Life & Health Chapter 15 | Health Chapter 6 Exam: Medical Expense Insurance

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-of-pocket medical expenses for 2013?

  1. $2,000

  2. $1,000

  3. $1,500

  4. $500

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?

  1. $8,000

  2. $11,000

  3. 0

  4. $3,000

All of the following statements about Major Medical benefits are true, EXCEPT:

  1. The deductible can be expressed as a fixed dollar amount

  2. Benefits are generally expressed as a percentage of eligible expenses

  3. The benefit period begins only after a specified amount of expenses have accrued

  4. Benefits have no maximum limit

Which of the following BEST describes a Hospital Indemnity policy?

  1. Coverage that reimburses an insured for surgeon expenses

  2. Coverage that replaces lost income due to hospitalization

  3. Coverage that pays a stated amount per day of a covered hospitalization

  4. Coverage that pays for hospital room and board

T was treated for an ailment 2 months prior to applying for a health insurance policy. This condition was noted on the application and the policy was issued shortly afterwards. How will the insurer likely consider this condition?

  1. Insurer will permanently exclude the condition from the policy

  2. Insurer will require a higher deductible for any claims resulting from this condition

  3. Insurer will likely treat as a pre-existing condition which may not be covered for one year

  4. Insurer is required to initially cover this pre-existing condition

This type of deductible provision states that should more than one family member be involved in a common accident, or suffer the same illness, only one individual deductible amount shall be applied.

  1. Common accident deductible

  2. Family maximum deductible

  3. Corridor deductible

  4. Individual deductible

Which of the following statements BEST defines usual, customary, and reasonable (UCR) charges?

  1. The maximum premium an insurer can charge for their health insurance based on geography

  2. The maximum amount considered eligible for reimbursement by an insurance company under a health plan

  3. The maximum deductible an insured can be charged

  4. The maximum amount an employer can contribute to a contributory health plan

Which of the following situations does a Critical Illness plan cover?

  1. Alcohol rehabilitation

  2. Leukemia

  3. Asthma

  4. Severe car accident

A catastrophic illness would be best covered by which of the following health insurance plans?

  1. Major Medical

  2. Indemnity

  3. Limited

  4. Surgical Expense

Which of these options can an individual use their medical flexible spending account to pay for?

  1. Prescription drugs

  2. Vitamins and supplements

  3. Household expenditures

  4. Cosmetic procedures

What type of policy would only provide coverage for specific types of illnesses (cancer, stroke, etc.)?

  1. Disability insurance

  2. Blanket insurance

  3. MEWA

  4. Dread disease insurance

Basic Hospital and Surgical policy benefits are:

  1. normally subject to deductibles

  2. higher than the actual expenses incurred

  3. normally subject to coinsurance

  4. lower than the actual expenses incurred

Under a Basic Medical Expense policy, what does the hospitalization expense portion cover?

  1. physician fees

  2. hospital room and board

  3. hospital administration expenses

  4. surgeon's fees

Which of the following types of health coverage frequently uses a deductible?

  1. Basic Hospital policy

  2. Major Medical policy

  3. Basic Surgical policy

  4. Worker's Compensation

Deductibles are used in health policies to lower:

  1. the coinsurance amount

  2. adverse selection

  3. the incidents of fraud

  4. overuse of medical services