Medical Expense Insurance Exam Review

Which of these is NOT a characteristic of a Health Reimbursement Arrangement (HRA)?

Employee funds the HRA entirely -HRA plans are employer-funded medical reimbursement plans

Deductibles are used in health policies to lower

One of the primary reasons for using deductibles in health policies is to reduce the overuse of medical services.

In Major Medical Expense policies, what is the intent of a Stop Loss provision?

limits an insured's out-of-pocket medical expenses

What services are covered under a hospitalization expense policy

daily room and board, intensive care, miscellaneous expenses

A comprehensive major medical health insurance policy contains an Eligible Expenses provision which identifies the types of health care services that are covered. All of the following health care services are typically covered EXCEPT for

experimental and investigative services

Basic Medical Expense insurance

has lower benefit limits than Major Medical Insurance

With a Basic Medical Expense policy, what does the hospitalization expense cover?

hospital room and board

The first portion of a covered Major Medical insurance expense that the insured is required to pay is called the

initial deductible

The phrase "This policy will only pay for a semi-private room" is an example of a(n)

internal limit

Which of the following is NOT a limited benefit plan?

life insurance policy

Which of the following services is NOT covered under a hospitalization expense policy?

surgeon's fees

All of the following statements about Major Medical benefits are true EXCEPT

Benefits have no maximum limit -Major medical benefits normally have a maximum limit

A Health Reimbursement Arrangement MUST be established

by the employer

What are some limited benefit plans

cancer policies, dental policies, critical illness policies

J's Major Medical policy has a $2,000 deductible and an 80/20 Coinsurance clause. If J is hospitalized and receives a bill for $10,000, J would pay

$3,600

Comprehensive Major Medical policies usually combine

A Comprehensive Major Medical Policy combines Basic Hospital/Surgical and Major Medical insurance.

A major medical policy typically

A major medical policy provides benefits for reasonable and necessary medical expenses, subject to policy limits.

Which of the following BEST desscribes a Hospital Indemnity policy?

Coverage that pays a stated amount per day of a covered hospitalization

Which of the following statements BEST describes dental care indemnity coverage?

Dental care indemnity plans reimburse services only after the carrier receives the bill.

M has a Major Medical insurance policy with a $200 flat deductible and an 80% Coinsurance clause. If M incurs a $2,200 claim for an eligible medical expense, how much will M receive in payment for this claim?

In this situation, $2,200 - $200 deductible x 80% = $1,600.

An individual has a Major Medical policy with a $5,000 deductible and an 80/20 Coinsurance clause. How much will the INSURED have to pay if a total of $15,000 in covered medical expenses are incurred?

In this situation, $5,000 + 20% of the remaining bill = $7,000

A Hospital/Surgical Expense policy was purchased for a family of four in March of 2013. The policy was issued with a $500 deductible and a limit of four deductibles per calendar year. Two claims were paid in September 2013, each incurring medical expenses in excess of the deductible. Two additional claims were filed in 2014, each in excess of the deductible amount as well. What would be this family's out-of-pocket medical expenses for 2013?

In this situation, the insured's maximum out-of-pocket expenses for 2013 would be $1,000.

Which of the following types of health coverage frequently uses a deductible?

Major Medical Policy

C was injured while deep sea diving and requires a hospital stay. C has a Major Medical policy with a 80/20 coinsurance clause and a $400 deductible. What is the MAXIMUM C will pay if the covered medical expenses are $2000?

The correct answer is "$720". In this situation, $400 deductible + 20% of the remaining medical bill = $720.

Which of the following phrases refers to the fees charged by a healthcare professional?

The insurance phrase which considers a particular fee charged by a physician or other health professional is usual, customary, and reasonable expenses.

M is insured under a basic Hospital/Surgical Expense policy. A physician performs surgery on M. What determines the claim M is eligible for?

Under a basic hospital/surgical expense policy, the amount of the patient's claim payment will be based on the terms of the policy.