Questions and Answers
For which of the following expenses does a Basic Hospital policy pay?
Which of the following services is NOT covered under a hospitalization expense policy?
Assuming a plan had a $1,000 deductible and an 80/20 coinsurance clause, how much will the insured pay if they have $11,000 in covered medical expenses?
$3,000
Which of the following statements BEST describes the intent of a Coinsurance clause in a Major Medical policy?
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Which of the following statements BEST defines usual, customary, and reasonable (UCR) charges?
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Benefits under Major Medical plans have no maximum limit.
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Which of the following types of health coverage frequently uses a deductible?
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Which of the following phrases refers to the fees charged by a healthcare professional?
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Which of these options can an individual use their medical flexible spending account to pay for?
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How will the insurer likely consider a pre-existing condition noted on the application after T was treated for an ailment?
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What is the MAXIMUM C will pay if the covered medical expenses are $2,000, given a Major Medical policy with a 80/20 coinsurance clause and a $400 deductible?
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Which of the following medical expenses does Cancer insurance NOT cover?
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M has a Major Medical insurance policy with a $200 flat deductible and an 80% Coinsurance clause. How much will M receive in payment for a $2,200 claim?
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Which of the following statements BEST describes dental care indemnity coverage?
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A characteristic of Preferred Provider Organizations (PPOs) would be:
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What provision requires N to pay a portion of their medical expenses with their Major Medical policy?
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Which of the following BEST describes a Hospital Indemnity policy?
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In Major Medical Expense policies, what is the intent of a Stop Loss provision?
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What determines the claim M is eligible for under a basic Hospital/Surgical Expense policy?
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How much will the insured have to pay with a Major Medical policy with a $5,000 deductible and an 80/20 Coinsurance clause, if $15,000 in covered medical expenses are incurred?
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Major Medical policies typically do not contain a deductible and coinsurance.
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To qualify for a tax-exempt Health Savings Account, what must S be enrolled in?
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What would be this family's out-of-pocket medical expenses for 2013 if a Hospital/Surgical Expense policy has a $500 deductible and a limit of four deductibles per calendar year?
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Which of the following situations does a Critical Illness plan cover?
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If J has a major medical policy with a $2,000 deductible and an 80/20 coinsurance clause, how much would J pay for a $10,000 bill?
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With a Basic Medical Expense policy, what does the hospitalization expense cover?
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How much will Q be responsible for paying on a claim of $10,100 with a Major Medical policy that has a $100 deductible and 80/20 coinsurance?
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Deductibles are used in health policies to lower what?
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Comprehensive Major Medical policies usually combine with what?
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Basic Hospital and Surgical policy benefits are typically:
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Which of the following policy features allows an insured to defer current health charges to the following year's deductible?
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Which of the following costs would a Basic Hospital/Surgical policy likely cover?
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Basic Medical Expense insurance typically has lower benefit limits than Major Medical insurance.
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The first portion of a covered Major Medical insurance expense that the insured is required to pay is called the:
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If the employee paid for qualified medical expenses, the reimbursements from Health Reimbursement Arrangements (HRA) may be tax-free.
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Study Notes
Medical Expense Coverage
- Basic Hospital policies cover hospital room and board expenses.
- Hospitalization expense policies typically exclude services like surgeon's fees.
Major Medical Insurance
- Major Medical plans may have deductibles and coinsurance, often with an 80/20 split.
- A deductible requires payment of the initial amount before insurance contributes.
- Usual, customary, and reasonable (UCR) charges define reimbursement limits by insurers.
Coinsurance and Deductibles
- Coinsurance clauses encourage prudent use of benefits by sharing costs between insured and insurer.
- Major Medical coverage usually features a deductible and coinsurance structure for claims.
Health Savings and Flexible Spending Accounts
- Health Savings Accounts require enrollment in high-deductible health plans to qualify.
- Medical flexible spending accounts can cover expenses like prescription drugs.
Coverage Limits and Exclusions
- Major Medical policies may impose limits on benefits.
- Cancer insurance does not typically cover conditions like arthritis.
- Pre-existing conditions may not be covered by insurers for a specified period after policy issuance.
Indemnity and Policy Features
- Hospital Indemnity policies provide daily payouts for covered hospital stays.
- Dental care indemnity coverage reimburses services after invoices are received.
- The carryover provision allows deferral of health charges to the next year's deductible.
Hospital Expenses and Claims
- The insured's responsibility in hospitalization cases depends on plan terms and deductibles.
- Claims resulting in multiple bills may lead to significant out-of-pocket expenses.
Employer-Funded Accounts
- Health Reimbursement Arrangements (HRA) may provide tax-free reimbursements for qualified medical expenses.
Additional Insights
- Comprehensive Major Medical policies combine features of Basic Hospital and Major Medical insurances, covering more extensive expenses but usually with strict terms.
- Basic Medical Expense insurance typically offers lower benefit limits compared to Major Medical coverage.
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Description
Test your knowledge on medical expenses with this quiz focused on Basic Hospital policies and Major Medical plans. Each flashcard presents a scenario or question to enhance your understanding of coverage types. Perfect for students and professionals in healthcare or insurance.
