Medical Expense Insurance

Question 1

Basic medical expense insurance sometimes called “first dollar insurance” does what?

Answer 1

Provides benefits up front without having to satisfy a deductible

Question 2

The fee charged by a physician or other health professional is called a what?

Answer 2

Usual, customary and reasonable expense

Question 3

Hospital expense policies are covered when?

Answer 3

While the insured is confined in a hospital

Question 4

What are the limits on these policies for number of days and deductible limits?

Answer 4

No specific amount

Question 5

Surgical schedule approach?

Answer 5

Every surgery cal procedure is assigned a dollar amount by the insurer

Question 6

Usual, customary, and reasonable approach?

Answer 6

Surgical expense is compared to what is deemed reasonable and customary for the geographical part of the country where the surgery was performed.. this is the maximum amount an insurer will consider eligible for reimbursement under a health plan.

Question 7

Relative value approach?

Answer 7

Instead of a flat dollar amount like the surgical schedule method, a specified set of units is assigned. It will carry a filler per units amount to determine the benifit known as the conversion factor

Question 8

Major medical expense plans differ from basic medical expense plans how?

Answer 8

They usually carry deductibles, coinsurance requirements and have large benefit maximums

Question 9

Coverage under major medical expense plans is provided for what?

Answer 9

Both inpatient and outpatient hospital expenses

Question 10

Drug formulary is what?

Answer 10

The list of prescription drugs covered by a pharmacy benefit

Question 11

supplementary major medical?

Answer 11

Provides coverage for expense that were not covered by basic policy

Question 12

Comprehensive major medical?

Answer 12

Combines the features of basic expense coverage and major medical coverage, sold as one policy

Question 13

Deductible?

Answer 13

The specific dollar amount an individual is required to pay before insurance benefits are paid

Question 14

Deductibles are used primarily to help control the cost of premiums and reduce over-utilization of medical services.

Answer 14

True

Question 15

The term “deductible” is use most frequently with major medical insurance policies

Answer 15

True dat nigga

Question 16

Flat deductible?

Answer 16

A stated dollar amount that applies to a covered loss. Sometimes referee to as an “initial deductible”

Question 17

Corridor deductible?

Answer 17

Applied after the basic coverage has been exhausted after a major medical policy is supplementing the basic coverage. Ifffffff it contains no deductible

Question 18

Integrated deductible

Answer 18

Used when a major medical plan is supplementing basic coverages.

Question 19

Per cause deductible

Answer 19

Insured must pay each deductible for each accident

Question 20

All cause deductible

Answer 20

Insured only has to meet the deductible once during the benifit period

Question 21

Carry over provision

Answer 21

Allows insured to defer current health charges to the following years deductible instead of the current years. Also the period normally applies to the expense incurred during the last three months of the plan year

Question 22

Coinsurance

Answer 22

Sharing of expenses by the insured and the insurer and its purpose is to reduce over utilization of the coverages

Question 23

Also wth coinsurance…

Answer 23

After the insured pays the deductible the insurance company pays up to 75-80% of the additional expense leaving the rest to the insured, hence the term “coinsurance”

Question 24

Stop loss provision

Answer 24

Limits the amount of an insureds out of pocket medical expenses

Question 25

Also with stop loss

Answer 25

It will state that after the insured has paid a specific amount toward his covered expense the insurer will pay 100% of the remaining

Question 26

Who is a health savings account available to?

Answer 26

Individuals who are enrolled in a high deductible health plan

Question 27

Are the funds contributed to an account in a HSA subject to federal income tax?

Answer 27

Fuck no

Question 28

Who are HSA’s owned by?

Answer 28

The individual

Question 29

Are HSAs tax-deductible?

Answer 29

Yes

Question 30

What are HSAs designed for?

Answer 30

Help individuals safe for qualified health expense that they and their families incur

Question 31

What are health reimbursement arrangements?

Answer 31

They are employee funded, tax advantaged health benifit plans that reimburse employees for out of pocket medical expenses and individual health insurance premiums

Question 32

Reimbursements may be tax free if the employee paid for qualified medical expenses or a qualified medical plan

Answer 32

True

Question 33

Who are health reimbursement arrangements established by?

Answer 33

Employer

Question 34

What’s the purpose of medical savings accounts?

Answer 34

Help employees of small employers pay for their medical care expenses. They are tax feee accounts set up with banks and insurance companies

Question 35

Med savings accounts are available for employers with no more than?

Answer 35

50employees

Question 36

Hospital indemnity policies?

Answer 36

Pays a specified amount on a daily, weekly or monthly basis to the insured while the insured is confined to a hospital