Podcast
Questions and Answers
For which of the following expenses does a Basic Hospital policy pay?
For which of the following expenses does a Basic Hospital policy pay?
- Surgeon's fees
- Physical therapy
- Prescription drugs
- Hospital room and board (correct)
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?
- Tests and lab work
- Surgeon's fees (correct)
- Emergency room visits
- Hospital room and board
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?
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?
Which of the following statements BEST describes the intent of a Coinsurance clause in a Major Medical policy?
Which of the following statements BEST defines usual, customary, and reasonable (UCR) charges?
Which of the following statements BEST defines usual, customary, and reasonable (UCR) charges?
Benefits under Major Medical plans have no maximum limit.
Benefits under Major Medical plans have no maximum limit.
Which of the following types of health coverage frequently uses a deductible?
Which of the following types of health coverage frequently uses a deductible?
Which of the following phrases refers to the fees charged by a healthcare professional?
Which of the following phrases refers to the fees charged by a healthcare professional?
Which of these options can an individual use their medical flexible spending account to pay for?
Which of these options can an individual use their medical flexible spending account to pay for?
How will the insurer likely consider a pre-existing condition noted on the application after T was treated for an ailment?
How will the insurer likely consider a pre-existing condition noted on the application after T was treated for an ailment?
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?
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?
Which of the following medical expenses does Cancer insurance NOT cover?
Which of the following medical expenses does Cancer insurance NOT cover?
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?
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?
Which of the following statements BEST describes dental care indemnity coverage?
Which of the following statements BEST describes dental care indemnity coverage?
A characteristic of Preferred Provider Organizations (PPOs) would be:
A characteristic of Preferred Provider Organizations (PPOs) would be:
What provision requires N to pay a portion of their medical expenses with their Major Medical policy?
What provision requires N to pay a portion of their medical expenses with their Major Medical policy?
Which of the following BEST describes a Hospital Indemnity policy?
Which of the following BEST describes a Hospital Indemnity policy?
In Major Medical Expense policies, what is the intent of a Stop Loss provision?
In Major Medical Expense policies, what is the intent of a Stop Loss provision?
What determines the claim M is eligible for under a basic Hospital/Surgical Expense policy?
What determines the claim M is eligible for under a basic Hospital/Surgical Expense policy?
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?
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?
Major Medical policies typically do not contain a deductible and coinsurance.
Major Medical policies typically do not contain a deductible and coinsurance.
To qualify for a tax-exempt Health Savings Account, what must S be enrolled in?
To qualify for a tax-exempt Health Savings Account, what must S be enrolled in?
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?
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?
Which of the following situations does a Critical Illness plan cover?
Which of the following situations does a Critical Illness plan cover?
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?
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?
With a Basic Medical Expense policy, what does the hospitalization expense cover?
With a Basic Medical Expense policy, what does the hospitalization expense cover?
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?
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?
Deductibles are used in health policies to lower what?
Deductibles are used in health policies to lower what?
Comprehensive Major Medical policies usually combine with what?
Comprehensive Major Medical policies usually combine with what?
Basic Hospital and Surgical policy benefits are typically:
Basic Hospital and Surgical policy benefits are typically:
Which of the following policy features allows an insured to defer current health charges to the following year's deductible?
Which of the following policy features allows an insured to defer current health charges to the following year's deductible?
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?
Basic Medical Expense insurance typically has lower benefit limits than Major Medical insurance.
Basic Medical Expense insurance typically has lower benefit limits than Major Medical insurance.
The first portion of a covered Major Medical insurance expense that the insured is required to pay is called the:
The first portion of a covered Major Medical insurance expense that the insured is required to pay is called the:
If the employee paid for qualified medical expenses, the reimbursements from Health Reimbursement Arrangements (HRA) may be tax-free.
If the employee paid for qualified medical expenses, the reimbursements from Health Reimbursement Arrangements (HRA) may be tax-free.
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.
