Chapter 4: Medical expense insurance Flashcards
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?
$2200-200*80%=$1,600
Which of the following types of health coverage frequently uses a deductible?
major medical policy
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:
experimental and investigative services
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 $2,000?
$400 deductible + 20% of the remaining medical bill = $720
Which of the following services is NOT included under hospitalization expense coverage?
surgical fees
In major medical expense policies, what is the objective of a stop loss provision?
limits an insured’s out of pocket medical expenses
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?
$10,000*20% coinsurance +$100 deductible =$2,100
In order to establish a Health Reimbursement Arrangement (HRA), it must:
be established by the employer
Which of the following statements BEST defines usual, customary, and reasonable (UCR) charges?
The maximum amount considered eligible for reimbursement by an insurance company under a health plan
Basic hospital and surgical policy benefits are:
lower than the actual expenses incurred
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 deductible?
carryover provision
The individual health insurance policy that offers the broadest protection is a(n) _______ _______ policy
major medical
Which of the following BEST describes a hospital indemnity policy?
Coverage that pays a stated amount per day of a covered hospitalization
Which of the following costs would a basic hospital/surgical policy likely cover?
Care given at a nursing home
Lost income caused by a hospital stay
**Surgically removing a facial birthmark
All of the following statements about major medical benefits are true, EXCEPT:
Benefits have no maximum limit
