Unit 20 - Medical Expense Insurance Exam Questions With 100% Correct Answers.

Medical Expense Insurance - Categorized as basic medical expense insurance, major medical insurance, comprehensive major medical insurance, and special policies. Note that these products have largely been replaced by managed care alternatives and are no longer sold as stand alone coverages. Basic Medical Expense - -Basic coverage provided by an individual medical expense policy include hospital expense, surgical expense, and medical expense. -May be sold together or separate. -Frequently written as first dollar coverage which means there is no deductible. Hospital Expense Benefits - -Coverage provides benefits for expenses incurred during hospitalization. (Not including telephone and television) -Indemnities classified into two groups 1- Room and Board, including nursing care and special diets 2- Miscellaneous including X-rays, lab fees, medications, medical supplies, and treatment rooms including doctor's charges. -Generally stated as a limit separate from the room and board benefit. Room and Board Benefit - This policy provides a certain dollar amount for the daily hospital room and board benefit, although the trend is toward coverage of not more than the semiprivate room rate unless a private room is medically necessary. Surgical Expense Policies - Pay surgeons' fees and related costs incurred when the insured has an operation. Related costs might be fees for an assistant surgeon, an anesthesiologist, and even the operating room, when it is not covered as a miscellaneous medical item. Scheduled Plan - Benefit amounts are included in a schedule that lists major commonly performed operations and benefits payable for each. "Specific dollar amount in the schedule." (Surgical Expense Benefits)Nonscheduled Plan - When surgical benefits (and sometimes other benefits) are not listed by a specific dollar amount in a schedule, a policy will pay on the basis of what is considered usual, customary, and reasonable (UCR) in a certain geographic area. (Surgical Expense Benefits) Regular Medical Expense Benefits - AKA Basic Medical Expense Coverage is for nonsurgical services a physician provides. Sometimes, they specify a max number of visits per day, max dollar amount per visit, and a max number of days that coverage applies.