Xcel 4 Exame (Medical Expense)
19. Comprehensive Major Medical policies usually combine:
Major Medical with Basic Hospital/Surgical coverage
23. What type of policy would only provide coverage for specific types of illnesses (cancer, stroke, etc)?
Dread disease insurance
20. Which of the following statements about Health Reimbursement Arrangements (HRA) is CORRECT?
If the employee paid for qualified medical expenses, the reimbursements may be tax-free
4. Which of the following situations does a Critical Illness plan cover?
Leukemia
3. In Major Medical Expense policies, what is the objective of a Stop Loss provision?
Limits an insured's out-of-pocket medical expenses
25. Which of the following statements BEST defines usual, customary, and reasonable (UCR) charges?
The maximum amount considered eligible for reimbursement by an insurance company under a health plan
1. A Health Reimbursement Arrangement MUST be established:
by the employer
12. A prospective insured completes and signs an application for health insurance but intentionally conceals information about a pre-existing heart condition. The company issues the policy. Two months later, the insured suffers a heart attack and submits a claim. While processing the claim, the company discovers the pre-existing condition. In this situation, the company will:
continue coverage but exclude the heart condition
16. The first portion of a covered Major Medical insurance expense that the insured is required to pay is called the:
initial deductible
7. J was reviewing her Health Insurance policy and noticed the phrase "This policy will only pay for a semi-private room". This phrase is considered to be a(n)
internal limit
21. Which of the following services is NOT included under hospitalization expense coverage?
surgical fees
9. Which of the following policy features allows an insured to defer current health charges to the following year's deductible instead of the current year's deductible?
Carryover provision
2. A Major Medical policy typically contains a provision that requires the insurer to pay only part of a loss, while the balance is paid by the insured. This provision is called
Coinsurance
17. 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?
$1,600
6. S wants to open a tax-exempt Health Savings Account. To qualify for this type of account, Federal law dictates that S must be enrolled in a:
High-deductible health plan
15. Which provision allows a portion of any used medical benefits to be restored following a particular amount of benefit has been used, or after the policy has been in effect for a particular period of time?
Restoration of used benefit
10. A characteristic of Preferred Provider Organizations (PPOs) would be:
Discounted fees for the patient
18. Which of the following medical expenses does Cancer insurance NOT cover?
Arthritis
5. Which of the following BEST describes a Hospital Indemnity policy?
Coverage that pays a stated amount per day of a covered hospitalization
24. A catastrophic illness would be best covered by which of the following health insurance plans?
Major Medical
13. M is insured under a basic Hospital/Surgical Expense policy. A physician performs surgery on M. What determines the claim M is eligible for?
Determined by the terms of the policy
11. This type of deductible provision waives the deductible for all family members after some of them have satisfied individual deductibles within the same year:
Family maximum deductible
22. Basic Medical Expense insurance:
has lower benefit limits than Major Medical insurance
8. Under a Basic Medical Expense policy, what does the hospitalization expense portion cover?
hospital room and board
14. Basic Hospital and Surgical policy benefits are:
lower than the actual expenses incurred
