Questions and Answers
Which of the following costs would a Basic Hospital/Surgical policy likely cover?
How much will Q be responsible for paying on a claim of $10,100 with a Major Medical policy and $100 deductible with 80/20 coinsurance?
$2,100
What is the intent of a Stop Loss provision in Major Medical Expense policies?
Limits an insured's out-of-pocket medical expenses
Major Medical policies typically contain a deductible and coinsurance.
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How much will the insured be responsible to pay with $11,000 in covered medical expenses under a Major Medical plan with a $1,000 deductible and 80/20 Coinsurance?
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What do Comprehensive Major Medical policies usually combine?
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Which of the following statements about Health Reimbursement Arrangements (HRA) is correct?
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What is the first portion of a covered Major Medical insurance expense that the insured is required to pay called?
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What is the intent of a Coinsurance clause in a Major Medical policy?
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What does a Hospital Indemnity policy provide coverage for?
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All of the following statements about Major Medical benefits are true EXCEPT that benefits have no maximum limit.
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Basic Medical Expense insurance has lower benefit limits than Major Medical insurance.
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What is the provision that requires the insurance company to pay only part of a loss while the insured pays the balance called?
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What kind of benefits does a major medical policy provide?
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Which of these is NOT a characteristic of a Health Reimbursement Arrangement (HRA)?
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Which health insurance coverage is best suited for meeting the expenses of catastrophic illness?
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What can an individual use their medical flexible spending account to pay for?
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How much would J pay with a $2,000 deductible and 80/20 coinsurance if hospitalized with a $10,000 bill?
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What type of policy provides coverage for specific types of illnesses such as cancer or stroke?
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Which of the following services is NOT covered under a hospitalization expense policy?
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What must S be enrolled in to open a tax-exempt Health Savings Account?
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What defines usual, customary, and reasonable (UCR) charges?
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What would be the family’s out-of-pocket medical expenses for 2013 with a policy issued with a $500 deductible and a limit of four deductibles per year?
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What type of health coverage frequently uses a deductible?
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What will the company do if an insured conceals information about a pre-existing condition?
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Study Notes
Basic Hospital/Surgical Policy
- Covers cosmetic surgery for conditions such as facial birthmarks.
- Major Medical policies include deductibles and coinsurance clauses.
Major Medical Policies
- After a $100 deductible, an insured with $10,100 in bills pays $2,100 (20% of $10,000 + deductible).
- A Stop Loss provision limits the out-of-pocket medical expenses for the insured.
- Insureds may pay a maximum of $3,000 for an $11,000 bill with a $1,000 deductible and 80/20 coinsurance.
Comprehensive and Basic Medical Expense
- Comprehensive Major Medical combines Basic Hospital/Surgical coverage.
- Basic Medical Expense insurance has lower benefit limits compared to Major Medical.
Health Reimbursement Arrangements (HRA)
- Allows tax-free reimbursement for qualified medical expenses paid by employees.
- HRA plans are employer-funded, not employee-funded.
Coinsurance and Deductibles
- Coinsurance discourages overutilization of coverage by requiring insured to share costs.
- Initial deductible is the amount the insured must first pay before coverage applies.
Hospital Indemnity Policies
- Provide specified daily payments during covered hospitalizations, not related to total medical expenses.
Health Savings Account (HSA)
- Tax-exempt HSAs require enrollment in a high-deductible health plan (HDHP).
- Eligibility excludes individuals covered by other health insurance or those eligible for Medicare.
Usual, Customary, and Reasonable (UCR) Charges
- UCR charges represent the maximum amounts deemed eligible for insurance reimbursement within health plans.
Dread Disease Insurance
- Specializes in covering specific illnesses like cancer or stroke, not general medical expenses.
Hospitalization Expense Policy
- Covers various services incurred during hospitalization but does not include payment for surgeon's fees.
Claim Processing with Pre-existing Conditions
- Insurers can exclude coverage for pre-existing conditions if they weren't disclosed on the insurance application, as per "time limit on certain defenses" provision.
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Description
This quiz covers various aspects of health insurance policies including Basic Hospital/Surgical, Major Medical, and Comprehensive coverage. Key concepts like deductibles, coinsurance, and Health Reimbursement Arrangements (HRAs) are also explored. Test your understanding of how these policies function and their implications.
