Unit 17

Question 1

The miscellaneous expense benefit in a basic hospital expense policy normally will cover:

(A) physicians’ bedside visits
(B) the administering of anesthesia
(C) drugs and medicine administered in the hospital
(D) hospital room and board

Answer 1

(C) drugs and medicine administered in the hospital

Question 2

Clarence is to enter the hospital for a thyroidectomy. His basic medical expense policy includes a relative value schedule for surgical expense. The schedule lists 55 units for a thyroidectomy and a conversion factor of $8. How much will the policy pay?

(A) $400
(B) $440
(C) $540
(D) $550

Answer 2

(B) $440

Question 3

Which of the following statements about deductible provisions in medical insurance policies is NOT correct?

(A) They help to eliminate small claims
(B) They provide that initial expenses up to a specified amount are to be paid by the insured
(C) They are most common in basic medical expense policies
(D) They help to hold down premium rates

Answer 3

(C) They are most common in basic medical expense policies

Question 4

An insured has a basic hospital/surgical expense policy, which provides benefits of $50 per day for up to 30 days of hospitalization and $750 for miscellaneous charges.  It bases its surgical benefits on a schedule approach.  The insured is hospitalized for a severely broken leg that requires surgery.  The surgical procedure has been assigned $500 by the policy, though the customary charge in the area is $600.  The insured incurs the following covered expenses:
$80 per day for 7 days hospital charge
$675 for the surgical procedure
$800 for miscellaneous expenses
The insured's policy will pay:

(A) $1,600
(B) $1,700
(C) $1,810
(D) $2,035

Answer 4

(A) $1,600

Question 5

When a medical expense policy pays benefits on a fixed-rate basis, it pays:

(A) a certain percentage of whatever the hospital room charges are
(B) for total hospital expenses, less a deductible
(C) a flat amount per day for hospital room and board
(D) only for surgery and miscellaneous hospital expenses

Answer 5

(C) a flat amount per day for hospital room and board

Question 6

Wilbur’s basic medical expense policy limits the miscellaneous expense benefit to 20 times the $90 daily room and board benefit. During his recent hospital stay, miscellaneous expenses totaled $2,100. How much, if any, of this amount will Wilbur have to pay?

(A) $0
(B) $210
(C) $300
(D) $2,100

Answer 6

(C) $300

Question 7

Which of the following examples pertaining to major medical policy deductibles is CORRECT?

(A) Eric’s major medical policy has a $500 flat deductible provision. He incurs covered expenses totaling $350. He will pay nothing and his major medical policy will pay $350.
(B) Sarah has a major medical policy with a $500 flat deductible and an 80/20 coinsurance provision. Her covered expenses total $1,800. Of that amount, she will pay $500 and her insurance will pay $1,300.
(C) Valerie incurs a hospital bill of $8,300. Her basic medical expense insurance pays $2,400. Valerie pays a $200 deductible and her major medical plan takes care of the balance of covered expenses. Her deductible would be classified as a corridor deductible.
(D) An integrated deductible amount is $2,00. With this deductible, after the basic policy benefits are exhausted, the insured pays the full $2,000 deductible and then the major medical benefits are payable.

Answer 7

(C) Valerie incurs a hospital bill of $8,300. Her basic medical expense insurance pays $2,400. Valerie pays a $200 deductible and her major medical plan takes care of the balance of covered expenses. Her deductible would be classified as a corridor deductible.

Question 8

Arthur incurs total hospital expenses of $9,500, all of which are covered by his major medical policy. The policy includes a $500 deductible and a 75/25 coinsurance feature. Of the total expense, how much will Arthur have to pay?

(A) $2,375
(B) $2,750
(C) $2,875
(D) $6,675

Answer 8

(B) $2,750

Question 9

All of the following are types of deductible provisions associated with major medical policies EXCEPT:

(A) corridor
(B) integrated
(C) flat
(D) stop-loss

Answer 9

(D) stop-loss

Question 10

If the coinsurance in a major medical insurance policy is 75/25 with a $100 deductible, how much of a $2,100 bill would the insured pay?

(A) $100
(B) $500
(C) $600
(D) $1,500

Answer 10

(C) $600