Xcel ch 15 medical expense insurance
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
an insured has a stop-loss limit of $5,000, a deductible of $500, and an 80/20 insurance. The insured incurs $25,000 of covered losses. How much will the insured have to pay?
$5,000 the insured will pay the stop-loss limit of $5,000
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
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
Which of the following statements is NOT true regarding a Critical Illness Plan?
Coverage is limited to a single devastating disease
What type of policy would only provide coverage for specific types of illnesses (cancer, stroke, etc)?
Dread disease insurance
all of the following plans allow for employee contributions to be taken on a pre-tax basis EXCEPT
Health reimbursement Arrangement plan CORRECT: section 125 plan, premium only plan, cafeteria plan
which of the following is NOT included under health benefit plan?
Hospital Indemnity plan CORRECT: major medical policy, basic Hospital policy, surgical expense policy
Low frequency diseases can be exclusively covered by what kind of health insurance policies?
Limited policies
Who is the individual paid on a fee-for-service basis?
OProvider
Major Medical expense plans provide coverage for each of the following EXCEPT
Work-related injuries
A fee for service health insurance plan will normally Cover
a disease
Major medical insurance will typically cover medical expenses that result from
a negative reaction to prescribed medication
an insured has a health plan that pays established amounts in accordance with the list of injuries, surgical procedures, or other losses. This list is called a
benefit schedule
which of the following types of deductibles would apply a single deductible to both medical and dental insurance coverage?
integrated deductible
low-frequency diseases can be exclusively covered by what kind of health insurance policies?
limited policies
the focus of major medical insurance is providing coverage for
medical and hospitalization expenses
when an insured has a major medical plan with first dollar coverage, how does this impact the benefits paid?
no deductible payment is required
what is the tax liability for employer contributions and Health Savings Account (HSA's)?
no tax payment needed
an Indemnity plan
provides the insured a specific dollar amount for services
An example of elective cosmetic surgery would be
removing excess fat from an insured's waistline
Distributions from a Health Savings Account (HSA) for qualified medical expenses are
tax-free
a fee-for-service health insurance plan will normally cover
the disease
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
Kate has a Major Medical Plan with a 75/25 coinsurance and a deductible of $25. How much will she have to pay if she, not having met any of her deductible, visits the doctor and receives a bill for $125?
$50.00
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 type of coverage pays an amount per day for hospitalization directly to the insured regardless of the insured's other health insurance?
Hospital indemnity
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
Jennifer is required to pay a specific sum out of pocket before any benefits are paid in a year. Her health policy most likely contains a(n)
deductible
A pharmacy benefit covers prescription drugs derived from a list called a(n)
drug formulary
all of these are characteristics of a major medical expense policy EXCEPT
elimination periods CORRECT: large benefit maximum, deductibles, coinsurance elimination period is the period of time between the onset of a disability and the time you're eligible for benefits. and is typically a characteristic of disability policies, not major medical expense policies.
all of the following are qualifications for establishing a health savings account (HSA) EXCEPT
enrolled in a health plan with the prescription drug benefit CORRECT: enrolled in a high-deductible health plan, be under the age of 65 and not enrolled in Medicare, enrolled in a health plan that limits out-of-pocket expenses
A payment system for health care in which the provider is paid for each service given is called
fee-for-service
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
A dread disease policy is considered to be a type of
limited health insurance policy
A health insurance policy will typically Cover
preventative health services
the elimination period under a hospital Indemnity plan is
the specified number of days in 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
