Section 15 - medical expense insurance Flashcards
Which of the following types of deductibles would apply a single deductible to both medical and dental insurance coverage?
A. Standard deductible
B. Combined deductible
C. Integrated deductible
D. Blended deductible
Integrated deductible
And insured has a health plan that pays established amounts in accordance with a list of injuries, surgical procedures, or other losses. This list is called a
A. Loss capital
B. Benefit summary
C. Benefits schedule
D. Coverage menu
Benefits schedule
Major medical insurance will typically cover medical expenses that result from
A. A crime committed by the insured
B. A self-inflicted injury
C. Intoxication
D. A negative reaction to prescribe medication
A negative reaction to prescribed medication
Kate has a major medical plan with a 75% 25% coinsurance and deductible of $25. How much will she have to pay if she, not having met any of her deductible, visits the doctor and received a bill for $125?
A. $25.00
B. $50.00
C $75.00
D $100.00
$50.00
A Pharmacy benefit covers prescription drugs, derived from a list called a(n)
A. Administrative drug list
B. Drug formulary
C. Controlled substance list
D. Generic benefit manager
Drug formulary
All of these are characteristics of a major medical expense policy, EXCEPT
A. Large benefit maximums
B. Deductibles
C. Elimination periods
D. Coinsurance
Elimination Periods
A policyholder has a major medical plan with a 80% 20% coinsurance and deductible of $75. If the insured has previously met her deductible and receives a bill for $175. How much will the insurer pay?
A. $35
B. $75
C. $100
D. $140
$140
Which of the following is NOT included under a health benefit plan?
A. Major medical policy
B. Basic hospital policy
C. Hospital indemnity plan
D. Surgical expense policy
Hospital indemnity plan
“Maximum benefits” refers to the
A. Upper limit of the total lifetime benefits the insurance company will pay
B. Upper limit percentage of what the insurance company will pay for coinsurance
C. Upper limit of what the insured will pay in out-of-pocket expenses D. Upper limit of what an insurance company will pay for any particular claim
Upper limit of the total lifetime benefits the insurance company will pay
Amy has a Group medical policy through her employer with a $500 deductible and 90% coinsurance provision. She incurs $1500 in covered healthcare services. How much will her group insurance carrier pay?
A. $500
B. $900
C. $1000
D. $1350
$900
Ted has a health insurance plan that requires him to pay a specific some out of pocket before any benefits are paid in a calendar year. Which of these does his health plan have?
A. Calendar-year deductible
B. Coinsurance provision
C. Stop loss feature
D. Integrated deductible
Calendar-year deductible
Jennifer is required to pay a specific some out of pocket before any benefits are paid in a year. Her health policy most likely contains a(n)
A. Stop-loss provision
B. Deductible
C. Copayment
D. Out of pocket provision
Deductible
Low frequency diseases can be exclusively covered by what kind of health insurance policies?
A. Limited policies,
B. Blanket policies
C. Employer policies
D. Restricted policies
Limited policies
How is a health provider reimbursed if they do NOT have an agreement in place with the insurance company?
A. With a contingent fee
B. With us scheduled fee
C. With a usual, customary, and reasonable fee
D. With a reasonably appropriate fee
With a usual, customary, and reasonable fee
Medical expense insurance would cover
A. An injury occurring at the insurance residence
B. An injury occurring at work
C. An injury caused by war
D. An elective surgeries
An injury occurring at the insured’s residence
