Medical Expense Insurance Exam Questions with Complete Solutions

Medical Expense Insurance Exam Questions with Complete Solutions 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 deducitble? - 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 continue 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