Course 14

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? -$500 -$900 -$1,000 -$1,350

"$900". In this situation, the group insurance carrier will pay 90% of the covered loss after the deductible has been applied.

What does the term coinsurance refer to? -The stated initial dollar amount that the individual insured is required to pay before insurance benefits are paid -The amount the Federal government pays after the deductible is met -A situation where two insurance policies cover the same claim -After the deductible is satisfied, the percentage paid by the insured for the remaining covered expenses

"After the deductible is satisfied, the percentage paid by the insured for the remaining covered expenses". After the insured satisfies the deductible, the insurance company pays a high percentage of the additional expenses (usually 75% or 80%) and the insured pays the remainder.

What is considered the most common type of specified disease insurance policy? -Multiple Sclerosis -Heart disease -Cancer -Stroke

"Cancer" Cancer affects 1 in 2 men and 1 in 3 women and typically involves a lot of out-of-pocket expenses. It's no wonder Cancer insurance is considered the most common type of specified disease insurance.

Which of the following terms is NOT associated with a Major Medical policy? -Stop-loss -Comprehensive -Deductible -Capitation

"Capitation" Capitation is the method in which HMO providers are paid.

Health insurance policies typically contain a provision stating that insureds and their insurer will share covered losses in an agreed proportion. Which provision does this refer to? -Internal limit -Stop-loss -Deductible -Coinsurance

"Coinsurance" Coinsurance is a sharing of expenses by the insured and the insurer. Once the insured satisfies the deductible, the insurance company pays a high percentage of the additional expenses (usually 75% or 80%) and the insured pays the remainder.

All of the these are examples of cost sharing in a health insurance policy EXCEPT -Co payments -Deductibles -Coinsurance -Coordination

"Coordination" Cost sharing is the share of costs covered by your insurance that you pay out of your own pocket. This term generally includes deductibles, coinsurance, and co payments.

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" There are normally a number of "Critical illnesses" that a Critical Illness Plan will cover.

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 a prescription drug benefit -Enrolled in a health plan that limits out of pocket expenses

"Enrolled in a health plan with a prescription drug benefit". Establishing an HSA does not require enrollment in a prescription drug plan.

Which of the following is NOT included in comprehensive major medical plans? -Maximum coverage limits -Coinsurance -First-dollar coverage -Deductibles

"First-dollar coverage" First-dollar coverage is not normally associated with comprehensive major medical plans.

Which of the following types of policies pays a stated amount for each day an individual is hospitalized? -Hospital confinement indemnity -Hospital endowment -Short-term major medical -Surgical expense

"Hospital confinement indemnity" A hospital indemnity policy pays a specified amount on a daily, weekly, or monthly basis to the insured while the insured is confined to a hospital.

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

"Hospital indemnity plan". A health benefit plan includes all of these plans EXCEPT a hospital indemnity plan.

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" A hospital indemnity policy pays an amount per day for hospitalization directly to the insured regardless of the insured's other health insurance.

Medical expense policies will typically cover which of the following? -Injuries caused by accidents -Routine dental care -Prescription eyeglasses -Voluntary cosmetic procedures

"Injuries caused by accidents" Medical expense policies will typically cover injuries caused by accidents.

What is the tax liability for employer contributions in Health Savings Accounts (HSA's)? Taxable as regular income to the employee Tax-deductible expense to the employee No tax payment needed Taxable to the employee when they exceed 7 1/2 % AGI

"No tax payment needed" Employer-paid contributions to Health Savings Accounts are tax-free to the employee.

What does a Hospital Confinement indemnity policy pay for? -Pays for the entire cost of the hospital stay -Pays for the deductible and coinsurance of the hospital stay -Pays for cost of the hospital stay after the deductible and coinsurance has been met -Pays a specified daily amount while the insured is confined to a hospital

"Pays a specified daily amount while the insured is confined to a hospital". A Hospital Confinement indemnity policy pays a specified daily amount while the insured is confined to a hospital.

An insured is protected from the expense of a catastrophic illness by which of the following health insurance provisions? -Self-insurance -Stop-loss -Deductible -Reimbursement

"Stop-lose" The Stop-loss provision states that after the insured has paid a specific amount toward a covered expense, the insurer will pay 1 00% of the remaining expenses. It is a feature designed to limit the amount of an insured's out-of-pocket medical expenses and protect the insured from the expenses involved with a catastrophic illness/accident.

At what point does a self-insured group qualify for stop-loss coverage? -When the insured reaches an age stated in the policy -When claims exceed a specified limit in a set period of time -When claims exceed the policy's maximum lifetime benefit limit -When the average claim amount exceeds the limit stated in the policy

"When claims exceed a specified limit in a set period of time" A self-insured group qualifies for stop-loss coverage after claims exceed a specified limit in a set period of time.

Which of the following does specified disease insurance NOT cover? -costs covered by medical expense insurance -medical expenses that are non covered -incidental costs -out-of-pocket expenses

"costs covered by medical expense insurance". Specified disease insurance covers all of these EXCEPT costs covered by medical expense insurance.

The elimination period in a disability income policy serves the same purpose as a(n) in a medical expense policy. -deductible -coinsurance -HSA -reimbursement

"deductible". A deductible is a stated initial dollar amount that the individual insured is required to pay before insurance benefits are paid. In a disability income policy, the elimination period is the time immediately following the start of a disability when benefits are not payable.

Major medical expense plans typically use a cost containment measure for emergency hospital care. This is referred to as a(n) -capitation -exclusion -limitation -deductible

"deductible". Deductibles are used primarily to help control the cost of premiums and reduce over utilization of medical services.

A health insurance policy will typically cover -injuries obtained from war -elective cosmetic surgery -preventative health services -work related injuries

"preventative health services" Preventative health services are normally covered under a health insurance policy.

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" Surgery to remove excess fat from an insured's waistline would be considered elective cosmetic surgery.