Podcast
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?
- Medicare
- Short-term health insurance
- Major Medical policy (correct)
- Critical Illness plan
Which of the following situations does a Critical Illness plan cover?
Which of the following situations does a Critical Illness plan cover?
- Heart Attack
- Broken Arm
- Stroke
- Leukemia (correct)
What do Major Medical policies typically contain?
What do Major Medical policies typically contain?
deductible and coinsurance
What is the first portion of a covered Major Medical insurance expense that the insured is required to pay called?
What is the first portion of a covered Major Medical insurance expense that the insured is required to pay called?
Which statement BEST describes the intent of a Coinsurance clause in a Major Medical policy?
Which statement BEST describes the intent of a Coinsurance clause in a Major Medical policy?
How much will the insured pay if they have a Major Medical policy with a $5,000 deductible and an 80/20 Coinsurance clause for $15,000 in expenses?
How much will the insured pay if they have a Major Medical policy with a $5,000 deductible and an 80/20 Coinsurance clause for $15,000 in expenses?
If J has a Major Medical policy with a $2,000 deductible and an 80/20 Coinsurance clause, how much would they 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 they pay for a $10,000 bill?
What is the MAXIMUM C will pay for covered medical expenses of $2,000 with an 80/20 Coinsurance clause and a $400 deductible?
What is the MAXIMUM C will pay for covered medical expenses of $2,000 with an 80/20 Coinsurance clause and a $400 deductible?
How much will Q be responsible for paying with a $100 deductible and 80/20 Coinsurance for a $10,100 bill?
How much will Q be responsible for paying with a $100 deductible and 80/20 Coinsurance for a $10,100 bill?
How will the insurer likely consider T's condition noted on the application 2 months prior to applying for health insurance?
How will the insurer likely consider T's condition noted on the application 2 months prior to applying for health insurance?
All of the following statements about Major Medical benefits are true EXCEPT?
All of the following statements about Major Medical benefits are true EXCEPT?
A Health Reimbursement Arrangement MUST be established by whom?
A Health Reimbursement Arrangement MUST be established by whom?
Study Notes
Major Medical Insurance
- Major Medical policies typically have a deductible and coinsurance.
- Benefits begin to be paid only after the deductible is satisfied.
- The initial portion of a Major Medical expense the insured pays is termed the initial deductible.
Coinsurance Clause
- The main purpose of the Coinsurance clause is to discourage overutilization of health insurance coverage.
- It requires the insured to share in the cost of claims, promoting responsible use of services.
Deductibles and Payments
- Insureds must pay the initial deductible before coverage applies.
- The insured is responsible for a percentage (e.g., 20%) of the remaining medical expenses after the deductible is met.
Sample Calculations
- An insured with a $5,000 deductible and 80/20 coinsurance facing $15,000 in expenses pays $7,000 ($5,000 + 20% of $10,000).
- An insured with a $2,000 deductible and 80/20 coinsurance facing a $10,000 bill pays $3,600 ($2,000 + 20% of $8,000).
- Maximum out-of-pocket for an insured with an 80/20 coinsurance and $400 deductible for $2,000 in expenses is $720.
Pre-existing Conditions
- Conditions noted on an application may be considered pre-existing and could be excluded from coverage for one year.
Policy Limits
- Major Medical benefits generally have a maximum limit, contrary to some common misconceptions that they are unlimited.
Health Reimbursement Arrangement (HRA)
- HRAs must be established by the employer, and funds must come from the employer as part of employee health benefits.
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Description
Test your knowledge on medical expense insurance with this quiz. Covering essential topics such as major medical policies and critical illness plans, this quiz consists of 10 focused questions. Perfect for students and professionals in the healthcare field.
