Medical Expense Insurance EXAM LATEST EXAM 170+ QUESTIONS AND CORRECT ANSWERS (VERIFIED ANSWERS)

Medical Expense Insurance EXAM LATEST EXAM 170+ QUESTIONS AND CORRECT ANSWERS (VERIFIED ANSWERS) 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? - ANSWER- Carryover provision A Health Reimbursement Arrangement MUST be established - ANSWER- by the employer M is insured under a basic Hospital/Surgical Expense policy. A physician performs surgery on M. What determines the claim M is eligible for? - ANSWER- determined by terms of the policy Which of these is NOT a characteristic of a Health Reimbursement Arrangement (HRA)? Employee funds the HRA entirely Employer funds the HRA entirely HRA's can be offered with other health plans HRA's allow reimbursement for eligible medical expenses - ANSWER- Employee funds the HRA entirely Q is hospitalized for 3 days and receives a bill for $10,100. Q has a Major Medical policy with a $100 deductible and 80/20 coinsurance. How much will Q be responsible for paying on this claim? - ANSWER- $2,100 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 - ANSWER- continues coverage but exclude the heart condition Which of the following statements about Health Reimbursement Arrangements (HRA) is CORRECT? - ANSWER- If the employee paid for qualified medical expenses, the reimbursements may be tax-free C was injured while deep sea diving and requires a hospital stay. C has a Major Medical policy with a 80/20 coinsurance clause and a $400 deductible. What is the MAXIMUM C will pay if the covered medical expenses are $2000? - ANSWER- $720 In this situation, $400 deductible + 20% of the remaining medical bill = $720. 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? - ANSWER- Insurer will likely treat as a pre-existing condition which may not be covered for one year For which of the following expenses does a Basic Hospital policy pay? - ANSWER- Hospital room and board What type of policy would only provide coverage for specific types of illnesses (cancer, stroke, etc.)? - ANSWER- Dread disease insurance Which of the following statements BEST defines usual, customary, and reasonable (UCR) charges? - ANSWER- The maximum amount considered eligible for reimbursement by an insurance company under a health plan 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 - ANSWER- experimental and investigative services 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 deductible amount as well. What would be this family's out-of-pocket medical expenses for 2013? - ANSWER- $1,000 Major Medical policies typically - ANSWER- contain a deductible and coinsurance Which of the following health insurance coverage’s is BEST suited for meeting the expenses of catastrophic illness? - ANSWER- Major Medical Which of the following BEST describes a Hospital Indemnity policy? - ANSWER- Coverage that pays a stated amount per day of a covered hospitalization Which of the following situations does a Critical Illness plan cover? A. Asthma B. Leukemia C. Alcohol rehabilitation D. Severe car accident - ANSWER-B. Leukemia