Life & Health Insurance Licensing Exam 2026 LATEST REAL QUESTIONS AND
CORRECT ANSWERS G, Exams of Nursing
Basic Medical Expense policies - ANSWERProvide coverage for Hospital,
Surgical and Physicians Medical Expense.
-Purchased as a individual or group policy.
-provide first dollar coverage (no deductibles).
-limited benefit periods and low coverage limits.
Major Medical Expense Policy - ANSWER-A supplement (in addition) to Basic
Medical or as a stand-alone policy.
-individual or group policy.
-Take over when the Basic Policy runs out
Hospital Expenses - ANSWER-Pay for covered expenses incurred during a
hospital stay.
1. Daily hospital benefit - Room and Board
,2. Miscellaneous expenses - Other Medical Expenses (X-Rays, MRI,
Prescriptions, Doctor Visits)
Daily Hospital Benefit - ANSWER-Cost of a hospital room, up to a daily $ limit.
The limit may be expressed either as a dollar amount, e.g. $500 per day, or it
may be expressed as the Usual, Customary and Reasonable (UCR) and Charge
Usual, Customary and Reasonable (UCR) - ANSWERInsurance company will
pay an amount for a given procedure based upon the average charge for that
procedure in that specific geographic area. The coverage is subject to a
maximum amount or number of days.
Benefit Schedule - ANSWER-Specifically states what is covered in the plan and
for how much. The coverage is subject to a maximum amount or number of
days.
Indemnity - ANSWERInsured pays the bill and is reimbursed by the insurance
company up to a specified limit amount. Medical expense policies that pay a
fixed rate provide the insured with a stated benefit amount for each day of
hospital confinement.
Reimbursement - ANSWERPolicyowners obtain medical treatment from
whatever source they want and submit their charges to their insurer for
reimbursement (actual amount).
Service Based Contracts - ANSWER-Pay doctors and hospitals directly
according to the # of days of coverage that is provided in the contract for
each event and are prepayment plans. Once a claim is settled, the insured
will receive an Explanation of Benefit (EOB), which is a written confirmation
, that the claim was paid. Blue Cross and Blue Shield, Health Service
Corporations and Medicare coverage are all provided on a Service Basis.
Miscellaneous Expense Benefits - ANSWER-Secondary benefits (inside
benefits) because they occur inside the hospital for charges related to the
stay. X-rays, prescriptions, MRI's, anesthesia and lab fees are usually separate
fees incurred during a stay. Miscellaneous Expense Benefits have separate
limits, referred to as Inside Limits. The are expressed usually as a multiple of
the daily amount (UCR)
Surgical Expense - ANSWERA schedule of procedures lists the amount
allowable for each procedure. If a surgical procedure is not found in the
schedule, it will still be payable. The amount payable for a procedure not
listed is based on its relative value to a procedure of similar difficulty. There
are usually no deductibles.
Surgical Schedule - ANSWERIs simply a price list. Each procedure is listed and
a dollar amount assigned and if a procedure is not listed in the schedule it is
still paid.
Relative Value - ANSWERscientific method of paying different benefits based
on the region of the country an insured lives. It is based on assigning a value
to each procedure and using a conversion factor. A schedule of assigned
points for each procedure must be included in the policy.
Physicians Medical Expense - ANSWERPays for visits to the doctor (office
hospital) plus post operation care. There may be a per-visit benefit, or the
coverage is based on UCR.
-May or may not be a deductible . This policy is usually written as an
indemnity plan and has first dollar coverage (no deductible).
CORRECT ANSWERS G, Exams of Nursing
Basic Medical Expense policies - ANSWERProvide coverage for Hospital,
Surgical and Physicians Medical Expense.
-Purchased as a individual or group policy.
-provide first dollar coverage (no deductibles).
-limited benefit periods and low coverage limits.
Major Medical Expense Policy - ANSWER-A supplement (in addition) to Basic
Medical or as a stand-alone policy.
-individual or group policy.
-Take over when the Basic Policy runs out
Hospital Expenses - ANSWER-Pay for covered expenses incurred during a
hospital stay.
1. Daily hospital benefit - Room and Board
,2. Miscellaneous expenses - Other Medical Expenses (X-Rays, MRI,
Prescriptions, Doctor Visits)
Daily Hospital Benefit - ANSWER-Cost of a hospital room, up to a daily $ limit.
The limit may be expressed either as a dollar amount, e.g. $500 per day, or it
may be expressed as the Usual, Customary and Reasonable (UCR) and Charge
Usual, Customary and Reasonable (UCR) - ANSWERInsurance company will
pay an amount for a given procedure based upon the average charge for that
procedure in that specific geographic area. The coverage is subject to a
maximum amount or number of days.
Benefit Schedule - ANSWER-Specifically states what is covered in the plan and
for how much. The coverage is subject to a maximum amount or number of
days.
Indemnity - ANSWERInsured pays the bill and is reimbursed by the insurance
company up to a specified limit amount. Medical expense policies that pay a
fixed rate provide the insured with a stated benefit amount for each day of
hospital confinement.
Reimbursement - ANSWERPolicyowners obtain medical treatment from
whatever source they want and submit their charges to their insurer for
reimbursement (actual amount).
Service Based Contracts - ANSWER-Pay doctors and hospitals directly
according to the # of days of coverage that is provided in the contract for
each event and are prepayment plans. Once a claim is settled, the insured
will receive an Explanation of Benefit (EOB), which is a written confirmation
, that the claim was paid. Blue Cross and Blue Shield, Health Service
Corporations and Medicare coverage are all provided on a Service Basis.
Miscellaneous Expense Benefits - ANSWER-Secondary benefits (inside
benefits) because they occur inside the hospital for charges related to the
stay. X-rays, prescriptions, MRI's, anesthesia and lab fees are usually separate
fees incurred during a stay. Miscellaneous Expense Benefits have separate
limits, referred to as Inside Limits. The are expressed usually as a multiple of
the daily amount (UCR)
Surgical Expense - ANSWERA schedule of procedures lists the amount
allowable for each procedure. If a surgical procedure is not found in the
schedule, it will still be payable. The amount payable for a procedure not
listed is based on its relative value to a procedure of similar difficulty. There
are usually no deductibles.
Surgical Schedule - ANSWERIs simply a price list. Each procedure is listed and
a dollar amount assigned and if a procedure is not listed in the schedule it is
still paid.
Relative Value - ANSWERscientific method of paying different benefits based
on the region of the country an insured lives. It is based on assigning a value
to each procedure and using a conversion factor. A schedule of assigned
points for each procedure must be included in the policy.
Physicians Medical Expense - ANSWERPays for visits to the doctor (office
hospital) plus post operation care. There may be a per-visit benefit, or the
coverage is based on UCR.
-May or may not be a deductible . This policy is usually written as an
indemnity plan and has first dollar coverage (no deductible).
