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WorksheetsInsurance Quiz 1
Total questions: 26
Worksheet time: 13mins
What type of policy would only provide coverage for specific types of illnesses (cancer, stroke, etc)?
MEWA
Blanket insurance
Dread disease insurance
Disability insurance
Select the appropriate response: Basic Medical Expense insurance:
normally has a deductible and coinsurance
covers an illness but not an accident
pays for lost wages while hospitalized
has lower benefit limits than Major Medical insurance
Which of the following statements BEST defines usual, customary, and reasonable (UCR) charges?
The maximum premium an insurer can charge for their health insurance based on geography
The maximum amount an employer can contribute to a contributory health plan
The maximum deductible an insured can be charged
The maximum amount considered eligible for reimbursement by an insurance company under a health plan
Select the appropriate response: 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.
Individual deductible
Corridor deductible
Family maximum deductible
Common accident deductible
Which of the following types of health coverage frequently uses a deductible?
Major Medical policy
Basic Surgical policy
Basic Hospital policy
Worker's Compensation
Which of the following statements BEST describes the intent of a Coinsurance clause in a Major Medical policy?
Discourages overutilization of the insurance coverage
Minimizes the need for deductibles
Discourages adverse selection
Minimizes the waiting period
A comprehensive major medical health insurance policy contains an Eligible Expenses provision which identifies the types of health care services that are covered. All of the following health care services are typically covered, EXCEPT for:
hospital charges
physician fees
experimental and investigative services
nursing services
An individual has a Major Medical policy with a $5,000 deductible and an 80/20 Coinsurance clause. How much will the INSURED have to pay if a total of $15,000 in covered medical expenses are incurred?
$2,000
$5,000
$7,000
$10,000
Which of the following BEST describes a Hospital Indemnity policy?
Coverage that reimburses an insured for surgeon expenses
Coverage that pays a stated amount per day of a covered hospitalization
Coverage that replaces lost income due to hospitalization
Coverage that pays for hospital room and board
Which of the following phrases refers to the fees charged by a healthcare professional?
Deductible
Coinsurance
Usual, customary, and reasonable expenses
Hospital expense
Select the appropriate response: The first portion of a covered Major Medical insurance expense that the insured is required to pay is called the:
corridor deductible
initial deductible
stop-loss deductible
coinsurance deductible
J’s Major Medical policy has a $2,000 deductible and an 80/20 Coinsurance clause. If J is hospitalized and receives a bill for $10,000, J would pay:
$1,600
$2,000
$3,600
$8,000
Major Medical policies typically:
pay 100% of covered expenses
contain a deductible and coinsurance
require use of in-network facilities only
do not contain a deductible and coinsurance
All of the following statements about Major Medical benefits are true, EXCEPT:
The deductible can be expressed as a fixed dollar amount
The benefit period begins only after a specified amount of expenses have accrued
Benefits are generally expressed as a percentage of eligible expenses
Benefits have no maximum limit
In Major Medical Expense policies, what is the objective of a Stop Loss provision?
Limits an insurer's premium increases
Limits an insurer's liability
Limits an insured's out-of-pocket medical expenses
Limits an insured's coverage for pre-existing conditions
Select the appropriate response: All of these are characteristics of a Health Reimbursement Arrangement (HRA) EXCEPT
HRA is entirely funded by the employee
HRA is entirely funded by the employer
Reimbursement for eligible medical expenses are allowed
HRA can be offered with other health plans
Basic Hospital and Surgical policy benefits are:
lower than the actual expenses incurred
higher than the actual expenses incurred
normally subject to deductibles
normally subject to coinsurance
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?
Insurer will require a higher deductible for any claims resulting from this condition
Insurer is required to initially cover this pre-existing condition
Insurer will permanently exclude the condition from the policy
Insurer will likely treat as a pre-existing condition which may not be covered for one year
This type of deductible provision waives the deductible for all family members after some of them have satisfied individual deductibles within the same year:
Individual deductible
Corridor deductible
Family maximum deductible
Common accident deductible
A Health Reimbursement Arrangement MUST be established:
with employee funding
with other employer-sponsored benefit plans
by the employer
only during specific open enrollment periods
M is insured under a basic hospital and surgical expense policy. A physician performed surgery on M what determines the claim M is eligible for
claim payment is equal to physicians actual charges
claim payment is negotiated between physician and patient
determined by the schedule of benefits from the hospital
determined by the terms of the policy
A prospective insured completes and signs and application for health insurance, but intentionally conceals information about a pre-existing heart condition. The company issues the policy two months later the insured suffers a heart attack and submits a claim while processing the claim, the company discovers the pre-existing condition in this situation the company will
continue cover coverage, but request a corrected application
deny coverage and increase premiums
continue coverage, but exclude the heart condition
resend the coverage and return the premiums
which provision allows, a portion of any used medical benefits to be restored following a particular amount of benefit has been used or after the policy has been in effect for a particular period of time
reimbursement benefit
restoration of unused benefit
restoration of used benefit
medical offset benefit
comprehensive major medical policies usually combine
major medical with disability income coverage
Major medical with basic hospital and surgical coverage
Basic hospital and surgical with accidental coverage
Basic hospital and surgical with disability income coverage
For which of the following expenses does a basic hospital policy pay
Hospital room and board
prescription medication
surgical fees
physicians fees
which of the following statements about health reimbursement arrangements (HRA) is correct
If the employee had a qualified medical leave from work, lost wages can be reimbursed
if the employee paid for qualified medical expenses, the reimbursements may be tax-free
any unused amounts are added to employees gross income
health insurance premiums can be reimbursed to the employee
