Medical Expense

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For which of the following expenses does a Basic Hospital policy pay?
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Hospital room and board
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Which of the following services is NOT covered under a hospitalization expense policy?
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surgeon’s fees
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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?
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$3,000
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Which of the following statements BEST describes the intent of a Coinsurance clause in a Major Medical policy?
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Discourages overutilization of the insurance coverage
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Which of the following statements BEST defines usual, customary, and reasonable (UCR) charges?
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The maximum amount considered eligible for reimbursement by an insurance company under a health plan
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All of the following statements about Major Medical benefits are true EXCEPT
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Benefits have no maximum limit
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Which of the following types of health coverage frequently uses a deductible?
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Major Medical policy
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Which of the following phrases refers to the fees charged by a healthcare professional?
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Usual, customary, and reasonable expenses
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Which of these options can an individual use their medical flexible spending account to pay for?
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Prescription drugs
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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?
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Insurer will likely treat as a pre-existing condition which may not be covered for one year
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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?
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$720
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Which of the following medical expenses does Cancer insurance NOT cover?
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Arthritis
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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?
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$1,600
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Which of the following statements BEST describes dental care indemnity coverage?
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Services are reimbursed after insurer receives the invoice
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A characteristic of Preferred Provider Organizations (PPOs) would be:
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Discounted fees for the patient
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N has a Major Medical policy that only pays a portion of N’s medical expenses. N is responsible for paying the remaining balance. This provision is known as
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Coinsurance
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Which of the following BEST describes a Hospital Indemnity policy?
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Coverage that pays a stated amount per day of a covered hospitalization
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In Major Medical Expense policies, what is the intent of a Stop Loss provision?
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Limits an insured’s out-of-pocket medical expenses
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M is insured under a basic Hospital/Surgical Expense policy. A physician performs surgery on M. What determines the claim M is eligible for?
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Determined by the terms of the policy
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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?
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$7,000
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Major Medical policies typically
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contain a deductible and coinsurance
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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
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High-deductible health plan
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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?
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$1,000
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Which of the following situations does a Critical Illness plan cover?
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Leukemia
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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
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$3,600
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With a Basic Medical Expense policy, what does the hospitalization expense cover?
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hospital room and board
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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?
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$2,100
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Deductibles are used in health policies to lower
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overuse of medical services
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Comprehensive Major Medical policies usually combine
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Major Medical with Basic Hospital/Surgical coverage
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Basic Hospital and Surgical policy benefits are
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lower than the actual expenses incurred
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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?
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Carryover provision
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Which of the following costs would a Basic Hospital/Surgical policy likely cover?
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Surgically removing a facial birthmark
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Basic Medical Expense insurance
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has lower benefit limits than Major Medical insurance
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The first portion of a covered Major Medical insurance expense that the insured is required to pay is called the
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initial deductible
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Which of the following statements about Health Reimbursement Arrangements (HRA) is CORRECT?
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If the employee paid for qualified medical expenses, the reimbursements may be tax-free

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