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19 Cards in this Set
- Front
- Back
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J's Major Medical Policy has a $2k deductible and 80/20 Coinsurance clause. If J is hosptilized and the covered medical expenses total $10k, J would pay |
$3,600 |
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S wants to open a tax-exempt Health Savings Account. To qualify for this type of account, Federal law dictates that S must be enrolled in a |
High-deductible health plan. (To be eligible for a Health Savings Account, an individual must be covered by other health insurance, must not be eligible for Medicare, and cannot be claimed as a dependent on someone else's tax return) |
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What expenses does a Basic Hospital policy pay for? |
Hospital room & board |
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A Hospital/Surgical Expense policy was purchased for a family of four in March of 2013. The policy was issued with a $500 deductible and a limit of four deductibles per calendar year. Two claims were paid in September 2013, each incurring medical expenses in excess of the deductible. Two additional claims were filed in 2014, each in excess of the deductive amount as well. What would be this family's out-of-pocket medical expenses for 2013? |
$1,000 |
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Which of the following health insurance coverages is BEST suited for meeting the expenses of catastrophic illness? -Major medical -Hospital expense -Surgical Expense -Hospital Income |
Major medical |
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The phrase "This policy will only pay for a semi-private room" is an example of a(n) |
internal limit |
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Which of the following individual health policies will provide the broadest protection? -Hospital Expense -Surgical Expense -Major Medical -Limited Sickness |
Major Medical |
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A prospective insured completes and signs an application for health insurance but intentionally conceals information about a pre-existing heart condition. The company issues the policy. Two months later, the insured suffers a heart attack and submits a claim. While processing the claim, the company discovers the pre-existing condition. In this situation, the company will |
continue coverage but exclude the heart condition |
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A Health Reimbursement Arrangement MUST be established |
by the employer (HRAs are employer-established benefit plans that must be funded by the employer) |
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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 -hospital charges -physician fees -experimental and investigative services -nursing services |
experimental and investigative services (usually not part of major medical) |
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C was injured while deep sea diving and requires a hospital stay. C has a Major Medical policy with a 80/20 coinsurance clause adn a $400 deductible. What is the MAXIMUM C will pay if the covered medical expenses are $2000? |
$720 |
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Which of the following can an individual use their medical flexible spending account to pay for? -Vitamins & supplements -Prescription drugs -Household expenditures -Cosmetic procedures |
Prescription drugs |
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Major Medical policies typically |
contain a deductible and coinsurance |
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Which provision in a Major Medical Policy requires the insurer to pay only part of a loss and the insured to pay the remaining balance? |
Coinsurance |
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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? |
$1600 |
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All of the following statements about Major Medical Benefits are true EXCEPT -The deductible can be expressed as a fixed dollar amount -The benefit period begins only after a specified amount of expenses have accrued -Benefits are generally expressed as a percentage of eligible expenses -Benefits have no maximum limit |
Benefits have no maximum limit |
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Which of the following health insurance coverages is BEST suited for meeting the expenses of catastrophic illness? -Major Medical -Hospital Expense -Surgical Expense -Hospital Income |
Major Medical |
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Which of the following situations does a Critical Illness plan cover? -Asthma -Leukemia -Alcohol rehabilitation -Severe car accident |
Leukemia |
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Comprehensive Major Medical policies usually combine |
Major Medical with Basic Hospital/Surgical coverage |
