Accident and Health Insurance Final Exam Questions and Answers Latest Version Graded A+

Accident and Health Insurance Final Exam Questions and Answers Latest Version Graded A+ What does a deductible represent in a health insurance policy? The amount the insured must pay before the insurance company begins to pay benefits. What is the purpose of coinsurance in health insurance? To share medical costs between the insurer and the insured after the deductible is met. Who is the beneficiary in a health insurance policy? The person who receives benefits or reimbursement from the policy. What is the grace period in most health insurance policies? A set amount of time after a missed premium payment during which the policy remains active. What type of insurance provides income if a person is unable to work due to illness or injury? Disability income insurance. 2 What does the term “pre-existing condition” mean in health insurance? A medical condition that existed before the policy began. What is the elimination period in a disability policy? The waiting period before disability benefits start after an illness or injury. What is the main difference between an HMO and a PPO? An HMO requires members to use network providers, while a PPO allows more flexibility in choosing providers. What is the primary goal of managed care plans? To control healthcare costs and improve quality of care. What is a copayment in a health insurance plan? A fixed fee the insured pays for covered services at the time of care. What is the purpose of a coordination of benefits provision? 3 To prevent overpayment when a person is covered by multiple insurance policies. Who pays the premium in a group health insurance policy? It is often shared between the employer and the employee. What is the benefit of a major medical insurance policy? It provides broad coverage for serious illness or injury with high benefit limits. What is the role of the primary care physician in an HMO? To coordinate the patient’s healthcare and provide referrals to specialists. What is the free-look period in a health insurance policy? A period (typically 10 days) when the policyholder can cancel the policy and receive a full refund. What happens if an insured fails to pay a premium and the grace period expires? The policy will lapse and coverage will be terminated. 4 What is the main purpose of accidental death and dismemberment insurance? To provide financial benefits for death or loss of limbs due to an accident. When does a health insurance policy typically become incontestable? After two years from the date it was issued. What is the purpose of a stop-loss limit in a health insurance policy? To cap the insured’s out-of-pocket expenses for the year. How is a short-term disability policy different from a long-term disability policy? Short-term covers disabilities for a limited time, while long-term covers extended or permanent disabilities. What is the role of underwriting in health insurance? To assess the risk of the applicant and determine policy terms. What is a health savings account (HSA)?