Lesson 6 Medical Expense Insurance

Question 1

Basic Medical Insurance

Answer 1

Provides limited coverage to select types of medical care.

Question 2

Major Medical Insurance

Answer 2

Provides broader, more complete coverage

Question 3

Taxation of medical expense insurance pertains to people who accumulate medical expenses that add up to ___% of their gross income

Answer 3

7.5

Question 4

Medical Expense Categories

Answer 4

• Hospital Expenses- daily room/board & misc. never covers physician services
• Surgical Expenses- cost of surgeon and anesthesiologist services
• Physicians Expenses- office visits, no surgical care
• Nurses Expenses- private duty nurse care
• Convalescent Care Expenses- skilled nursing facility expenses

Question 5

Basic Surgical Expense Methodology

Answer 5

surgical schedule method- every surgical procedure is assigned a $ amount by insurer

Reasonable and customary approach- surgical expenses compared to what is reasonable and customary for that part of country.

Relative Value Scale- assigns points to procedures instead of $ figures

Question 6

Basic Physicians Expense Policy

Answer 6

covers dr visits while hospitalized for non surgical reason. based on indemnity approach.

xrays, drugs, and dental treatment are excluded

Question 7

Comprehensive Major Medical Insurance

Answer 7

provide coverage for all major medical expenses under a single policy, not coordinated with basic plans.

low deductible, coinsurance clause, high maximum benefits.

Question 8

Supplementary Major Medical

Answer 8

can be combined with basic plans to pick up expenses . both supplementary and comprehensive major medical plans contain deductibles and coinsurance

Question 9

Flat Deductible

Answer 9

states amount that insured must pay before policy benefits become payable.

Question 10

Corridor Deductible

Answer 10

basic medical policy will pay its limits, then deductible, and then supplementary will pick up remainder.

Question 11

Integrated Deductible

Answer 11

whatever amount basic medical expense covers is applied to the deductible

Question 12

Preexisting condition clauses

Answer 12

protect insurers from adverse selection

Question 13

Preexisting Condition

Answer 13

condition that existed before policies effective date. usually excluded from coverage.

Question 14

FACT:

HSA’s accumulate tax free funds to be used for medical expenses in high deductible and high out of pocket plans.

Answer 14

Non qualified withdrawals are subject to 10% penalty tax.

HSA’s are fully portable and assets accumulate over years.

upon death HSA ownership may be transferred to a spouse tax free.

Question 15

in 2015 individual participants must be under age ____ and must be enrolled in a qualified health plan with minimum deductible of _____$ and a _____$ cap on out of pocket expenses

Answer 15

65
$1300
$6650

Question 16

minimum deductible for family coverage is ____$ and a _____$ cap on out of pocket expenses

Answer 16

$2600

$12,900

Question 17

in 2015 the maximum annual HSA contribution for self only policies is ____$ and ____$ for family policies.

catchup contributions in the amount of ____$ per year are available to individuals ___ years of age and older

Answer 17

$3350

$6650

$1000

55

Question 18

Basic Medical Expense Policies

Answer 18

Health policy that provides”first dollar” benefits for specified and limited health care.

characterized by limited benefit periods and relatively low coverage limits.

Question 19

Coinsurance

Answer 19

company insures only part of potential loss, policy owner pays other part.

Question 20

Deductible

Answer 20

amount to be paid by insured before health policy starts paying benefits

Question 21

Hospital Expense Insurance

Answer 21

health benefits subject to specified daily maximum for specified period of time while confined to hospital .

limited allowance for misc hospital expenses like OR, anesthesia, lab fees, etc

Question 22

Hospital Indemnity Insurance

Answer 22

provides stipulated daily, weekly, monthly indemnity during hospital confinement.

payable on unallocated basis without regard to actual hospital expense.

Question 23

Limited Risk Policy

Answer 23

coverage for specific kinds of accidents or illness

ex: travel accidents, medical expenses from specific disease

Question 24

Stop Loss Feature

Answer 24

designed to stop the companies loss at a given point. or placement of a limit on individual out of pocket expenses.

Question 25

Surgical Expense Insurance

Answer 25

benefits to pay for cost of surgical operations