Chapter 14: Medical Expense insurance

What is not true regarding a Critical Illness Plan

Coverage is limited to a single devastating disease

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

Limited policies

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

fee-for-service

The focus of major medical insurance is providing coverage for

medical and hospitalization expenses

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; the insured will pay the stop-loss limit

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 (.2 x 1000)

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. What provision does he have?

Calendar-year deductible

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

Dread disease insurance

A dread disease policy is considered to be a type of

Limited health insurance policy

A fee for service health insurance plan will normally cover

a disease

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

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

deductible

a stated initial dollar amount that the individual insured is required to pay before insurance benefits are paid

deductible

A pharmacy benefit covers prescription drugs derived from a list called a

drug formulary

True or false: A health benefit plan includes hospital indemnity plan

false

True or false: elimination periods are a characteristic of a major medical expense policy

false

A single deductible applied to both medical and dental insurance coverage is referred to as an ____

integrated deductible

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

no deductible payment is required

These health services are normally covered under a health insurance policy

preventative

An indemnity plan

provides the insured a specific dollar amount for services

An example of elective cosmetic surgery would be

removing excess fat from an insured's waistline

Distributions from a HSA for qualified medical expenses are

tax-free

Maximum benefits refers to the

upper limit of the total lifetime benefits the insurance company will pay