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Which of the following species of to plan integrates its coverage with a an easy medical cost coverage, offering benefits in excess of those stated in the simple plan?* A) straightforward umbrella.* B) Hospital indemnity.* C) Supplementary major medical.* D) Comprehensive significant medical.
A supplementary major medical arrangement is coordinated v a basic plan and also is design to choose up coverage wherein the basic plan leaves off. It covers expenses not had under a straightforward plan and provides coverage for prices that exceed the simple plan"s dollar limits.
All of the complying with medical prices generally space excluded from coverage under individual medical cost policies EXCEPT:* A) nursing treatment in a hospital.* B) custodial care in a convalescent facility.* C) therapy for drug and alcohol abuse.* D) nursing treatment at home.
Individual medical expense policies cover nursing care in a hospital, yet usually exclude treatment for drug or alcohol abuse, custodial care in a convalescent home, and also nursing care at home.
When different deductibles are required for each illness or accident, what kind of deductible is in effect?* A) Revolving.* B) every benefit.* C) every cause.* D) Flat.
If a policy defines causes of lose on the basis of each sickness or injury, different (per cause) deductibles must be to solve every time a case is submitted to the insurer.
Major medical policies the pay 100% of extended expenses over a mentioned amount and also after the insured"s deductible contain what sort of a provision?* A) Blue sky.* B) Stop-loss.* C) maximum benefit.* D) Umbrella.
Some major medical plans contain a stop-loss provision, meaning that the insurer payment 100% the covered prices after the insured"s out-of-pocket payments for eligible expenses reach a mentioned level, such as $1,000 or $2,000. The an interpretation of a stop-loss lid will count on the policy.
Prescription medicine coverage deserve to be readily available as one optional advantage under which of the following arrangements?* A) group medical cost plans.* B) HMOs.* C) PPOs.* D) COBRAs.
While HMOs and PPOs encompass coverage for prescription drugs, insureds in a group medical expense arrangement must to buy the coverage together an optional benefit. COBRA is federal regulation that protects the services of insureds who have actually lost coverage since of termination of employment.
Fees for all of the complying with items commonly are covered under a medical price policy"s assorted expense benefit EXCEPT:* A) surgeon"s fees.* B) x-rays.* C) activities fees.* D) use of the operating room.
The assorted expense advantage covers hospital "extras," such together x-rays, laboratory fees, and also use the the operation room. That does not cover a surgeon"s fees, which would certainly be extended under a surgical cost policy.
Which type of deductible is entirely or partially absorbed by a straightforward medical cost policy?* A) Integrated.* B) first dollar.* C) Corridor.* D) Decreasing.
All or part of the integrated deductible is soaked up by, or integrated into, the basic medical cost policy. Then major medical benefits are payable.
All of the following statements about preexisting conditions are correct EXCEPT:* A) clues exclusions because that preexisting problems helps one insurer to maintain reasonable premium rates.* B) medical expense policies typically exclude benefits for losses because of such conditions.* C) by most policy definitions, a preexisting problem is one the was contract by the insured in ~ 1 year prior to a policy was issued.* D) impairment income policies commonly include a probationary duration to assist control the hazard of preexisting conditions.
A preexisting condition is one that first manifested or to be treated in ~ a stipulated period before the insured applied for the policy. This duration is not necessarily limited to one year.
Margie’s medical expense policy will pay the really hospital room and also board charges for a semiprivate room. Her policy likely pays services on which basis?* A) Service.* B) Credit.* C) Indemnity.* D) Reimbursement.
In regards come room and board benefits, medical cost policies composed on a reimbursement basis generally either pay for actual charges because that a semiprivate room or a portion of the actual charges, with no details dollar limit.
Basic hospital expense insurance offers coverage for all of the adhering to EXCEPT:* A) doctor services.* B) anesthesia and also use that the operation room and supplies.* C) hospital room and board.* D) drugs and also X-rays.
Physicians" services are not covered under a straightforward hospital cost policy, even in the instance of surgery. The expense for a physician is spanned under a basic surgical cost or basic physician"s (nonsurgical) cost policy.
All of the adhering to approaches are supplied by insurers to recognize benefits payable under straightforward surgical expense insurance EXCEPT:* A) classic net cost method.* B) reasonable and customary approach.* C) family member value scale approach.* D) surgical schedule method.
There room 3 various approaches provided by insurers to recognize benefits payable because that surgical services: operation schedule approach, the reasonable and also customary approach, and also the relative value scale approach. Under the operation schedule method, every surgical procedure is assigned a dollar quantity by the insurer. The reasonable and customary technique is more open in its decision of benefits payable. The loved one value scale is similar to the operation schedule method, except that rather of a level dollar amount being assigned to every operation procedure, a collection of points is assigned. The number of points assigned to any one procedure is family member to the variety of points assigned come a preferably procedure. The classic net cost technique is a means of comparing costs of comparable policies.
All of the adhering to home health care services will be spanned by team plans EXCEPT:* A) work therapy.* B) emergency surgery.* C) physics therapy.* D) nutritional consultation.
Group medical benefits contracts should cover home care services. Home care services mean services detailed in a patient"s residence and also not in a hospital or experienced nursing or rehabilitation facility. These services have to be approved by a physician and also include: nursing and also physical therapy, occupational therapy, decided therapy, clinical social work, nutritional consultation, services of a home health aid, and use of sturdy medical equipment and also supplies.
The miscellaneous clinical expense benefit in a medical price policy usually will cover:* A) the administration of anesthesia.* B) room and board.* C) drugs and medicine administered in the hospital.* D) physicians" bedside visits.
The miscellaneous medical expense advantage in a medical expense policy usually will cover drugs and medicine administered in the hospital and other incidental hospital expenses.
Which the the complying with methods that determining services under a surgical cost policy assigns a collection of clues to operation procedures?* A) surgical schedule.* B) Corridor offset.* C) relative value.* D) Reasonable and customary costs.
The loved one value technique to determining services assigns a variety of points to different surgical procedures, relative to the number of points assigned to a preferably procedure, such together a heart bypass. If a heart bypass to be assigned, say, 1,000 points, every various other procedure"s point assignment would certainly be family member to that. Because that example, an appendectomy could be assigned 200 points; setting a damaged finger might be assigned five points. A dollar-per-point conversion element is then used to identify dollar benefits.
Leonard owns a major medical health policy which needs him to salary the first $200 that covered prices each year before the plan pays that benefits. The $200 is the policy"s:* A) annual premium.* B) stop-loss amount.* C) deductible.* D) coinsurance amount.
A deductible is a stated initial dollar amount that the separation, personal, instance insured is required to pay before insurance benefits space paid.
A stop-loss feature in a significant medical plan specifies the maximum:* A) quantity the insured should pay in premiums.* B) advantage amount the policy provides each year.* C) amount the insured have to pay toward covered expenses.* D) benefit amount the policy offers in a life time
To carry out a safeguard because that insureds, many significant medical policies contain a stop-loss function that limits the insured"s out-of-pocket expenses. This way that as soon as the insured has actually paid a specified amount towards his or her extended expenses-usually $1,000 come $2,000-the agency pays 100% the covered costs after the point.
Comprehensive medical price insurance covers all of the complying with EXCEPT:* A) hospital miscellaneous expenses.* B) hospital room and also board.* C) lose of income resulting from sickness.
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* D) operation fees.
Comprehensive medical expense insurance consists room and also board, operation fees and also hospital miscellaneous costs up come a dollar limit. Disability income insurance covers ns of income resulting native accident or illness.
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