Chapter 5 Flashcards
Unforeseen and unintended injury resulted from accident rather than sickness
Cafeteria plan
Cancellation
Deductible
Accidental bodily injury
Type of employee benefit plan that allows insureds to choose between different types of benefits
Accidental bodily injury
Lump sum
Riders
Cafeteria plan
Cafeteria plan
Termination of in-force insurance policy by either insured or by insurer prior to expiration date shown in policy
No renewal
Riders
Sickness
Cancellation
Cancellation
Health ins that provides coverage format types of medical expenses
Deductible
Lump sum
Comprehensive coverage
Comprehensive coverage
Specified dollar amount insured must pay first before ins company will pay policy benefits
Lump sum
No renewal
Riders
Deductible
Deductible
Payout method that pays beneficiary entire benefit in one payment
No renewal
Tax exempt
Lump sum
Lump sum
Termination of ins policy at expiration date by not offering continuation of existing policy or replacement policy
Riders
Sickness
Underwriting
Nonrenewal
Nonrenewal
Added to basic ins policy to add modify or delete policy provisions
Underwriting
Cafeteria pan
Lump sum
Riders
Riders
Illness which first manifests itself while policy is in force
Sickness
Not subject to taxation
Tax exempt
Taxable
Deductible
Cancellation
Tax exempt
Subject to taxation
Underwriting
Accidental bodily injury
Taxable
Taxable
Risk selection and classification process
Underwriting
Cafeteria plan
Cancellation
Underwriting
Assigned points=
Relative value
Assigned points multiplied by conversion factor
200x$10
Total amount payable
Relative value system
In relativ value system of determining coverage for given procedure what term describes total amount payable per point
Relative value
Practical value
Conversion factor
Conversion factor
Coverage written in conjunction with hospital expense policies covers surgeons fees anesthesiologist and operating room
Basic surgical expense
Basic medical expense
Major medical expense
Basic surgical expense
This includes surgeons fees anesthesiologist and operating room when covered as miscellaneous medical item
Which would basic medical expense coverage not cover
Mental illness
Metarnity
Hospice
Surgeons services
Surgeon services
Not true regarding basic surgical expense coverage
Coverage is unlimited
No deductible
Include surgical schedule
Commonly written in conjunction with hospital expense policies
Coverage is unlimited
If not required to pay deductible what kind of coverage
Major medical
Comprehensive
Corridor
First dollar
First dollar
Three basic coverages for medical expense ins
Reimbursement preventive service
Hospital surgical medical
Basic major overhead
Medical dental vision
Hospital surgical medical
Not covered under basic hospital
Hospital room and board
Lab charges
Surgeons fees
Surgeon fees
Good has hernia which requires repair. Learns ins plan will cover 200 points of surgical expenses. Each point represents $10
$2000 will be covered by ins plan. What system is Todd’s ins company using?
Relative value
Basic surgical
Point based medical
Conversion factor
Relative value
Typical deductible for basic surgical expense ins
0
100
200
500
0
But coverage is limited
Best describes first dollar coverage principal in basic medical ins
Not required to pay deductible
Must first pay deductible
Insurer covers first claim on policy
Insured not required to pay deductible
In basic expense policy after limits of basic policy are exhausted insured must pay what kind of deductible
None
Cooidor
Full
Half
Corridor
Derives its name from fact that applied between basic coverage and major medical coverage
Coridoor
Describes coverage on first dollar basis
Accident expense
Limited major medical
Basic expense
Basic expense
Which is NOT true of major medical health ins policy
Benefits are subject to deductibles
Usually has maximum benefit amount
Designed to pay on first dollar of expense basis
Designed to cover hospital and medical expenses of a catastrophic nature
Designed to pay a first dollar of expense basis
Usually has deductibles and copayment requirement
Major medical policy
Corridor deductible derives its name from the fact that it is applied between basic coverage and
Interval expense
Limited coverage
Major medical coverage
Major medical coverage
Don has basic expense and major medical policy
He is injured in accident which requires several major surgeries. Quickly exhausts don’s basic expense policy. What does don need to do before major medical policy can pick up where basic expense policy left off?
Submit notification to major medical ins implant
Wait six months in order to be covered again
Pay special deductible on his major medical policy
Pay special deductible on his major medical policy
Lists types of operations covered and their assigned dollar amounts
Surgical schedule
