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Questions and Answers
Which of the following types of deductibles would apply a single deductible to both medical and dental insurance coverage?
Which of the following types of deductibles would apply a single deductible to both medical and dental insurance coverage?
- Family deductible
- Aggregate deductible
- Integrated deductible (correct)
- Separate deductible
When an insured has a major medical plan with first dollar coverage, how does this impact the benefits paid?
When an insured has a major medical plan with first dollar coverage, how does this impact the benefits paid?
No deductible payment is required
The elimination period under a hospital indemnity plan is?
The elimination period under a hospital indemnity plan is?
The specified number of days an insured must wait before becoming eligible to receive benefits for each hospitalization
What type of policy would only provide coverage for specific types of illnesses such as cancer or stroke?
What type of policy would only provide coverage for specific types of illnesses such as cancer or stroke?
A fee for service health insurance plan will normally cover?
A fee for service health insurance plan will normally cover?
Medical Expense Insurance would cover?
Medical Expense Insurance would cover?
A payment system for health care in which the provider is paid for each service given is called?
A payment system for health care in which the provider is paid for each service given is called?
When applying for health insurance, the heart disease treatment indicates?
When applying for health insurance, the heart disease treatment indicates?
If the insured has previously met her deductible and receives a bill for $175, how much will the insurer pay?
If the insured has previously met her deductible and receives a bill for $175, how much will the insurer pay?
How is a health provider reimbursed if they do NOT have an agreement in place with the insurance company?
How is a health provider reimbursed if they do NOT have an agreement in place with the insurance company?
How much will Kim pay if she incurs a loss of $1,500 with a deductible of $500 and an 80/20 coinsurance?
How much will Kim pay if she incurs a loss of $1,500 with a deductible of $500 and an 80/20 coinsurance?
How much will the insured have to pay if they have a stop-loss limit of $5,000, a deductible of $500, and incur $25,000 of covered losses?
How much will the insured have to pay if they have a stop-loss limit of $5,000, a deductible of $500, and incur $25,000 of covered losses?
The focus of major medical insurance is providing coverage for?
The focus of major medical insurance is providing coverage for?
A payment system for health care in which the provider is paid for each service given is called?
A payment system for health care in which the provider is paid for each service given is called?
How much will Amy's group insurance carrier pay if she incurs $1,500 in covered health care services with a $500 deductible and a 90% coinsurance provision?
How much will Amy's group insurance carrier pay if she incurs $1,500 in covered health care services with a $500 deductible and a 90% coinsurance provision?
An insured has a health plan that pays established amounts in accordance with a list of injuries, surgical procedures, or other losses. This list is called?
An insured has a health plan that pays established amounts in accordance with a list of injuries, surgical procedures, or other losses. This list is called?
Preventative health services are normally covered under a health insurance policy. What does this imply?
Preventative health services are normally covered under a health insurance policy. What does this imply?
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Study Notes
Integrated Deductible
- Applies a single deductible to both medical and dental insurance coverage.
First Dollar Coverage
- A health insurance plan that requires no deductible payment before expenses are reimbursed.
Elimination Period
- Refers to the specified number of days an insured must wait before becoming eligible for benefits after hospitalization in a hospital indemnity plan.
Dread Disease Insurance
- Provides coverage exclusively for specific illnesses, such as cancer or stroke.
Fee-for-Service Plans
- Typically cover diseases and operate on a model where providers are paid for each service rendered.
Medical Expense Insurance
- Covers injuries that occur at the insured's residence.
Usual, Customary, and Reasonable Fee
- The reimbursement amount for providers without a payment agreement with an insurer is based on usual, customary, and reasonable fees.
Preexisting Condition
- Treatment for a condition, like heart disease, within the past year indicates a preexisting condition when applying for health insurance.
Major Medical Plan Payment
- A policyholder with an 80%/20% coinsurance and a $75 deductible pays $140 when receiving a $175 bill after meeting the deductible.
Deductible and Coinsurance Payment
- Kim incurs a $1,500 loss and pays $700, which includes $500 deductible and $200 coinsurance under her health insurance plan.
Stop-Loss Limit
- An insured with a stop-loss limit of $5,000, a $500 deductible, and 80/20 coinsurance pays a maximum of $5,000 despite incurring $25,000 in covered losses.
Major Medical Insurance Focus
- Primarily provides coverage for medical and hospitalization expenses.
Benefit Schedule
- Sets pre-determined limits or maximum reimbursement amounts for covered losses based on a list of injuries or procedures.
Preventative Health Services
- Typically covered by health insurance policies to promote early detection and wellness.
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