Chapter 4 - Medical Expense Insurance

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 insure have to pay? $500 $5,000 $5,400 $5,600

$5,000

Which of the following statements is NOT true regarding a critical illness plan? Pays a lump sum to the insured upon the diagnosis of a critical illness The insurer may have a list of critical illnesses they will cover Coverage is limited to a single devastating disease Also known as Specified Disease Plans

Coverage is limited to a single devastating disease

A pharmacy benefit covers prescription drugs derived from a list called a(n) Administrative drug list Drug formulary Controlled substance list Generic benefit manager

Drug formulary

A payment system for health care in which the [provider is paid for each service given is called A blanket plan Lump sum Fee-for-service A prepaid arrangement

Fee-for-service

Which type of coverage pays an amount per day for hospitalization directly to the insured regardless of the insured's other health insurance MEWA Mutual Group Hospital indemnity

Hospital indemnity

Which of the following is NOT included under a health benefit plan? Major medical policy Basic hospital policy Hospital indemnity policy Surgical expense policy

Hospital indemnity policy

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

Integrated deductible

Who is the individual paid on a fee-for-service basis Subscriber Administrator Insured Provider

Provider

Major medical expense plans provide coverage for each of the following EXCEPT Medically necessary surgery Diagnostic tests Blood and urine lab screens Work-related injuries

Work-related injuries

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? $25 $50 $75 $100

$50

A fee for service health insurance plan will normally cover Vitamins and natural remedies Cosmetic procedures Gym membership A disease

A disease

Major medical insurance will typically cover medical expenses that result from A crime committed by the insured A self-inflicted injury Intoxication A negative reaction to the prescribed medication

A negative reaction to the prescribed medication

An insured has a health plan that pays established amounts in accordance with a list if injuries, surgical procedures, or other losses. This list is called a Loss chart Benefit summary Benefit schedule Coverage menu

Benefit schedule

All of the following are qualifications for establishing a health savings account (HSA) EXCEPT Enrolled in a high deductible health plan Be under the age of 65 (not enrolled in Medicare) Enrolled in a health plan with the prescription drug benefit Enrolled in a health plan that has limits out of pocket expenses

Enrolled in a health plan with the prescription drug benefit

A dread disease policy is considered to be a type of Hospital expense policy Group health insurance policy Major medical insurance policy Limited health insurance policy

Limited health insurance policy

The focus of major medical insurance is providing coverage for Critical illnesses only Preventative care Medical and hospitalization expenses Doctor's visits

Medical and hospitalization expenses

When an insured has a major medical plan with first dollar coverage, how does this impact the benefits paid? No deductible payment is required Deductible specified in the contract is payable by the insured Insured must pay a percentage of the covered losses An initial deductible plus a percentage of the remaining covered loss us owed by the insured

No deductible payment is required

A health insurance policy will typically cover Injuries obtained from war Elective cosmetic surgery Preventative health services Work related injuries

Preventative health services

An example of elective cosmetic surgery would be Reconstructive breast surgery after a mastectomy Removing excess fat from an insured's waistline Surgery to correct a birth defect Reconstructive surgery after suffering injuries from an automobile accident

Removing excess fat from an insured's waistline

The elimination period under a hospital indemnity plan is The period in which pre-existing conditions are not taken into consideration The period in which all deductibles are eliminated The specified number of days after an insurance policy's issue date during which coverage is not afforded for sickness The specified number of days an insured mist wait before becoming eligible to receive benefits for each hospitalization

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

"Maximum benefits" refers to the Upper limit of the total lifetime the insurance company will pau Upper limit coverage of what the insurance company will pay for coinsurance Upper limits of what the insured will pay in out-of-pocket expenses Upper limits of what an insurance company will pay for a particular claim

Upper limit of the total lifetime the insurance company will pau

How is a health provided reimbursed if they do NOT have an agreement in place with the insurance company With a contingent fee With a scheduled fee With a usual, customary, and reasonable fee With a reasonably appropriate fee

With a usual, customary, and reasonable fee