Medical Expense Insurance 2023 Exam Questions with Complete Solutions

Medical Expense Insurance 2023 Exam Questions with Complete Solutions In Major Medical Expense policies, what is the intent of a Stop Loss provision? -Limits an insurer's premium increases -Limits an insurer's liability -Limits an insured's out-of-pocket medical expenses -Limits an insured's coverage for pre-existing conditions - CORRECT ANSWER limits an insured's out-of-pocket medical expenses Which of the following costs would a Basic Hospital/Surgical policy likely cover? -Surgically removing a facial birthmark -Care given at a nursing home -Treating a wound from a soldier injured at war -Lost income caused by a hospital stay - CORRECT ANSWER surgically removing a facial birthmark 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? $2,100 $2,020 $2,000 $100 - CORRECT ANSWER $2,100 For which of the following expenses does a Basic Hospital policy pay? Hospital room and board Prescription medication Surgical fees Physician's fees - CORRECT ANSWER hospital room and board In order to establish a Health Reimbursement Arrangement (HRA), it MUST -be offered in conjunction with other employer provided health benefits -limit the benefits to prescription drugs only -be established by the employer -limit the amount of money the employee can contribute toward the account - CORRECT ANSWER be established by the employer Which of the following situations does a Critical Illness plan cover? Asthma Leukemia Alcohol rehabilitation Severe car accident - CORRECT ANSWER leukemia Basic Hospital and Surgical policy benefits are lower than the actual expenses incurred higher than the actual expenses incurred normally subject to deductibles normally subject to coinsurance - CORRECT ANSWER lower than the actual expenses Which of these options can an individual use their medical flexible spending account to pay for? Vitamins and supplements Prescription drugs Household expenditures Cosmetic procedures - CORRECT ANSWER prescription drugs 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 request a corrected application -deny coverage and increase premiums -continue coverage but exclude the heart condition -rescind the coverage and return the premiums - CORRECT ANSWER continue coverage but exclude the heart condition 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? Deferral provision Carryover provision Stop Loss provision Corridor provision - CORRECT ANSWER carryover provision