Life & Health Insurance Exam Prep Questions and Answers 100% Pass

Life & Health Insurance Exam Prep Questions and Answers 100% Pass Basic Medical Expense policies - Correct Answer ️️ -Provide 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 - Correct 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 - Correct 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 - Correct 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) - Correct 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 - Correct 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 - Correct 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 - Correct Answer ️️ -Policyowners obtain medical treatment from whatever source they want and submit their charges to their insurer for reimbursement (actual amount). Service Based Contracts - Correct 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 - Correct 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 - Correct 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 - Correct 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 - Correct 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 - Correct 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 - Correct Answer ️️ --Cover "catastrophic" or