Medical Expense Insurance

Kim has health insurance with a deductible of $500 and an 80/20 coinsurance. How much will she pay if she incurs a loss of $1,500?

$700- In this situation, the insured will pay $500 deductible plus $200 coinsurance = $700.

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

Integrated deductible

An example of elective cosmetic surgery would be

removing excess fat from an insured's waistline

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

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

A proposed insured for a health insurance policy was treated for heart disease within the past year. When applying for health insurance, the heart disease treatment

indicates a preexisting condition

The focus of major medical insurance is providing coverage for

medical and hospitalization expenses

The elimination period under a hospital indemnity plan is the period in which pre-existing conditions are not taken into consideration

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

"Maximum benefits" refers to the

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

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

No deductible payment is required

A policyholder has a major medical plan with a 80%/20% coinsurance and a deductible of $75. If the insured has previously met her deductible and receives a bill for $175, how much will the insurer pay?

$140 - Because the insured has previously met her deductible, the eligible expenses for a claim is the entire $175. The insurance company pays 80% of $175, or $140.

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

Which type of coverage pays an amount per day for hospitalization directly to the insured regardless of the insured's other health insurance?

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

All of these are characteristics of a major medical expense policy EXCEPT

elimination periods - The elimination period is the period of time between the onset of a disability, and the time you are eligible for benefits. It is typically a characteristic of disability policies, not major medical expense policies.

A health insurance policy will typically cover

preventative health services