Chapter 6 Pt 4 Flashcards
L has major medical policy with 500 deductible and 80/20 coinsurance. L is hospitalized and sustains a 2500 loss. What is the maximum amount that l wil have to pay of deductible
500
1000 20% of entire bill
2500 entire bill
900 deductible +20% of bill after deductible (20% of 2000)
500 deductible out of remaining 2000
Insurer will pay 80% (1600)
Insured will pay 20% (400)
Ray has individual major medical policy that requires coinsurance payment. Ray very rarely visits his physician and would prefer to pay the lowest premium possible. Which
80/20
90/10
50/50
75/25
50/50
The less the insurer must pay with coinsurance payments the
Lower the payments will be
If more than one family member covered under same major medical policy is injured in the same accident family only has to pay one deductible
Common accident provision
Integrated deductible
Carry over provision
Elimination period
Common accident provision
Under this provision ony one deductible applies for all family members involved in same accident
Elimination period
Carryover provision
Common accident provision
Common accident provision
Policy begins in January. His policy contains carryover provision. In November he has small claim less than his deductible. Which is true
Deductible will be waived
Insured is now eligible for an integrated deductible until new policy year
Insured may carry over amount of this year’s expenses to next year which will help satisfy next yera’s deductible
Insured may carry over amount of this year’s expenses to next year which will help satisfy next year’s deductible
If insured did not incur sufficient medical costs during year to meet deductible any medical expenses incurred during last three months may be carried forward to next year offsetting total deductible costs for that year
Common accident provision
Flay deductible
Carryover provision
Carryover provision
Insured is required to pay for each claim possibly resulting in more than one deductible being paid in given year
Flat deductible aka occurrence deductible
Common accident provision
Integrated deductible
Flat deductible aka per occcurrence deductible
Main difference bwetween coinsurance and copayments
Copayment is set dollar amount
Coinsurance is set dollar amount
With copayments insured pays all of cost
Copayment is set dollar amount
Which of following is not an exclusion in medical expense ins policies
Coverage for dependents
Military duty
Self inflicted injuries
Routine dental care
Coverage for dependents
Which is true re coinsurance PAID By INSURED
Larger percentage paid by insured lower required premium
Larger percentage paid by insured higher required premium will be
Smaller percentage paid by insured lower premium will be
Smaller percentage paid by insured more consistent premium will be
Larger percentage paid by insured lower premium will be
Items that insurer will not provide coverage for are found in
Insuring clause
Benefit payment clause
Exclusions
Exclusions
Disability income and long term care policies usually have this in form of elimination period
Time deductible
Carryover provision
Reduction provision
Exclusion provision
Time deductible
Decrease in benefits bc of certain specified conditions
Reductions
Exclusions
Eligible expenses
Reductions
Ins company will pay an amount for a given procedure based upon average charge for procedure in specific geo area
Usual/reasonable/customary
Lifetime annual per cause
Impairment future guaranteed purchase
Usual reasonable customary
Specifies benefit amount max policy will pay during lifetime of insured
Annual limit
Per cause limit
Lifetime limit
Lifetime limit
Most a policy will pay each year policy is in force
Annual limit
Per cause limit
Lifetime limit
Annual limit
Limit is most a policy will pay for expenses incurred from same or related causes
Annual limit
Lifetime limit
Per cause
Per cause limit
May be attached to contract for purpose of eliminating coverage for specifically defined pre existing condition such as back injuries
Impairment
Future increase option
Guaranteed purchase option
Impairment/exclusion rider
Which would not increase premium for policyowner
Multiple indemnity rider
Impairment rider
Payor benefit rider
Waiver of premium rider
Impairment rider
Expense policy that establishes amount of benefit paid based on prevailing charges which fall within standard range of fees charged for specific procedure by doctor of similar training and experience in that geographic area
Usual customary reasonable
Relative value schedule
Benefit schedule
Usual customary reasonable
Guaranteed renewable disability ins policy
Guaranteed to have a level premium for life of policy
Cannot be cancelled by insured before 65
Renewable at insured’s option to a specified age
Renewable at insured’s option to a specified age
Renewable at insured’s option to a specified age
Deductible is
Specified dollar amount must be paid before ins co will pay policy benefits
Percentage of medical bill must be paid before services will be rendered
Insurer’s obligation to service provider
Nominal fee for use of insurer’s services
Specified dollar amount that insured must pay first before ins company will pay policy benefits
Premium charged for exercising guaranteed instability rider is based upon insured’s
Attained age
Issue age
Assumed age
Average age
Attained age
Which rider would not increase premium for policyowner
Multiple indemnity rider
Impairment rider
Payor benefit rider
Impairment rider
In health ins if doctor chargers 50 more than what ins co considers usual customary and reasonable extra cost
Is not covered
Must be covered by insurer
Counts toward coinsurance
Is not covered
Guaranteed renewable disability policy
Cannot be cancelled by insured before age 65
Is renewable at the insured’s option to a specified age
Is renewable at the option of insurer to specified age of insured
Is renewable at the insured’s option to a specified age
Means that insured has right to keep policy until specific age
Noncancellable
Cancellable
Guaranteed renewable
Guaranteed renewable
According to rights of renewability rider for cancellable policies, all of following are correct about cancellation of individual ins policy except
Unearned premiums are retained by ins company
Insurer must provide insured a written notice of cancellation
Claims incurred before cancellation must be honored
Unearned premiums are retained by ins company
Purchased noncancellable health ins policy 1 year ago. Which would not be reason for ins company to cancel policy
Insured does not pay premium
Insured reaches maximum age limit specified in policy
Within two years of applicationinsurer discovers misrepresentation
Insured is an an accident and incurs a large claim
Insured is in an accident and incurs a large claim
Insured purchased noncancellable insurance policy 1 year ago; which circumstance would not be reason for ins co to cancel policy?
Company may not cancel coverag due to covered claims; all reset are allowable reasons for insurer to terminate contract
In accident and incurs large claim
Provision describes right to cancel coverage
Renewable provision
Cancellation provision
Policy duration provision
Renewal provision
Included in each health ins contract and outlines both insurer and insured right to cancel or renew coverage
Cancellation provision
Renewal provision
Policy duration provision
Renewability provision
Guaranteed insurability rider aka
Future increase option or guaranteed purchase option
Guaranteed renewable
Future increase option or guaranteed purchase option
Will allow the insured to purchase additional amounts of disability income coverage without evidence of insurability; usually provided number of option dates on which additional purchase option may be exercised
Future decrease option
Guaranteed purchase option
Guaranteed renewable
Guaranteed purchase option
Insurer will usually limit amount that may be purchased at each of the option dates to some specified amount such as 500 or 5000
Cancellable
Guaranteed insurability rider
Exclusion clause
Guaranteed insurability rider
Must clearly state what conditions policy may be renewed
Face page
Cancellation page
Mandatory provisions page
Face page
If insurer reserves right to refuse renewal they must delver or mail written notice of its intention not to renew policy beyond period premiums has been accepted
Noncancellable provisions clause
Face page
Guaranteed renewable
Face page
Which of following is not a feature of noncancellable policy
Premiums cannot be increased beyond amount stated in policy
Guarantee to renew coverage usually applies until insured reaches certain age
Insured has right to renew policy for life of contract
Insurer may terminate contract only at renewal for certain conditions
Insurer may terminate contract only at renewal for certain conditions
