends to elect COBRA

A "good" health insurance plan pays what percentage of out-of-hospital expenses once a yearly deductible for the individual and family have been met?

80%

What qualifications must you have to be eligible for Medicare?

Be under age 65 with certain disabilities Be 65 or older

A(n) _______ policy provides specified benefits regardless of whether the actual expenses are greater or less than the benefits. A(n) ______ policy provides benefits based on the actual expense.

Blank 1: indemnity Blank 2: reimbursement

Which type of insurance is complete major medical insurance that has a very low deductible?

Comprehensive

Which type of insurance provides reimbursement for the expense of services and supplies and encourages preventive care for teeth?

Dental expense insurance

True or false: Married people who each have their own health insurance through their employers may be able to receive benefits exceeding the allowable medical expenses.

False

Which of the following is a plan that is funded solely by employers and gives you a pool of money to spend on health care?

Health reimbursement account

______ allow you to contribute money to a tax-free account that can be used for out-of-pocket health care expenses if you buy high-deductible health insurance policies to cover catastrophic expenses.

Health savings accounts (HSAs)

Which type of insurance pays part or all of hospital bills for room, board, and other charges?

Hospital expense insurance

Which type of policy pays benefits when you are hospitalized that are in cash that you can spend as you choose?

Hospital indemnity policy

What are some questions to ask or things to consideration when evaluating a long-term care insurance policy?

How much does the policy pay each day? Does the policy have a maximum lifetime benefit? Is the policy guaranteed renewable?

If your hospital room costs $1,000 per day but you will only receive $500 per day from your health insurance, then your policy has which type of limit?

Internal

Which part of Medicare helps pay for doctors' services and a variety of other health services and supplies?

Medical (Part B)

_______ insurance makes up the difference between Medicare payments and medical costs not covered by Medicare by providing supplemental insurance.

Medigap or Medsup

A "good" health insurance policy provides which of the following?

Pay at least 80 percent of out-of-hospital expenses after a yearly deductible of $1,000 per person or $2,000 per family Offer basic coverage for hospital and doctor bills

Which of the following is a provision of the Patient Protection and Affordable Care Act?

Requires health insurance companies to submit justification for all requested premium increases

Dread disease insurance policy plays upon _______ fears, and they are considered illegal in many states.

Unrealistic

Physician expense insurance provides benefits for which of the following?

X rays Doctors' fees for nonsurgical care Lab tests

A combination of hospital expense insurance, physician expense insurance, and surgical expense insurance is called:

basic health insurance

Long-term care insurance provides coverage for:

daily help

Group policies:

do not always cover the needs of every employee

The exclusions and limitations provision specifies the conditions or circumstances for which the policy:

does not provide benefits

Age, marital status, and dependency requirements are usually specified in the ______ provision of an insurance policy.

eligibility

In a group health insurance plan arrangement, ______ and ______ are most likely to pay for the cost of health care.

employees employers

Coordination of benefits prevents you from collecting benefits from two or more group policies that would in total ______ the actual charges.

exceed

With a(n) ______ policy provision, the insurance company cannot cancel unless you fail to pay premiums when due.

guaranteed renewable

A health insurance plan that provides a wide range of health care services for a fixed prepaid monthly premium is called a:

health maintenance organization (HMO)

The ______ the deductible, the less expensive the policy.

higher

Health insurance is one way people protect themselves against economic losses due to:

injury illness

Coinsurance is a provision under which the ______ share the covered losses.

insurer and the insured

The eligibility provision defines who:

is entitled to benefits under the policy

Prepaid health plans that provide comprehensive health care to members are called

managed care

Health insurance includes:

medical expense insurance and disability income insurance

Surgical expense insurance pays part or all of surgeons' fees for a(n)

operation, procedure, or surgery

A policy that limits the total of the coinsurance and deductibles you must pay will limit your financial burden, but also increase your:

premiums

One difference between point-of-service (POS) plans and preferred provider organizations (PPOs) is that POS plans:

require a referral to a specialist

The reasons for the increased need for home health care include:

rising hospital costs older U.S. population new medical technology

_______ benefits are always preferable to dollar amount coverage because the insurer will pay all the costs.

service

The Health Insurance Portability and Accountability Act of 1996 provides:

standards so workers would not lose health insurance if they change jobs a parent with a sick child can move from one health plan to another without paying more for coverage than other employees do

A provision under which an insured pays all costs up to a certain amount, after which the insurance company pays 100% of the remaining covered expenses, is called a:

stop-loss

The two factors that greatly affect the cost of health insurance are:

the amount of coinsurance

True or false: Copayment is the provision under which the insured pays a flat dollar amount each time a covered medical service is received.

true

True or false: In a service benefit provision, insurance benefits are expressed in terms of entitlement to receive specified hospital or medical care rather than a fixed dollar amount for each procedure.

true

______ care insurance may cover eye exams, eye surgery, glasses, and contact lenses.

vision