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Questions and Answers
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 statements BEST defines usual, customary, and reasonable (UCR) charges?
Which of the following statements BEST defines usual, customary, and reasonable (UCR) charges?
M has a Major Medical insurance policy with a $200 flat deductible and an 80% Coinsurance clause. If M incurs a $2,200 claim for an eligible medical expense, how much will M receive in payment for this claim?
M has a Major Medical insurance policy with a $200 flat deductible and an 80% Coinsurance clause. If M incurs a $2,200 claim for an eligible medical expense, how much will M receive in payment for this claim?
1,600
N has a Major Medical policy that only pays a portion of N's medical expenses. What is this provision known as?
N has a Major Medical policy that only pays a portion of N's medical expenses. What is this provision known as?
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What type of policy would only provide coverage for specific types of illnesses (cancer, stroke, etc)?
What type of policy would only provide coverage for specific types of illnesses (cancer, stroke, etc)?
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Comprehensive Major Medical Policies usually combine what?
Comprehensive Major Medical Policies usually combine what?
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An individual has a Major Medical policy with a $5,000 deductible and an 80/20 Coinsurance clause. How much will the INSURED have to pay if a total of $15,000 in covered medical expenses are incurred?
An individual has a Major Medical policy with a $5,000 deductible and an 80/20 Coinsurance clause. How much will the INSURED have to pay if a total of $15,000 in covered medical expenses are incurred?
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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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Which of the following individual health insurance policies will provide the broadest protection?
Which of the following individual health insurance policies will provide the broadest protection?
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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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Which of the following situations does a Critical Illness plan cover?
Which of the following situations does a Critical Illness plan cover?
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Which of the following policy features allows an insured to defer current health charges to the following year's deductible instead of the current year's deductible?
Which of the following policy features allows an insured to defer current health charges to the following year's deductible instead of the current year's deductible?
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All of the following are limited benefit plans, EXCEPT:
All of the following are limited benefit plans, EXCEPT:
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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?
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What is the type of deductible provision that states that should more than one family member be involved in a common accident, or suffer the same illness, only one individual deductible amount shall apply?
What is the type of deductible provision that states that should more than one family member be involved in a common accident, or suffer the same illness, only one individual deductible amount shall apply?
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Study Notes
Major Medical Insurance
- Major Medical policies often require a deductible to be met before benefits begin.
- Coinsurance is a feature of Major Medical that involves shared responsibility for expenses between the insurer and the insured.
- Comprehensive Major Medical Policies combine both Major Medical and Basic Hospital/Surgical coverage for broader protection.
Usual, Customary, and Reasonable (UCR) Charges
- UCR charges represent the maximum amount that a health plan will reimburse for medical services.
- Understanding UCR is essential for navigating insurance reimbursements.
Deductibles and Claims
- For a $200 deductible and an 80% coinsurance clause, a $2,200 medical expense will result in a payment of $1,600 after deductibles and coinsurance are applied.
- With a $5,000 deductible and an 80/20 coinsurance, a total of $15,000 in expenses results in the insured paying $7,000.
Limited Benefit Plans
- Limited benefit plans do not provide comprehensive coverage. Life insurance policies are not considered limited benefit plans.
- Dread disease insurance specifically covers only certain illnesses such as cancer or stroke.
Health Reimbursement Arrangements (HRA)
- HRAs are employer-funded plans designed to reimburse employees for medical expenses, not funded entirely by employees.
Critical Illness Plans
- Critical Illness plans provide coverage for specific serious conditions, including leukemia, which is classified as a critical illness.
Carryover Provision
- The carryover provision allows medical expenses incurred in the last three months of the year to be applied toward the next year's deductible.
Purpose of Coinsurance
- The coinsurance clause in Major Medical policies aims to discourage overutilization of medical services by requiring insured individuals to share costs.
Common Accident Deductible
- The common accident deductible provision allows a single deductible to be applied when multiple family members are involved in the same incident or illness.
Studying That Suits You
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Description
Test your knowledge of medical expense insurance with these flashcards. This quiz covers key concepts such as deductibles and the definition of usual, customary, and reasonable charges. Perfect for studying major medical policies and insurance reimbursement criteria.
