Health Insurance

Question 1

2 Perils

Answer 1

Accident and Sickness

Question 2

Accident

Answer 2

unintentional bodily injury caused by an unforeseen event

Question 3

Sickness

Answer 3

a need for medical care due to a cause other than an accident

Question 4

Hospital/Medical Expense Coverage

Answer 4

helps pay doctor and hospital bills; includes coverage for diagnostic and treatment-related expenses such as lab tests, x-rays, and medical supplies (sometimes prescription drugs)

Question 5

Disability Income Insurance

Answer 5

pays a stated amount of income to the insured when an accident or sickness leaves them unable to work for an extended period; provides money to pay other bills (aka Income Replacement/Loss-of-time coverage)

Question 6

Dental Expense Insurance

Answer 6

helps to pay dental bills; coverage is generally provided for routine dental care such as cleanings, fillings, crowns, root canals, and braces.

Question 7

Long-term-care (LTC)

Answer 7

insurance provides coverage for medical and non-medical care for individuals with chronic illnesses, cognitive impairment, or difficulty performing activities of daily living (ADLs) such as bathing, dressing, eating, toileting, transfering, or continence.

Question 8

Individual Insurance

Answer 8

Anyone can apply for coverage.
Each person has a policy.
Individual can choose coverage from whatever is available in the health insurance market.
Individual’s health is evaluated; a medical exam may be required.
Coverage renewable at option of the insured, sometimes insurer.
All accidents are covered regardless of when or where they occur.

Question 9

Group Insurance

Answer 9

Only group members may be covered; group must meet size and purpose definitions.
There is one master contract; individuals are given certificates as evidence of coverage.
Benefits are essentially the same for all group members; individuals may be able to choose among a limited number of pre-established packages.
Group as a whole is evaluated, usually no individual underwriting. (No evidence of insurability required if individual enrolls within a given time after becoming eligible)
Group sponsor may change coverage; coverage stops when insured leaves the group.
Only off-the-job accidents are generally covered (on the job accidents are covered by worker’s compensation, a state-mandated program)

Question 10

TRICARE

Answer 10

for active duty and retired military personnel

Question 11

Veterans Benefits

Answer 11

for discharged military service members

Question 12

Medicare

Answer 12

healthcare primarily for senior citizens and recipients of social security disability

Question 13

Medicaid

Answer 13

healthcare for individuals and families who are or become poor

Question 14

Social Security Disability

Answer 14

for eligible individuals who become totally and permanently disabled.

Question 15

Comprehensive Policies

Answer 15

offer broad coverage for health care services.

Question 16

Limited Policies

Answer 16

provide benefits for only a particular type of loss; there are a number of special health insurance policies that provide limited coverage

Question 17

Limited Benefit Plan

Answer 17

limited perils. limited benefits. notice to proposed insured

Question 18

Limited Perils

Answer 18

while medical expense plans cover losses that arise from almost any cause with just a few exceptions, limited benefit plans cover losses that arise only from one peril or one type of peril, or which occur relative to a specific situation or location.

Question 19

Limited Benefits

Answer 19

while medical expense plans have moved quickly toward providing very high or unlimited benefits, the amounts paid by limited benefit plans are typically much smaller and often restricted to stated amounts

Question 20

Notice to Proposed Insured

Answer 20

to assure that insureds understand the limited nature of the coverage they are buying, states require these policies to contain a prominent notice on their first page stating that the coverage provides only limited benefits.

Question 21

Accident-only Policies

Answer 21

only cover accidents as a peril, and exclude any type of sickness or disease. (Premiums are smaller than policies that cover both illness and injury) - may also pay a benefit if an accident results in dismemberment, disability, or death.

Question 22

Specified/Dread Disease Policies

Answer 22

policies were originally developed to cover one, or one type, of catastrophic illness specified in the policy such as cancer or heart disease.

Question 23

Critial Illness Policies

Answer 23

wider-range policies that may contain screening benefits to help with early diagnosis of catastrophic illnesses.

Question 24

Hospital Income/Indemnity

Answer 24

pays a flat dollar amount as a daily benefit for each day that the insured is hospitalzed as an inpatient. (paid directly to the insured)

Question 25

Credit Disability Insurance

Answer 25

a group policy with a retailer as master policyowner and the debtors are the group members.

Question 26

Blanket Coverage

Answer 26

type of group insurance where the group members are identified as the person engaged in a similar activity (such as emplyees at a company picnic, passengers on an airplane, players/spectators at a sporting event, students on school grounds)

Question 27

Prescription Drug Coverage

Answer 27

can be included in a medical expense plan, added as a supplement to a medical expense plan, or issued as stand-alone coverage.

Question 28

Vision Care Plans

Answer 28

Covers eye exams, cost of lenses and frames, cost of contact lenses, and other corrective items. (Routine eye care and vision correction)

Question 29

Hearing Insurance

Answer 29

a limited plan that provides coverage for hearing exams and some or all of the costs for hearing aids

Question 30

Short-term Medical Expense plans

Answer 30

sold as a means of temporary health insurance coverage (90 days - 12 months)

Question 31

Health Insurance Exclusions

Answer 31

Intentional Self-inflicted injuries. War/Act of War (excluded regardless of service in the military) . Elective Cosmetic Surgery. Workers Compensation. Commission/Attempted Felony