question

The individual who provides general medical care for a patient as well as the referral for specialized care is known as a

answer

Primary Care Physician

question

A 66 year-old is covered under a group health plan while employed with a business that has 40 employees. If she injures herself while walking in the park, what coverage would be considered primary?

answer

Her group health plan

question

The health insurance program which is administered by each state and funded by both the federal and state governments is called

answer

Medicaid

question

Which of the following statements is true about most Blue Cross/Blue Shield organizations?

answer

They are nonprofit organizations

question

Which of the following types of organizations are prepaid group health plans, where members pay in advance for the services of participating physicians and hospitals that have agreements?

answer

HMO

question

What is the maximum Social Security Disability benefit amount an insured can receive?

answer

100% of the insured's Primary Insurance Amount (PIA)

question

Which of the following does Social Security NOT provide benefits for?

answer

Dismemberment

question

What does Medicare Parts A and B cover?

answer

Part A covers hospitalization; Part B covers doctor's services

question

A medical care provider which typically delivers health services at its own local medical facility is known as a

answer

Health Maintenance Organization

question

Which of these statements is INCORRECT regarding a Preferred Provider Organization (PPO)?

answer

PPO's are NOT a type of managed care systems

question

The situation in which a group of physicians are salaried employees and conduct business in an HMO facility is called a(n)

answer

closed panel

question

Which of the following reimburses its insureds for covered medical expenses?

answer

Commercial insurers

question

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

answer

initial deductible

question

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

answer

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

question

Which of the following medical expenses does Cancer insurance NOT cover?

answer

Arthritis

question

Which of the following BEST desscribes a Hospital Indemnity policy?

answer

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

question

T was treated for an ailment 2 months prior to applying for a health insurance policy. This condition was noted on the application and the policy was issued shortly afterwards.How will the insurer likely consider this condition?

answer

Insurer will likely treat as a pre-existing condition which may not be covered for one year

question

Which of the following statements BEST describes the intent of a Coinsurance clause in a Major Medical policy?

answer

Discourages overutilization of the insurance coverage

question

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

answer

Determined by the terms of the policy

question

Q is hospitalized for 3 days and receives a bill for $10,100. Q has a Major Medical policy with a $100 deductible and 80/20 coinsurance. How much will Q be responsible for paying on this claim?

answer

$2,100

question

Which of the following individual health insurance policies will provide the broadest protection? Hospital Expense Surgical Expense Major Medical Limited Sickness 7 of 15 Questions RemainingSubmit Response

answer

Major Medical

question

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?

answer

$720

question

Which of the following statements BEST defines usual, customary, and reasonable (UCR) charges?

answer

The maximum amount considered eligible for reimbursement by an insurance company under a health plan

question

Basic Medical Expense insurance

answer

has lower benefit limits than Major Medical insurance

question

Comprehensive Major Medical policies usually combine

answer

Major Medical with Basic Hospital/Surgical coverage

question

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

answer

Services are reimbursed after insurer receives the invoice

question

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

answer

hospital room and board

question

Which of the following health insurance coverages is BEST suited for meeting the expenses of catastrophic illness?

answer

Major Medical

question

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 deducitble?

answer

Carryover provision

question

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?

answer

$7,000

question

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

answer

3600

question

Basic Hospital and Surgical policy benefits are

answer

lower than the actual expenses incurred

question

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

answer

Benefits have no maximum limit

question

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?

answer

$1,000

question

What type of policy would only provide coverage for specific types of illnesses (cancer, stroke, etc)?

answer

DREDA

question

Major Medical policies typically

answer

pay 100% of covered expenses

question

Which of the following statements about Health Reimbursement Arrangements (HRA) is CORRECT?

answer

If the employee had a qualified medical leave from work, lost wages can be reimbursed

question

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

answer

experimental and investigative services

question

Which of the following costs would a Basic Hospital/Surgical policy likely cover?

answer

Surgically removing a facial birthmark

question

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

answer

High-deductible health plan

question

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

answer

Employee funds the HRA entirely

question

A Health Reimbursement Arrangement MUST be established

answer

by the employer

question

An insured covered by a group Major Medical plan is hospitalized after sustaining injuries that resulted from an automobile accident. Assuming the plan had a $1,000 deductible and an 80/20 Coinsurance clause, how much will the INSURED be responsible to pay with $11,000 in covered medical expenses?

answer

3000

question

A characteristic of Preferred Provider Organizations (PPOs) would be:

answer

Discounted fees for the patient

question

Which of the following is NOT a limited benefit plan?

answer

life insurance policies

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