chapter 13 medical expense insurance

Question 1

which of the following costs would a basic/hospital/surgical policy likely cover

Answer 1

surgically removing a facial birthmark

Question 2

a major medical policy typically

Answer 2

provides benefits for reasonable and necessary medical expenses subject to policy limits

Question 3

basic hospital and surgical policy benefits are

Answer 3

lower than the actual expense insured

Question 4

which of the following is not a limited benefit plan

Answer 4

life insurance policy

Question 5

B’s policy provides coverage on an in-hospital basis only and contains a limited daily room and board benefit. which of these policies does B have

Answer 5

basic hospital

Question 6

this type of deductible provision waives the deductible for all family members after some of them have satisfies individual deductibles within the same year

Answer 6

family maximum deductible

Question 7

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

Answer 7

coinsurance

Question 8

a characteristic of preferred provider organizations would be

Answer 8

discounted fees for th patient

Question 9

which of the following policy features allow an insured to defer current health charges to the following dedutible instead of the current year deductible

Answer 9

carryover provision

Question 10

comprehensive major medical policies usually combine

Answer 10

major medical with basic hospital/surgical coverage

Question 11

major medical policies typically

Answer 11

contain a deductible and coinsurance

Question 12

in order to establish a health reimbursement arrangement (HRA) it must

Answer 12

be established by them employers

Question 13

deductibles are used in health policies to lower

Answer 13

overuse of medical services

Question 14

M has a major medical insurance policy with a $200 flat deductible and an 80% coinsurance clause. if M incurs a $2200 claim for an eligible medical expense, how much will M receive in payment for this claim?

Answer 14

1600

2200-200 x80%

Question 14

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 expense 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 14

$1000

Question 15

all of the following statements about major medical benefits are true except

Answer 15

benefits have no maximum limit

Question 16

a comprehensive major medical health insurance policy contains an eligible expenses provision which identifies the type of health care services that are covered. all of the following health care services are typically covered, except for

Answer 16

experimental and invetigative services

Question 16

which of the following medical expenses does cancer insurance not cover?

Answer 16

arthritis

Question 17

for which of the following expenses does a basic hospital policy pay

Answer 17

hospital room and board

Question 18

in major medical expense policies, what is the objective of a stop loss provision

Answer 18

limits the insured out of pocket medical expenses

Question 19

what type of policy would only provide coverage for specific types of illnessess (cancer stroke etc)

Answer 19

dread disease insurance

Question 20

what type of policy would only provide coverage for specific types of illnessess (cancer stroke etc)

Answer 20

dread disease insurance

Question 21

a catastrophic illness would be best covered by which of the following health insurance plans

Answer 21

major medical

Question 22

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 22

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

Question 23

what of the following best describes the intent of a coinsurance clause in a major medical policy

Answer 23

dicourages overutilization of the insurance coverage

Question 24

which of the following statments best defines usual customary and reasonable UCR charges

Answer 24

the maximum amount considered eligible for reimbursment by an insurance company under a health plan