chapter 13 medical expense insurance Flashcards
which of the following costs would a basic/hospital/surgical policy likely cover
surgically removing a facial birthmark
a major medical policy typically
provides benefits for reasonable and necessary medical expenses subject to policy limits
basic hospital and surgical policy benefits are
lower than the actual expense insured
which of the following is not a limited benefit plan
life insurance policy
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
basic hospital
this type of deductible provision waives the deductible for all family members after some of them have satisfies individual deductibles within the same year
family maximum deductible
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
a characteristic of preferred provider organizations would be
discounted fees for th patient
which of the following policy features allow an insured to defer current health charges to the following dedutible instead of the current year deductible
carryover provision
comprehensive major medical policies usually combine
major medical with basic hospital/surgical coverage
major medical policies typically
contain a deductible and coinsurance
in order to establish a health reimbursement arrangement (HRA) it must
be established by them employers
deductibles are used in health policies to lower
overuse of medical services
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?
1600
2200-200 x80%
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.
$1000
all of the following statements about major medical benefits are true except
benefits have no maximum limit
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
experimental and invetigative services
which of the following medical expenses does cancer insurance not cover?
arthritis
for which of the following expenses does a basic hospital policy pay
hospital room and board
in major medical expense policies, what is the objective of a stop loss provision
limits the insured out of pocket medical expenses
what type of policy would only provide coverage for specific types of illnessess (cancer stroke etc)
dread disease insurance
what type of policy would only provide coverage for specific types of illnessess (cancer stroke etc)
dread disease insurance
a catastrophic illness would be best covered by which of the following health insurance plans
major medical
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
insurer will likely treat as a pre existing condition which may not be covered for one year
