medical expense insurance
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
Which of the following terms is NOT associated with a Major Medical policy?
Capitation
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 of the following is NOT included in comprehensive major medical plans?
First-dollar coverage
Medical expense policies will typically cover which of the following?
Injuries caused by accidents
Low frequency diseases can be exclusively covered by what kind of health insurance policies?
Limited policies
What does a Hospital Confinement indemnity policy pay for?
Pays a specified daily amount while the insured is confined to a hospital
At what point does a self-insured group qualify for stop-loss coverage?
When claims exceed a specified limit in a set period of time
What does the term coinsurance refer to?
After the deductible is satisfied, the percentage paid by the insured for the remaining covered expenses
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
What type of policy would only provide coverage for specific types of illnesses (cancer, stroke, etc)?
Dread disease insurance
When an insured has a major medical plan with first dollar coverage, how does this impact the benefits paid?
No deductible payment is required
Who is the individual paid on a fee-for-service basis?
Provider
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
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
Which of the following does specified disease insurance NOT cover?
costs covered by medical expense insurance
A pharmacy benefit covers prescription drugs derived from a list called a(n)
drug formulary
A dread disease policy is considered to be a type of
limited health insurance policy
The focus of major medical insurance is providing coverage for
medical and hospitalization expenses
An indemnity plan
provides the insured a specific dollar amount for services
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
