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Questions and Answers
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?
- Surgically removing a facial birthmark (correct)
- Cosmetic laser surgery
- Elective procedures not covered by insurance
- Experimental treatments
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?
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?
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.
Major Medical policies typically contain a deductible and coinsurance.
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?
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?
What do Comprehensive Major Medical policies usually combine?
What do Comprehensive Major Medical policies usually combine?
Which of the following statements about Health Reimbursement Arrangements (HRA) is correct?
Which of the following statements about Health Reimbursement Arrangements (HRA) is correct?
What is the first portion of a covered Major Medical insurance expense that the insured is required to pay called?
What is the first portion of a covered Major Medical insurance expense that the insured is required to pay called?
What is the intent of a Coinsurance clause in a Major Medical policy?
What is the intent of a Coinsurance clause in a Major Medical policy?
What does a Hospital Indemnity policy provide coverage for?
What does a Hospital Indemnity policy provide coverage for?
All of the following statements about Major Medical benefits are true EXCEPT that benefits have no maximum limit.
All of the following statements about Major Medical benefits are true EXCEPT that benefits have no maximum limit.
Basic Medical Expense insurance has lower benefit limits than Major Medical insurance.
Basic Medical Expense insurance has lower benefit limits than Major Medical insurance.
What is the provision that requires the insurance company to pay only part of a loss while the insured pays the balance called?
What is the provision that requires the insurance company to pay only part of a loss while the insured pays the balance called?
What kind of benefits does a major medical policy provide?
What kind of benefits does a major medical policy provide?
Which of these is NOT a characteristic of a Health Reimbursement Arrangement (HRA)?
Which of these is NOT a characteristic of a Health Reimbursement Arrangement (HRA)?
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?
What can an individual use their medical flexible spending account to pay for?
What can an individual use their medical flexible spending account to pay for?
How much would J pay with a $2,000 deductible and 80/20 coinsurance if hospitalized with a $10,000 bill?
How much would J pay with a $2,000 deductible and 80/20 coinsurance if hospitalized with a $10,000 bill?
What type of policy provides coverage for specific types of illnesses such as cancer or stroke?
What type of policy provides coverage for specific types of illnesses such as cancer or stroke?
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?
What must S be enrolled in to open a tax-exempt Health Savings Account?
What must S be enrolled in to open a tax-exempt Health Savings Account?
What defines usual, customary, and reasonable (UCR) charges?
What defines usual, customary, and reasonable (UCR) charges?
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?
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?
What type of health coverage frequently uses a deductible?
What type of health coverage frequently uses a deductible?
What will the company do if an insured conceals information about a pre-existing condition?
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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