Podcast
Questions and Answers
A fee for service health insurance plan will normally cover:
A fee for service health insurance plan will normally cover:
- Routine check-ups
- Wellness checks
- Preventative services
- A disease (correct)
What does treatment for heart disease within the past year indicate when applying for health insurance?
What does treatment for heart disease within the past year indicate when applying for health insurance?
Preexisting condition
Which of the following is NOT included under a health benefit plan?
Which of the following is NOT included under a health benefit plan?
- Hospital indemnity plan (correct)
- Preferred Provider Organization (PPO)
- Health Maintenance Organization (HMO)
- Major medical insurance
Distributions from a Health Savings Account (HSA) for qualified medical expenses are tax-free.
Distributions from a Health Savings Account (HSA) for qualified medical expenses are tax-free.
What does major medical insurance typically cover that results from a negative reaction?
What does major medical insurance typically cover that results from a negative reaction?
A health insurance policy will typically cover preventative health services.
A health insurance policy will typically cover preventative health services.
What type of incident would Medical Expense Insurance cover?
What type of incident would Medical Expense Insurance cover?
How is a health provider reimbursed if they do NOT have an agreement in place with the insurance company?
How is a health provider reimbursed if they do NOT have an agreement in place with the insurance company?
What type of deductible does Ted's health insurance plan have?
What type of deductible does Ted's health insurance plan have?
How much will Kim pay if she incurs a loss of $1,500 with a deductible of $500 and an 80/20 coinsurance?
How much will Kim pay if she incurs a loss of $1,500 with a deductible of $500 and an 80/20 coinsurance?
Which of the following plans do NOT allow for employee contributions to be taken on a pre-tax basis?
Which of the following plans do NOT allow for employee contributions to be taken on a pre-tax basis?
What is a specific sum an insured must pay out of pocket before benefits are paid called?
What is a specific sum an insured must pay out of pocket before benefits are paid called?
What does 'maximum benefits' refer to in insurance?
What does 'maximum benefits' refer to in insurance?
If an insured has a major medical plan with an 80%/20% coinsurance and a deductible of $75, how much will the insurer pay for a bill of $175?
If an insured has a major medical plan with an 80%/20% coinsurance and a deductible of $75, how much will the insurer pay for a bill of $175?
Which of the following is NOT a characteristic of a major medical expense policy?
Which of the following is NOT a characteristic of a major medical expense policy?
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?
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.
Which statement is NOT true regarding a Critical Illness Plan?
Which statement is NOT true regarding a Critical Illness Plan?
With a stop-loss limit of $5,000, a deductible of $500, and an 80/20 coinsurance, how much will the insured have to pay after incurring $25,000 of covered losses?
With a stop-loss limit of $5,000, a deductible of $500, and an 80/20 coinsurance, how much will the insured have to pay after incurring $25,000 of covered losses?
What does an indemnity plan provide for services?
What does an indemnity plan provide for services?
How much is an insured responsible for if they file a claim of $1,000 with a zero deductible and an 80/20 coinsurance?
How much is an insured responsible for if they file a claim of $1,000 with a zero deductible and an 80/20 coinsurance?
What is the elimination period under a hospital indemnity plan?
What is the elimination period under a hospital indemnity plan?
What is a payment system for health care where the provider is paid for each service given called?
What is a payment system for health care where the provider is paid for each service given called?
A pharmacy benefit covers prescription drugs derived from a list called a(n):
A pharmacy benefit covers prescription drugs derived from a list called a(n):
Major Medical expense plans provide coverage for each of the following EXCEPT:
Major Medical expense plans provide coverage for each of the following EXCEPT:
Which types of deductibles would apply a single deductible to both medical and dental insurance coverage?
Which types of deductibles would apply a single deductible to both medical and dental insurance coverage?
A dread disease policy is considered to be a type of:
A dread disease policy is considered to be a type of:
Flashcards
Fee-for-service health plans
Fee-for-service health plans
Reimbursement for medical expenses incurred due to diseases.
Preexisting condition
Preexisting condition
Recent treatment for heart disease.
HSA tax benefits
HSA tax benefits
Distributions used for qualified medical expenses are not taxed.
Major medical insurance
Major medical insurance
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Preventative care coverage
Preventative care coverage
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Medical Expense Insurance coverage
Medical Expense Insurance coverage
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Calendar-year deductible
Calendar-year deductible
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Deductible
Deductible
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Maximum benefits
Maximum benefits
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Elimination period
Elimination period
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Limited health insurance policies
Limited health insurance policies
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First dollar coverage
First dollar coverage
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Indemnity plans
Indemnity plans
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80/20 coinsurance
80/20 coinsurance
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Elimination period (hospital indemnity)
Elimination period (hospital indemnity)
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Fee-for-service
Fee-for-service
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Drug formulary
Drug formulary
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Major medical expense plans exclusions
Major medical expense plans exclusions
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Integrated deductibles
Integrated deductibles
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Dread disease policies
Dread disease policies
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Study Notes
Medical Expense Insurance Key Points
- Fee-for-service health plans typically cover diseases, providing reimbursement for medical expenses incurred.
- Recent treatment for heart disease qualifies as a preexisting condition when applying for health insurance.
- Hospital indemnity plans are not included in standard health benefit plans.
- Health Savings Account (HSA) distributions for qualified medical expenses are exempt from taxes.
- Major medical insurance generally covers medical expenses linked to adverse reactions to prescribed medications.
- Health insurance policies usually include coverage for preventative health services.
- Medical Expense Insurance covers injuries even if they occur at the insured's residence.
- Health providers not contracted with an insurance company are reimbursed based on usual, customary, and reasonable fees.
- A calendar-year deductible requires insured individuals to pay a specified amount out-of-pocket before benefits are initiated annually.
- For a loss of $1,500 with a $500 deductible and 80/20 coinsurance, the out-of-pocket expense is $700.
- Except for Health Reimbursement Arrangement Plans, many plans allow employee contributions on a pre-tax basis.
- A deductible is the fixed sum an insured must pay before any benefits begin in their insurance plan.
- "Maximum benefits" define the cap on total lifetime benefits payable by an insurance provider.
- In a major medical plan with 80%/20% coinsurance and a $75 deductible, if the total bill is $175, the insurer pays $140.
- Major medical expense policies generally lack an elimination period, which is a waiting period for benefits to start.
- Limited health insurance policies can exclusively cover low-frequency diseases.
- Major medical plans with first dollar coverage do not require an upfront deductible payment before benefits.
- Critical Illness Plans do not limit coverage to a single devastating disease; this statement is false.
- With a stop-loss limit of $5,000 and an $80/20 coinsurance on $25,000 in losses, the insured's payment responsibility is capped at $5,000.
- Indemnity plans offer the insured a predetermined dollar amount for services rendered.
- Under a major medical plan with no deductible and an 80/20 coinsurance structure, a $1,000 claim would require the insured to pay $200.
- The elimination period in a hospital indemnity plan refers to the required waiting days before benefits are accessible for each hospitalization.
- Fee-for-service payment systems reimburse providers for each individual service rendered.
- Pharmacy benefits revolve around a drug formulary—a list of covered prescription medications.
- Major medical expense plans typically do not cover work-related injuries.
- Integrated deductibles apply a single deductible across both medical and dental insurance coverage.
- Dread disease policies are classified as limited health insurance policies, providing targeted coverage.
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