Accident & Health Insurance Policies Disability, medical expense

X has an 80/20 major medical policy with a $250 deductible. Since X has not satisfied any of the deductible, if X incurs $1500 in medical expenses, how much of the bill will the insurer pay?

• A. $500

• B. $1000

• C. $1200

• D. $1500

What is the feature that limits the amount of money that an insured has to pay out of pocket once he has paid a certain amount under the coinsurance clause?

• A. Restoration of Benefits

• B. Stop-Loss

• C. Maximum Policy Benefit

• D. Percentage Participation

The deductible that an insured has to pay before benefits begin to be paid by the insurer in a major medical policy is known as the

• A. Corridor Deductible

• B. Initial Deductible

• C. Integrated Deductible

• D. First Dollar Deductible

All of the following are features of a dental plan except

• A. Deductibles

• B. Preventive Care

• C. Coinsurance

• D. High Policy Limits

How is coinsurance in an individual health policy regulated?

• A. The insured can change the rates as long as they wish

• B. There are no regulations

• C. The insurer can change the rates as long as they don’t exceed 25%

• D. The insurer must leave the rate after the first year but not to exceed 25%

When a specialist within the insurance company reviews a file to assess whether an alternate treatment is available that might be cheaper, this is known as

• A. A Pretreatment Review

• B. A Second Surgical Opinion

• C. Case Management

• D. Stop-Loss

What does the term First Dollar mean?

• A. The company begins to pay as soon as the deductible is met

• B. The company begins to pay as soon as the stop loss amount is reached

• C. The policy does not have a deductible

• D. The company will cover the entire amount of expenses incurred as long as the charges are within the inside limit

Group medical expense policies must cover all of the following except

• A. Maternity benefits

• B. Chemical Dependency

• C. Mental Illness

• D. Work related injuries covered under Workers’ Compensation

By adding the major medical to the basic, the insured now has the equivalent of comprehensive major medical coverage. The deductible which is in between the basic and the major medical coverage is known as

• A. Initial Deductible

• B. Corridor Deductible

• C. Flat Deductible

• D. Family Deductible

X incurs $1400 in eligible expenses. The policy is 80/20 with a $200 annual deductible. This is the first claim for the year. What is the maximum amount the insured will be required to pay on this claim?

• A. $200

• B. $240

• C. $440

• D. $960