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Questions and Answers
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 services are covered under a hospitalization expense policy?
What services are covered under a hospitalization expense policy?
Daily room and board, intensive care, miscellaneous expenses
A comprehensive major medical health insurance policy contains an Eligible Expenses provision which identifies the types of health care services that are covered. All of the following health care services are typically covered EXCEPT for?
A comprehensive major medical health insurance policy contains an Eligible Expenses provision which identifies the types of health care services that are covered. All of the following health care services are typically covered EXCEPT for?
Basic Medical Expense insurance has what compared to Major Medical Insurance?
Basic Medical Expense insurance has what compared to Major Medical Insurance?
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If M has a Major Medical insurance policy with a $200 flat deductible and an 80% Coinsurance clause with a claim for $2,200, how much will M receive in payment for this claim?
If M has a Major Medical insurance policy with a $200 flat deductible and an 80% Coinsurance clause with a claim for $2,200, how much will M receive in payment for this claim?
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What BEST describes a Hospital Indemnity policy?
What BEST describes a Hospital Indemnity policy?
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Deductibles are used in health policies to lower what?
Deductibles are used in health policies to lower what?
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C was injured while deep sea diving and has a Major Medical policy with an 80/20 coinsurance clause and a $400 deductible. What is the MAXIMUM C will pay if the covered medical expenses are $2000?
C was injured while deep sea diving and has a Major Medical policy with an 80/20 coinsurance clause and a $400 deductible. What is the MAXIMUM C will pay if the covered medical expenses are $2000?
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What does a major medical policy typically provide?
What does a major medical policy typically provide?
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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?
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Which statement BEST describes dental care indemnity coverage?
Which statement BEST describes dental care indemnity coverage?
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Which of the following is NOT a limited benefit plan?
Which of the following is NOT a limited benefit plan?
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What are some examples of limited benefit plans?
What are some examples of limited benefit plans?
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Which types of health coverage frequently use a deductible?
Which types of health coverage frequently use a deductible?
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What phrase refers to the fees charged by a healthcare professional?
What phrase refers to the fees charged by a healthcare professional?
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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)?
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All of the following statements about Major Medical benefits are true EXCEPT?
All of the following statements about Major Medical benefits are true EXCEPT?
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A Health Reimbursement Arrangement MUST be established by whom?
A Health Reimbursement Arrangement MUST be established by whom?
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Comprehensive Major Medical policies usually combine what?
Comprehensive Major Medical policies usually combine what?
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With a Basic Medical Expense policy, what does the hospitalization expense cover?
With a Basic Medical Expense policy, what does the hospitalization expense cover?
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The phrase 'This policy will only pay for a semi-private room' is an example of what?
The phrase 'This policy will only pay for a semi-private room' is an example of what?
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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?
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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?
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If J's Major Medical policy has a $2,000 deductible and an 80/20 Coinsurance clause with a bill for $10,000, how much would J pay?
If J's Major Medical policy has a $2,000 deductible and an 80/20 Coinsurance clause with a bill for $10,000, how much would J pay?
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Study Notes
Hospitalization Expense Policy
- Services NOT covered include surgeon's fees.
- Covered services include daily room and board, intensive care, and miscellaneous expenses.
Comprehensive Major Medical Policy
- Identifies Eligible Expenses for covered health care services.
- Typically covers necessary services, excluding experimental and investigative services.
Basic Medical Expense Insurance
- Provides lower benefit limits compared to Major Medical Insurance.
Major Medical Insurance Claims
- With a $200 deductible and 80% coinsurance, a $2,200 claim results in a payment of $1,600.
- A policy typically covers reasonable and necessary medical expenses under specified limits.
Hospital Indemnity Policy
- Pays a set amount per day for hospitalization.
Deductibles in Health Policies
- Serve primarily to reduce overuse of medical services.
Medical Expense Calculation
- In a 80/20 coinsurance policy, the maximum a patient can pay is calculated by adding the deductible to 20% of the remaining bill. A $2,000 expense with a $400 deductible results in a maximum payment of $720.
Claims Eligibility
- Under basic hospital/surgical expense policies, claims are based on policy terms.
Dental Care Indemnity Coverage
- Reimbursement for services occurs only after the insurer receives the provider's bill.
Limited Benefit Plans
- Examples include cancer policies, dental policies, and critical illness policies. Life insurance is NOT considered a limited benefit plan.
Usual, Customary, and Reasonable Expenses
- Refers to the fees charged by healthcare providers.
Health Reimbursement Arrangement (HRA)
- Must be established by the employer and is not funded by employees.
Major Medical Benefits
- Generally includes a maximum limit on benefits.
Comprehensive Major Medical Policies
- Combine Basic Hospital/Surgical Insurances with Major Medical Insurance.
Basic Medical Expense Coverage
- Covers costs for hospital room and board.
Internal Limit Example
- A phrase like "This policy will only pay for a semi-private room" exemplifies an internal limit.
Major Medical Insurance Components
- The initial deductible is the first portion of an expense the insured pays.
Stop Loss Provision
- Limits an insured's total out-of-pocket medical expenses.
Major Medical Claims Calculation
- A $2,000 deductible and 80/20 coinsurance on a $10,000 bill results in a payment of $3,600 by the insured.
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Description
Test your knowledge with this flashcard quiz on medical expense insurance. Focus on what services are covered under hospitalization policies and major medical health insurance provisions. Perfect for exam preparation in healthcare finance.
