Medical Expense Insurance Questions And Answers Rated A+ New Update Assured Satisfaction

A characteristic of Preferred Provider Organizations (PPOs) would be: - Discounted fees for the patient A comprehensive major medical health insurance policy contains an Eligible Expenses provision which identifies the types of health care services that are covered. All of the following health care services are typically covered EXCEPT for hospital charges physician fees experimental and investigative services nursing services - experimental and investigative services A Health Reimbursement Arrangement MUST be established - by the employer A Hospital/Surgical Expense policy was purchased for a family of four in March of 2013. The policy was issued with a $500 deductible and a limit of four deductibles per calendar year. Two claims were paid in September 2013, each incurring medical expenses in excess of the deductible. Two additional claims were filed in 2014, each in excess of the deductible amount as well. What would be this family's out-ofpocket medical expenses for 2013? - $1,000 A major medical policy typically - provides benefits for reasonable and necessary medical expenses, subject to policy limits A prospective insured completes and signs an application for health insurance but intentionally conceals information about a pre-existing heart condition. The company issues the policy. Two months later, the insured suffers a heart attack and submits a claim. While processing the claim, the company discovers the pre-existing condition. In this situation, the company will - continue coverage but exclude the heart condition All of the following statements about Major Medical benefits are true EXCEPTThe deductible can be expressed as a fixed dollar amount The benefit period begins only after a specified amount of expenses have accrued Benefits are generally expressed as a percentage of eligible expenses Benefits have no maximum limit - Benefits have no maximum limit An individual has a Major Medical policy with a $5,000 deductible and an 80/20 Coinsurance clause. How much will the INSURED have to pay if a total of $15,000 in covered medical expenses are incurred? - $7,000 An insured covered by a group Major Medical plan is hospitalized after sustaining injuries that resulted from an automobile accident. Assuming the plan had a $1,000 deductible and an 80/20 Coinsurance clause, how much will the INSURED be responsible to pay with $11,000 in covered medical expenses? - $3,000 Basic Hospital and Surgical policy benefits are - lower than the actual expenses incurred Basic Medical Expense insurance - has lower benefit limits than Major Medical insurance C was injured while deep sea diving and requires a hospital stay. C has a Major Medical policy with a 80/20 coinsurance clause and a $400 deductible. What is the MAXIMUM C will pay if the covered medical expenses are $2000? - $720 In this situation, $400 deductible + 20% of the remaining medical bill = $720. Comprehensive Major Medical policies usually combine - Major Medical with Basic Hospital/Surgical coverage Deductibles are used in health policies to lower - overuse of medical services For which of the following expenses does a Basic Hospital policy pay? - Hospital room and boardIn Major Medical Expense policies, what is the intent of a Stop Loss provision? - Limits an insured's out-of-pocket medical expenses In order to establish a Health Reimbursement Arrangement (HRA), it MUST - be established by the employer J's Major Medical policy has a $2,000 deductible and an 80/20 Coinsurance clause. If J is hospitalized and receives a bill for $10,000, J would pay - $3,600