Basic surgical expense policies generally provide coverage for all of the following EXCEPT?
A) Surgeon services.
B) Postoperative care.
C) Anesthesiologist services.
D) Miscellaneous expenses, such as lab fees and x-rays.
D) Miscellaneous expenses, such as lab fees and x-rays.
Miscellaneous expenses are normally covered under basic hospital expense policies, not surgical expense policies.
HSA's are designed for?
A) helping an individual accumulate funds to cover health insurance.
B) helping an individual obtain medical insurance.
C) helping an individual accumulate funds to cover medical expenses.
D) helping an individual save for retireme
C) helping an individual accumulate funds to cover medical expenses.
An HSA is a tax-favored investment tool for accumulating funds to cover medical expenses.
A corridor deductible is used primarily to?
A) help control the cost of the premium.
B) enable the health insurer to make a profit.
C) deter people from seeking second opinions.
D) prevent the filing of large medical claim.
A) help control the cost of the premium.
Deductibles help control the cost of insurance premiums.
An insurance policy that lists an operation as a specified number of units has which feature?
A) Physicians expense benefit.
B) Stop-loss.
C) Relative value schedule.
D) Coinsurance.
C) Relative value schedule.
The relative value scale is a method for determining benefits payable under a basic surgical expense policy. Points are assigned to each surgical procedure and a dollar per point is used to determine the benefit.
An insured has a Major Medical policy with a $500 deductible, 80% coinsurance, and a $1,500 stop-loss provision. How much of $4,500 in covered claims will the policy pay?
A) $4,500.
B) $1,300.
C) $3,200.
D) $1,500.
C) $3,200.
$3,200 is the total covered on this claim after deductible and coinsurance.
Basic Medical Expense policies generally begin to pay benefits?
A) on the 5th day in the hospital.
B) after 10 days.
C) after 45 days.
D) on day 1.
D) on day 1.
Basic medical expense insurance is sometimes called "first dollar insurance". Unlike major medical expense insurance, it provides benefits up front, without requiring the insured to first satisfy a deductible.
Comprehensive Medical Expense insurance combines features of which types of insurance?
A) Major Medical and Basic Medical Insurance.
B) Hospital Indemnity and Major Medical Insurance.
C) Hospital Indemnity and Major Medical Insurance.
D) Hospital and Surg
A) Major Medical and Basic Medical Insurance.
Comprehensive Medical Expense insurance combines the features of Major Medical and Basic Medical Insurance.
When a group of doctors and hospitals in a designated area contract with an insurer to provide health care at a prearranged figure to the insured, the arrangement is known as?
A) Professional Service Organization (PSO).
B) Designated Provider Organization
C) Preferred Provider Organization (PPO).
PPO's is a collection of health care providers who offer their services to certain groups at prearranged prices.
Which of the following best describes the characteristics of Preferred Provider Organizations (PPO's)?
A) If service is obtained outside the PPO, benefits are reduced and costs increase.
B) PPO's are generally public in nature rather than private.
C) Heal
A) If service is obtained outside the PPO, benefits are reduced and costs increase.
Members are not mandated to use the PPO. However, if they go outside the PPO for health care services, benefits are reduced and costs increase.
Which of the following is NOT a general category by which Basic Medical Coverage Expense policies classify their coverages?
A) Loss of income expense.
B) Physicians nonsurgical expense.
C) Hospital expense.
D) Surgical expense.
A) Loss of income expense.
Lost income is not a category which Basic Medical Coverage Expense policies classify their coverages.