Questions and Answers
If J's Major Medical policy has a $2,000 deductible and an 80/20 Coinsurance clause, how much would J pay if hospitalized and billed $10,000?
3,600
To qualify for a tax-exempt Health Savings Account, what must S be enrolled in?
high-deductible health plan (HDHP)
Does leukemia fall under the coverage of a Critical Illness plan?
yes
Which of the following statements BEST describes dental care indemnity coverage?
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What policy feature allows an insured to defer current health charges to the following year's deductible?
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What does the hospitalization expense cover in a Basic Medical Expense policy?
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What is the term for the provision in a Major Medical policy that requires the insured to pay part of the medical expenses?
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What is one of the primary reasons for using deductibles in health policies?
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Major Medical benefits normally have a maximum limit.
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Who must fund a Health Reimbursement Arrangement (HRA)?
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Study Notes
Medical Expense Insurance Overview
- J's Major Medical policy features a $2,000 deductible and an 80/20 coinsurance clause. If hospitalized with a $10,000 bill, J pays $3,600 ($2,000 deductible + 20% of remaining $8,000).
Health Savings Accounts (HSAs)
- To qualify for a tax-exempt Health Savings Account, an individual must be enrolled in a high-deductible health plan (HDHP), cannot have other health insurance (except accident, disability, dental, vision, long-term care), must not be eligible for Medicare, and cannot be a tax-dependent.
Critical Illness Coverage
- Critical Illness plans cover specific severe conditions, including leukemia, which is a type of cancer.
Dental Care Indemnity Coverage
- Dental care indemnity plans reimburse patients for services rendered only after the insurance carrier has received the invoice.
Carryover Provision
- The Carryover provision allows health expenses incurred in the last three months of the year to be applied towards the deductible of the following year.
Basic Medical Expense Policy
- Hospitalization expenses under a Basic Medical Expense policy typically cover hospital room and board.
Major Medical Policies
- Coinsurance is the provision in a Major Medical policy that requires the insurer to pay a portion of medical expenses, leaving the remaining balance to be paid by the insured.
Deductibles in Health Policies
- Deductibles are employed in health policies to help minimize the overuse of medical services.
Major Medical Benefits Limitations
- While Major Medical benefits provide substantial coverage, there typically exists a maximum limit on the benefits.
Health Reimbursement Arrangements (HRAs)
- Health Reimbursement Arrangements must be established and funded solely by the employer.
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Description
Test your knowledge of medical expense insurance with these flashcards. Review key concepts such as deductibles, coinsurance, and health savings accounts to better understand how health insurance works.
