MEDICAL EXPENSE INSURANCE EXAM QUESTIONS AND ANSWERS. COMPLETE 2025 EXAM UPDATE ALREADY GRADED A+.

MEDICAL EXPENSE INSURANCE EXAM QUESTIONS AND ANSWERS. COMPLETE 2025 EXAM UPDATE ALREADY GRADED A+. A fee for service health insurance plan will normally cover vitamins and natural remedies cosmetic procedures gym membership a disease- CORRECT ANSWER - a disease Low frequency diseases can be exclusively covered by what kind of health insurance policies? Limited policies Blanket policies Employer policies Restricted policies- CORRECT ANSWER - Limited policies All of the following plans allow for employee contributions to be taken on a pre-tax basis EXCEPT Section 125 Plan Premium Only Plan Cafeteria Plan Health Reimbursement Arrangement Plan- CORRECT ANSWER - Health Reimbursement Arrangement Plan A health insurance policy will typically cover injuries obtained from war elective cosmetic surgery preventative health services work related injuries- CORRECT ANSWER - preventative health services Medical Expense Insurance would cover an injury occurring at the insured's residence an injury occurring at work an injury caused by war elective surgeries- CORRECT ANSWER - an injury occurring at the insured's residence The elimination period under a hospital indemnity plan is the period in which pre-existing conditions are not taken into consideration the period in which all deductibles are eliminated the specified number of days after an insurance policy's issue date during which coverage is not afforded for sickness the specified number of days an insured must wait before becoming eligible to receive benefits for each hospitalization- CORRECT ANSWER - the specified number of days an insured must wait before becoming eligible to receive benefits for each hospitalization Which type of coverage pays an amount per day for hospitalization directly to the insured regardless of the insured's other health insurance? MEWA Mutual Group Hospital indemnity- CORRECT ANSWER - hospital indemnity An indemnity plan pays both the insured and health care provider provides the insured a specific dollar amount for services pays the health care provider directly for services rendered is typically issued as a group plan- CORRECT ANSWER - provides the insured a specific dollar amount for services When an insured has a major medical plan with first dollar coverage, how does this impact the benefits paid? No deductible payment is required Deductible specified in the contract is payable by the insured Insured must pay a percentage of covered losses An initial deductible plus a percentage of the remaining covered loss is owed by the insured- CORRECT ANSWER - No deductible payment is required How is a health provider reimbursed if they do NOT have an agreement in place with the insurance company? With a contingent fee With a scheduled fee With a usual, customary, and reasonable fee With a reasonably appropriate fee- CORRECT ANSWER - With a usual, customary, and reasonable fee "Maximum benefits" refers to the upper limit of the total lifetime benefits the insurance company will pay upper limit percentage of what the insurance company will pay for coinsurance upper limits of what the insured will pay in out-of-pocket expenses upper limits of what an insurance company will pay for any particular claim- CORRECT ANSWER - upper limit of the total lifetime benefits the insurance company will pay An insured under a Major Medical expense plan with a zero deductible and 80/20 coinsurance provision files a $1,000 claim. How much of this claim is the insured responsible for? $160 $200 $600 $800- CORRECT ANSWER - $200 A policyholder has a major medical plan with a 80%/20% coinsurance and a deductible of $75. If the insured has previously met her deductible and receives a bill for $175, how much will the insurer pay? $35 $75 $100 $140- CORRECT ANSWER - $140. Because the insured has previously met her deductible, the eligible expenses for a claim is the entire $175. The insurance company pays 80% of $175, or $140. Who is the individual paid on a fee-for-service basis? Subscriber Administrator Insured Provider- CORRECT ANSWER - Provider A dread disease policy is considered to be a type of hospital expense policy group health insurance policy major medical insurance policy limited health insurance policy- CORRECT ANSWER - limited health insurance policy Which of the following statements is NOT true regarding a Critical Illness Plan? Pays a lump sum to the insured upon the diagnosis of a critical illness The insurer may have a list of critical illnesses they will cover Coverage is limited to a single devastating disease Also known as Specified Disease Plans- CORRECT ANSWER - Coverage is limited to a single devastating disease Which of the following is NOT included under a health benefit plan? Major medical policy Basic hospital policy Hospital indemnity plan Surgical expense policy- CORRECT ANSWER - Hospital indemnity plan Amy has a group medical policy through her employer with a $500 deductible and a 90% coinsurance provision. She incurs $1,500 in covered health care services. How much will her group insurance carrier pay? $500 $900 $1,000 $1,350- CORRECT ANSWER - $900. Insurance will pay 90% after deductible has been applied All of these are characteristics of a major medical expense policy EXCEPT large benefit maximums deductibles elimination periods coinsurance- CORRECT ANSWER - elimination period A pharmacy benefit covers prescription drugs derived from a list called a(n) administrative drug list drug formulary controlled substance list generic benefit manager- CORRECT ANSWER - drug formulary Kim has health insurance with a deductible of $500 and an 80/20 coinsurance. How much will she pay if she incurs a loss of $1,500? $200 $500 $700 $1,300- CORRECT ANSWER - $700 An insured has a stop-loss limit of $5,000, a deductible of $500, and an 80/20 coinsurance. The insured incurs $25,000 of covered losses. How much will the insured have to pay? $500 $5,000 $5,400 $5,600- CORRECT ANSWER - $5000 Major Medical expense plans provide coverage for each of the following EXCEPT Medically necessary surgery