LIFE AND HEALTH INSURANCE EXAM
SCRIPT VERIFIED QUESTIONS WITH
ACCURATE ANSWERS
●● 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)
,Answer: Insurance 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
Answer: Insured 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
Answer: Policyowners 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
Answer: A 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
Answer: Is 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
Answer: scientific 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
Answer: Pays 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).
-usually written as an indemnity plan and has first dollar coverage
●● Major Medical Expense
Answer: -Cover "catastrophic" or huge loss. A Catastrophic loss is
defined as whenever Basic coverage runs out and not a specific dollar
amount.
-High Maximum Limits ($2,000,000)
-Deductibles (per person or per family ea yr))
-Co- insurance (Usually 80/20%)
-Stop Loss
-Miscellaneous Expense Benefits - x-rays, MRI, lab tests, etc.
●● Coinsurance
Answer: - Once the deductible is met the insured and the insurance
company share in the expenses in what is called coinsurance. It is
SCRIPT VERIFIED QUESTIONS WITH
ACCURATE ANSWERS
●● 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)
,Answer: Insurance 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
Answer: Insured 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
Answer: Policyowners 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
Answer: A 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
Answer: Is 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
Answer: scientific 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
Answer: Pays 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).
-usually written as an indemnity plan and has first dollar coverage
●● Major Medical Expense
Answer: -Cover "catastrophic" or huge loss. A Catastrophic loss is
defined as whenever Basic coverage runs out and not a specific dollar
amount.
-High Maximum Limits ($2,000,000)
-Deductibles (per person or per family ea yr))
-Co- insurance (Usually 80/20%)
-Stop Loss
-Miscellaneous Expense Benefits - x-rays, MRI, lab tests, etc.
●● Coinsurance
Answer: - Once the deductible is met the insured and the insurance
company share in the expenses in what is called coinsurance. It is
