MS Life and Health Insurance Exam
Chapter 9(6
$1,200 - ANSWERSW has a health insurance policy with an 80/20 coinsurance, a $1,000
deductible. If in January W goes into the hospital for an overnight stay, the bill coming to
$2,000, what will W pay?
$3,000 - ANSWERSVictoria's adjusted gross income was $60,000. The total cost of her individual
medical insurance, LTC insurance, and out-of-pocket medical expenses was $7,500. Victoria may
qualify for a deduction in the amount of ______.
They charge patients utilizing providers contracted with the PPO less than those who are not
contracted with the PPO - ANSWERSHow do PPOs save consumers money?
Her PPO will pay a reduced amount with Sylvia paying the balance - ANSWERSSylvia is a
participant in a Preferred Provider Organization and finds that if she opts to use a provider
outside the network:
Coinsurance - ANSWERS___________ is a cost sharing feature and is stated as a percentage of
sharing between the insurer and the insured, such as 80/20.
Capitation fee - ANSWERSThe HMO provider is paid a set fee per enrollee, known as a:
$800 - ANSWERSWayne incurs a $2,000 medical bill. If his health policy has a $1,000 deductible
and an 80/20 coinsurance percentage, how much will the insurer pay?
$240,000 - ANSWERSB has a double indemnity clause on a $120,000 Accidental Death and
Dismemberment policy that will pay in the case of death due to a commercial plane crash. If B
, dies in a plane crash while flying on a commercial flight to a business meeting, the total amount
the policy will pay is:
$900 - ANSWERSW has a health insurance policy with an 80/20 coinsurance and a $1,000
deductible. In January, W goes into the hospital for an overnight stay and incurs $900 in covered
hospital expenses. How much of the $900 is W's responsibility?
The insurer pays 80% and the insured pays 20% - ANSWERSIf an insured has a policy with 80/20
coinsurance, how is payment split?
Short-Term Medical - ANSWERSX retired 6 months before becoming eligible for Medicare. To fill
in the gap of coverage during the interim before enrolling in Medicare, X can purchase what
limited policy to cover medical expenses?
Gatekeeper - ANSWERSDr. Doe is associated with an HMO. One of his main functions is to
oversee referrals to other physicians and specialists. Dr. Doe is functioning in the capacity of a:
"First Dollar" coverage - ANSWERSBasic Health Insurance plans do not have a deductible, so
they are known as providing:
Provides specific benefits for specific injuries from specific causes - ANSWERSWhat is the best
definition of a Limited Accident Policy?
Confined to the hospital - ANSWERSA Basic Hospital Expense Policy provides coverage for the
insured while ________.
From the date of placement of adoption - ANSWERSAll individual and group health insurance
policies providing coverage for the insured's dependents must provide coverage for adopted
children:
Chapter 9(6
$1,200 - ANSWERSW has a health insurance policy with an 80/20 coinsurance, a $1,000
deductible. If in January W goes into the hospital for an overnight stay, the bill coming to
$2,000, what will W pay?
$3,000 - ANSWERSVictoria's adjusted gross income was $60,000. The total cost of her individual
medical insurance, LTC insurance, and out-of-pocket medical expenses was $7,500. Victoria may
qualify for a deduction in the amount of ______.
They charge patients utilizing providers contracted with the PPO less than those who are not
contracted with the PPO - ANSWERSHow do PPOs save consumers money?
Her PPO will pay a reduced amount with Sylvia paying the balance - ANSWERSSylvia is a
participant in a Preferred Provider Organization and finds that if she opts to use a provider
outside the network:
Coinsurance - ANSWERS___________ is a cost sharing feature and is stated as a percentage of
sharing between the insurer and the insured, such as 80/20.
Capitation fee - ANSWERSThe HMO provider is paid a set fee per enrollee, known as a:
$800 - ANSWERSWayne incurs a $2,000 medical bill. If his health policy has a $1,000 deductible
and an 80/20 coinsurance percentage, how much will the insurer pay?
$240,000 - ANSWERSB has a double indemnity clause on a $120,000 Accidental Death and
Dismemberment policy that will pay in the case of death due to a commercial plane crash. If B
, dies in a plane crash while flying on a commercial flight to a business meeting, the total amount
the policy will pay is:
$900 - ANSWERSW has a health insurance policy with an 80/20 coinsurance and a $1,000
deductible. In January, W goes into the hospital for an overnight stay and incurs $900 in covered
hospital expenses. How much of the $900 is W's responsibility?
The insurer pays 80% and the insured pays 20% - ANSWERSIf an insured has a policy with 80/20
coinsurance, how is payment split?
Short-Term Medical - ANSWERSX retired 6 months before becoming eligible for Medicare. To fill
in the gap of coverage during the interim before enrolling in Medicare, X can purchase what
limited policy to cover medical expenses?
Gatekeeper - ANSWERSDr. Doe is associated with an HMO. One of his main functions is to
oversee referrals to other physicians and specialists. Dr. Doe is functioning in the capacity of a:
"First Dollar" coverage - ANSWERSBasic Health Insurance plans do not have a deductible, so
they are known as providing:
Provides specific benefits for specific injuries from specific causes - ANSWERSWhat is the best
definition of a Limited Accident Policy?
Confined to the hospital - ANSWERSA Basic Hospital Expense Policy provides coverage for the
insured while ________.
From the date of placement of adoption - ANSWERSAll individual and group health insurance
policies providing coverage for the insured's dependents must provide coverage for adopted
children:
