Medical Expense Insurance Questions And Answers With Verified Solutions Graded A+

A characteristic of Preferred Provider Organizations (PPOs) would be: Discounted fees for the patient Not allowed to see out-of-network physicians Physicians are paid on a capitation basis A primary care physician is required - discounted fees for the patient 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 A Health Reimbursement Arrangement MUST be established with employee funding with other employer-sponsored benefit plans by the employer only during specific open enrollment periods - by the employer 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-ofpocket medical expenses for 2013? $500 $1,000 $1,500$2,000 - $1,000 A major medical policy typically -provides benefits for surgical expenses only, subject to policy limits -contains more limitations than a Basic Hospital, Medical, or Surgical policy -contains a 60-day Elimination period for losses due to accident -provides benefits for reasonable and necessary medical expenses, subject to policy limits - provides benefits for reasonable and necessary medical expenses, subject to policy limits 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 - continue coverage but exclude the heart condition All of the following are limited benefit plans EXCEPT cancer policies life insurance policies dental policies critical illness policies - life insurance policies 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 limitAn individual has a Major Medical policy with a $5,000 deductible and an 80/20 Coinsurance clause. How much will the INSURED have to pay if a total of $15,000 in covered medical expenses are incurred? $2,000 $5,000 $7,000 $10,000 - $7,000