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Questions and Answers
What is Basic Medical Expense Insurance?
What is Basic Medical Expense Insurance?
To establish a health reimbursement arrangement (HRA), it must be established by the employer.
To establish a health reimbursement arrangement (HRA), it must be established by the employer.
True
Which type of health coverage frequently uses a deductible?
Which type of health coverage frequently uses a deductible?
To qualify for a Health Savings Account, what type of plan must one be enrolled in?
To qualify for a Health Savings Account, what type of plan must one be enrolled in?
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Basic hospital and surgical policy benefits are usually higher than the actual expenses incurred.
Basic hospital and surgical policy benefits are usually higher than the actual expenses incurred.
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How much will the insured be responsible to pay with $11,000 in covered medical expenses if the plan has a $1,000 deductible and an 80/20 Coinsurance clause?
How much will the insured be responsible to pay with $11,000 in covered medical expenses if the plan has a $1,000 deductible and an 80/20 Coinsurance clause?
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Which statement best describes dental care indemnity coverage?
Which statement best describes dental care indemnity coverage?
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Which of the following services is NOT covered under a hospitalization expense policy?
Which of the following services is NOT covered under a hospitalization expense policy?
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For which of the following expenses does a basic hospital policy pay?
For which of the following expenses does a basic hospital policy pay?
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What determines the claim M is eligible for under a basic Hospital/Surgical Expense policy?
What determines the claim M is eligible for under a basic Hospital/Surgical Expense policy?
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Major medical policies typically contain a deductible and coinsurance.
Major medical policies typically contain a deductible and coinsurance.
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What is a characteristic of preferred provider organizations?
What is a characteristic of preferred provider organizations?
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Which of the following costs would a basic hospital/surgical policy likely cover?
Which of the following costs would a basic hospital/surgical policy likely cover?
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Which health insurance coverage is best suited for meeting the expenses of catastrophic illness?
Which health insurance coverage is best suited for meeting the expenses of catastrophic illness?
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How much will Q be responsible for paying on a Major Medical claim of $10,100 with a $100 deductible and 80/20 coinsurance?
How much will Q be responsible for paying on a Major Medical claim of $10,100 with a $100 deductible and 80/20 coinsurance?
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What do comprehensive major medical policies usually combine?
What do comprehensive major medical policies usually combine?
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Which phrase refers to the fees charged by a healthcare professional?
Which phrase refers to the fees charged by a healthcare professional?
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Study Notes
Health Insurance Terminology
- Basic Medical Expense Insurance: Offers lower benefit limits compared to Major Medical insurance.
- Health Reimbursement Arrangement (HRA): Must be established by the employer for employees.
- Deductible Usage: Major medical policies commonly require the payment of a deductible by the insured.
Health Savings Account (HSA) Criteria
- To qualify for a tax-exempt HSA, the individual must enroll in a high-deductible health plan.
- Cannot be covered by any other health insurance (except for specific types like dental or vision), cannot be eligible for Medicare, and cannot be claimed as a dependent.
Hospital and Surgical Policies
- Basic hospital and surgical policy benefits tend to be lower than the actual expenses incurred during treatment.
- Hospitalization Expense Policy: Excludes certain expenses like surgeon's fees, which are not covered under this type of policy.
- Benefits under a basic hospital policy can include hospital room and board.
Medical Policy Claims
- Claim eligibility for basic hospital/surgical expense policy is determined by the terms of the policy itself.
- Major medical policies typically involve a deductible and include a coinsurance structure.
Insurance Payout Examples
- For an insured with $11,000 in covered medical expenses under a major medical plan with a $1,000 deductible and an 80/20 coinsurance, the insured's responsibility is $3,000.
- In another example, if an individual is hospitalized for 3 days with a bill of $10,100 under a major medical policy that has a $100 deductible and 80/20 coinsurance, they would be responsible for $2,100.
Types of Insurance Plans
- Preferred Provider Organizations (PPOs): Characterized by discounted fees for patients when they use specific network providers.
- Comprehensive major medical policies often combine elements of both major medical coverage and basic hospital/surgical coverage.
Dental and Surgical Expenses
- Dental care indemnity coverage typically operates on a reimbursement basis after the insurer receives the invoice for services rendered.
- Policies likely cover expenses such as surgically removing a facial birthmark as part of their benefits.
Key Terms
- Usual, Customary, and Reasonable Expenses: Refers to the fees charged by healthcare professionals for their services.
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Description
Test your knowledge on key concepts of health insurance with these flashcards from Chapter 3. Learn about basic medical expense insurance, health reimbursement arrangements, and deductible policies in major medical coverage. Perfect for students seeking to understand essential insurance terms.
