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Questions and Answers
What does 'maximum benefits' refer to?
What does 'maximum benefits' refer to?
Upper limit of the total lifetime benefits the insurance company will pay.
Coverage is limited to a single devastating disease in a Critical Illness Plan.
Coverage is limited to a single devastating disease in a Critical Illness Plan.
False
What type of insurance policy is a dread disease policy considered to be?
What type of insurance policy is a dread disease policy considered to be?
Limited health insurance policy.
What type of policy provides coverage for specific types of illnesses?
What type of policy provides coverage for specific types of illnesses?
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What provision does Ted have if he must pay a specific sum out of pocket before receiving benefits?
What provision does Ted have if he must pay a specific sum out of pocket before receiving benefits?
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What is the focus of major medical insurance?
What is the focus of major medical insurance?
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When an insured has a major medical plan with first dollar coverage, no deductible payment is required.
When an insured has a major medical plan with first dollar coverage, no deductible payment is required.
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A health benefit plan includes a hospital indemnity plan.
A health benefit plan includes a hospital indemnity plan.
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Elimination periods are a characteristic of a major medical expense policy.
Elimination periods are a characteristic of a major medical expense policy.
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What will a fee-for-service health insurance plan normally cover?
What will a fee-for-service health insurance plan normally cover?
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Distributions from a Health Savings Account (HSA) for qualified medical expenses are taxable.
Distributions from a Health Savings Account (HSA) for qualified medical expenses are taxable.
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A single deductible applied to both medical and dental insurance coverage is referred to as an ____
A single deductible applied to both medical and dental insurance coverage is referred to as an ____
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What is required from Jennifer before any benefits are paid in her health policy?
What is required from Jennifer before any benefits are paid in her health policy?
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What is a stated initial dollar amount the individual insured must pay before insurance benefits are paid?
What is a stated initial dollar amount the individual insured must pay before insurance benefits are paid?
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If an insured under a major medical plan with a zero deductible and 80/20 coinsurance files a $1,000 claim, how much does the insured have to pay?
If an insured under a major medical plan with a zero deductible and 80/20 coinsurance files a $1,000 claim, how much does the insured have to pay?
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If an insured has a stop-loss limit of $5,000, a deductible of $500, and incurs $25,000 of covered losses, how much will the insured have to pay?
If an insured has a stop-loss limit of $5,000, a deductible of $500, and incurs $25,000 of covered losses, how much will the insured have to pay?
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What list do pharmacy benefits cover prescription drugs derived from?
What list do pharmacy benefits cover prescription drugs derived from?
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What does an indemnity plan provide to the insured?
What does an indemnity plan provide to the insured?
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What types of health services are normally covered under a health insurance policy?
What types of health services are normally covered under a health insurance policy?
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What is the name of the list that pays established amounts for injuries, surgical procedures, or other losses?
What is the name of the list that pays established amounts for injuries, surgical procedures, or other losses?
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Low frequency diseases can be exclusively covered by what kind of health insurance policies?
Low frequency diseases can be exclusively covered by what kind of health insurance policies?
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What would medical expense insurance cover?
What would medical expense insurance cover?
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What type of payment system for health care pays the provider for each service given?
What type of payment system for health care pays the provider for each service given?
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What is an example of elective cosmetic surgery?
What is an example of elective cosmetic surgery?
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Study Notes
Medical Expense Insurance Key Concepts
- Maximum Benefits: Represents the upper limit of lifetime benefits that an insurance company will reimburse.
- Critical Illness Plan Limitation: Coverage is restricted to one specific severe illness.
- Dread Disease Policy: Classified as a limited health insurance policy targeting specific serious illnesses.
- Dread Disease Insurance: Exclusively covers designated illnesses like cancer or stroke.
- Calendar-Year Deductible: A predetermined amount that must be paid out of pocket by the insured before benefits kick in for the year.
- Major Medical Insurance: Primarily focuses on covering substantial medical and hospital expenses.
- First Dollar Coverage: In major medical plans, it eliminates the deductible requirement, enabling immediate benefits.
- Health Benefit Plans: Do not encompass hospital indemnity plans.
- Elimination Periods: Not characteristic of major medical expense policies.
- Fee for Service: Typically provides coverage for individual diseases.
- Health Savings Account (HSA): Distributions used for qualified medical expenses are exempt from taxes.
- Integrated Deductible: A single deductible that applies to both medical and dental coverage.
- Deductible Definition: The specified initial payment an insured must make before insurance benefits are disbursed.
- Coinsurance Responsibility: In a case with a zero deductible and 80/20 coinsurance, the insured pays 20% of the claim amount.
- Stop-Loss Limit: In a scenario with a $5,000 stop-loss limit and $25,000 covered losses, the insured's maximum out-of-pocket cost will not exceed $5,000.
- Drug Formulary: A list that guides which prescription drugs are covered under a pharmacy benefit.
- Indemnity Plan Structure: Offers the insured fixed amounts for services provided rather than percentage-based reimbursement.
- Preventative Services: Commonly included under health insurance policies.
- Benefit Schedule: A list outlining predetermined amounts for injuries, surgical procedures, or other health losses covered by the insured's plan.
- Limited Policies: Designed specifically to cover diseases with low frequency.
- Coverage for Injuries: Medical expense insurance includes cover for injuries that occur at the insured's home.
- Fee-for-Service Payment System: Providers receive payment for each individual service rendered.
- Elective Cosmetic Surgery Example: Removing excess fat from an individual’s waist is categorized as elective cosmetic surgery.
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Test your knowledge on Medical Expense Insurance with these flashcards from Chapter 14. Each card covers key terms and concepts essential for understanding medical insurance policies, including maximum benefits and critical illness plans. Perfect for students and professionals alike!
