Chapter 13 Medical Expense Insurance
This flashcard set covers the differences between basic hospital/surgical and major medical policies, including features like deductibles, coinsurance, PPO discounts, and carryover provisions. It also touches on HRAs and how cost-sharing controls overuse of services.
which of the following costs would a basic/hospital/surgical policy likely cover
surgically removing a facial birthmark
Key Terms
which of the following costs would a basic/hospital/surgical policy likely cover
surgically removing a facial birthmark
a major medical policy typically
provides benefits for reasonable and necessary medical expenses subject to policy limits
basic hospital and surgical policy benefits are
lower than the actual expense insured
which of the following is not a limited benefit plan
life insurance policy
B’s policy provides coverage on an in-hospital basis only and contains a limited daily room and board benefit. which of these policies does B have
basic hospital
this type of deductible provision waives the deductible for all family members after some of them have satisfies individual deductibles within the same year
family maximum deductible
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| Term | Definition |
|---|---|
which of the following costs would a basic/hospital/surgical policy likely cover | surgically removing a facial birthmark |
a major medical policy typically | provides benefits for reasonable and necessary medical expenses subject to policy limits |
basic hospital and surgical policy benefits are | lower than the actual expense insured |
which of the following is not a limited benefit plan | life insurance policy |
B’s policy provides coverage on an in-hospital basis only and contains a limited daily room and board benefit. which of these policies does B have | basic hospital |
this type of deductible provision waives the deductible for all family members after some of them have satisfies individual deductibles within the same year | family maximum deductible |
a major medical policy typically contains a provision that requires the insurer to pay only part of a loss, while the balance is paid by the insured. this provision is called | coinsurance |
a characteristic of preferred provider organizations would be | discounted fees for th patient |
which of the following policy features allow an insured to defer current health charges to the following dedutible instead of the current year deductible | carryover provision |
comprehensive major medical policies usually combine | major medical with basic hospital/surgical coverage |
major medical policies typically | contain a deductible and coinsurance |
in order to establish a health reimbursement arrangement (HRA) it must | be established by them employers |
deductibles are used in health policies to lower | overuse of medical services |
M has a major medical insurance policy with a $200 flat deductible and an 80% coinsurance clause. if M incurs a $2200 claim for an eligible medical expense, how much will M receive in payment for this claim? | 1600 2200-200 x80% |
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 expense in excess of the deductible. two additional claims were filed in 2014, each in excess of the deductible amount as well. what would be this family’s out of pocket medical expenses for 2013. | $1000 |
all of the following statements about major medical benefits are true except | benefits have no maximum limit |
a comprehensive major medical health insurance policy contains an eligible expenses provision which identifies the type of health care services that are covered. all of the following health care services are typically covered, except for | experimental and invetigative services |
which of the following medical expenses does cancer insurance not cover? | arthritis |
for which of the following expenses does a basic hospital policy pay | hospital room and board |
in major medical expense policies, what is the objective of a stop loss provision | limits the insured out of pocket medical expenses |
what type of policy would only provide coverage for specific types of illnessess (cancer stroke etc) | dread disease insurance |
what type of policy would only provide coverage for specific types of illnessess (cancer stroke etc) | dread disease insurance |
a catastrophic illness would be best covered by which of the following health insurance plans | major medical |
T was treated for an ailment 2 months prior to applying for a health insurance policy. this condition was noted on the application and the policy was issued shortly afterwards. how will the insurer likely consider this condition | insurer will likely treat as a pre existing condition which may not be covered for one year |
what of the following best describes the intent of a coinsurance clause in a major medical policy | dicourages overutilization of the insurance coverage |
which of the following statments best defines usual customary and reasonable UCR charges | the maximum amount considered eligible for reimbursment by an insurance company under a health plan |