Illinois Health Exam
First Dollar coverage correct answers-basic medical
-no
insurance
deductible
Basic hospital expense correct answers-policy states that the max daily room
and board
benefit is $500 per day for 30
-surgery not
days.
covered
Usual Customary and reasonable (UCR) correct answers-insurer
calculates the
averaging by cost of a specific surgery in a defined
geographic
-if actual charge
area.is more, policyowner pays the
difference
Major medical expense plan correct answers-designed to provide broad
coverage under
one
-low benefit
policy
limits
-covers everything that is usual and
customary
comprehensive major medical correct answers-covers virtually all
necessary medical
expense
s
-contracts are characterized by a deductible, co-insurance or percentage
participation,
stop-loss feature,
a and lifetime or maximum policy
benefit
deductible correct answerspolicyowner pays first before
benefits are paid
coinsurance correct answerspercentages shared after
deductible is met
higher % of coinsurance correct answerslower
premium
Stop-loss correct answerspolicyowners maximum out-of-pocket for
policy year
higher stop loss correct answerslower
premium
Supplemental major medical correct answers-very similar to
comprehensive major
medic
-offers first-dollar
al
coverage
Common exlusions and limitations correct answers-injury
due to war
-self-inflicted
-routine eye exam and
injury
glasses
-routine dental care/physical
-hearing
exams
aids
, probation period correct answersinsured is on " " for sickness claims the first
30the
of days
policy
individual coverage correct answers-premiums may be tax deductible.
policy
are never
benefits
taxed
-benefit period can last to
age 65
self employed or partner coverage correct answerspremiums are tax
deductible.
benefits arepolicy
never
taxed
group coverage correct answerspremiums paid by the employer are tax
deductible;
premiums paid by the employee are usually after tax (not
deductible)
policy benefits are never
taxed
Purpose of disability income insurance correct answersto provide
in the event the
replacement insured becomes disabled due to an accident or illness
income
and cannot
wor
k
Disability income benefit (how much will be received) correct answers-
Benefits
the form paid
of periodic
in income
payments
-less than insureds earned
-cannot be paid less frequently than
income
monthly.
Social insurance supplement substitute OR social security rider correct
answers-
promises to pay an additional amount each month while the insured is
waiting for social
security
benefits.
subrogation correct answersa provision that prevents over
indemnification
Probationary period correct answersinitial 30 day wait until benefits
can be paid
elimination period correct answers-time without benefits when a claim
is submitted
-The longer the elimination period, the lower the
premium
own occupation correct answers-definition of total disability,
expensive policy
any occupation correct answers-restrictive definition of total disability;
polic
more affordable
y
-cant perform any occupation he/she is
suited for
residual disability correct answerspays portion of lost income to due
partial disability
recurrent disability correct answerscontinuation of
prior claim
First Dollar coverage correct answers-basic medical
-no
insurance
deductible
Basic hospital expense correct answers-policy states that the max daily room
and board
benefit is $500 per day for 30
-surgery not
days.
covered
Usual Customary and reasonable (UCR) correct answers-insurer
calculates the
averaging by cost of a specific surgery in a defined
geographic
-if actual charge
area.is more, policyowner pays the
difference
Major medical expense plan correct answers-designed to provide broad
coverage under
one
-low benefit
policy
limits
-covers everything that is usual and
customary
comprehensive major medical correct answers-covers virtually all
necessary medical
expense
s
-contracts are characterized by a deductible, co-insurance or percentage
participation,
stop-loss feature,
a and lifetime or maximum policy
benefit
deductible correct answerspolicyowner pays first before
benefits are paid
coinsurance correct answerspercentages shared after
deductible is met
higher % of coinsurance correct answerslower
premium
Stop-loss correct answerspolicyowners maximum out-of-pocket for
policy year
higher stop loss correct answerslower
premium
Supplemental major medical correct answers-very similar to
comprehensive major
medic
-offers first-dollar
al
coverage
Common exlusions and limitations correct answers-injury
due to war
-self-inflicted
-routine eye exam and
injury
glasses
-routine dental care/physical
-hearing
exams
aids
, probation period correct answersinsured is on " " for sickness claims the first
30the
of days
policy
individual coverage correct answers-premiums may be tax deductible.
policy
are never
benefits
taxed
-benefit period can last to
age 65
self employed or partner coverage correct answerspremiums are tax
deductible.
benefits arepolicy
never
taxed
group coverage correct answerspremiums paid by the employer are tax
deductible;
premiums paid by the employee are usually after tax (not
deductible)
policy benefits are never
taxed
Purpose of disability income insurance correct answersto provide
in the event the
replacement insured becomes disabled due to an accident or illness
income
and cannot
wor
k
Disability income benefit (how much will be received) correct answers-
Benefits
the form paid
of periodic
in income
payments
-less than insureds earned
-cannot be paid less frequently than
income
monthly.
Social insurance supplement substitute OR social security rider correct
answers-
promises to pay an additional amount each month while the insured is
waiting for social
security
benefits.
subrogation correct answersa provision that prevents over
indemnification
Probationary period correct answersinitial 30 day wait until benefits
can be paid
elimination period correct answers-time without benefits when a claim
is submitted
-The longer the elimination period, the lower the
premium
own occupation correct answers-definition of total disability,
expensive policy
any occupation correct answers-restrictive definition of total disability;
polic
more affordable
y
-cant perform any occupation he/she is
suited for
residual disability correct answerspays portion of lost income to due
partial disability
recurrent disability correct answerscontinuation of
prior claim
