Medical Expense Plans Chapter 16 Flashcards
Which of the following organizations reimburses its insured for covered medical expenses?
A. Blue Cross/Blue Shield organizations
B. Health maintenance organizations
C. Preferred provider organizations
D. Commercial insurers
D
Basic hospital expense insurance subjected the insured to which of the following?
A. low limits
B. coinsurance
C. maximum out of pocket limits
D. deductibles
A
Which of the following types of plans integrates its coverage with basic medical expense coverage, providing benefits in excess of those specified in the basic plan?
A. supplementary major medical
B. comprehensive major medical
C. basic umbrella
D. hospital indemnity
A
Comprehensive medical expense insurance covers all of the following except
A. miscellaneous hospital expenses
B. loss of income resulting from sickness
C. surgical fees
D. hospital room and board
B
The insured has a $2,500 individual deductible and a $7,500 family deductible. The insured has an injury in February resulting in $6,000 of medical expenses. Later in the same year, her spouse incurs $4,000 of medical expenses. How much of these expenses will not be paid by the insurer?
A. $5,000
B. $7,500
C. $4,000
D. $2,500
A
Major medical policies that pay 100% of covered expenses above a specified amount and after the insured’s deductible contain what kind of a provision?
A. maximum benefit
B. stop loss
C. umbrella
D. blue sky
B
Leonard owns a major medical health policy that requires him to pay the first $200 of covered expenses each year before the policy pays its benefits. The $200 is the policy’s
A. deductible
B. stop loss amount
C. annual premium
D. coinsurance amount
A
The calendar year deductible provision of a major medical policy stipulates that
A. the deductible is applied against each claim during the first calendar ear the policy is in effect
B. the insurer pays a higher percentage of the medical expenses than the insured
C. all claims submitted during the calendar year are subject to the amount of the deducible
D. the deductible is applied only once during the calendar year
D
Major medical policies may include any of the following types of deductibles except
A. decreasing
B. family
C. corridor
D. individual
A
In major medical and comprehensive medical expense policies, a coinsurance provision
A. helps to satisfy the deductible amount
B. provides for percentage participation by the insured
C. does not apply until benefit amounts exceed $2,000
D. has no effect on claims
B
All of the following medical expenses are generally excluded from coverage under individual medical expense policies except
A. nursing care in a hospital
B. custodial care in a convalescent facility
C. treatment for drug and alcohol abuse
D. nursing care at home
A
Which of the following items is not typically covered under a medical expense policys miscellaneous expense benefit?
A. x-rays
B. labratory fees
C. surgeons fees
D. use of the operating room
C
All of the following are considered service providers except
A. a health maintenance organization
B. a preferred provider organization
C. a blue cross/blue shield organization
D. a commercial insurance company
D
Alice has a major medical policy with a $500 deductible and an 80%/20% coinsurance provision. If she receives a hospital bill for $7,500 of covered expenses, how much of that bill will she have to pay?
A. $2,400
B. $1,400
C. $2,000
D. $1,900
D
Arthur incurs total hospital expenses of $8,300. His major medical policy includes a $500 deductible and an 80%/20% coinsurance feature. If this is the first covered expense he has incurred this year, how much will Arthur have to pay toward his hospital bill?
A. $1,800
B. $2,060
C. $2,160
D. $5,900
B
