Question: An insured covered by a group Major Medical plan is hospitalized after sustaining injuries that resulted from an automobile accident. Assuming the plan had a $1,000 deductible and an 80/20 Coinsurance clause, how much will the INSURED be responsible to pay with $11,000 in covered medical expenses?

Answer: The correct answer is “$3,000”. In this situation, the insured is responsible for $1,000 deductible + 20% of the remaining bill = $3,000.

Question: Which of the following costs would a Basic Hospital/Surgical policy likely cover?

Answer: Surgically removing a facial birthmark

Question: Which of these is NOT a characteristic of a Health Reimbursement Arrangement (HRA)?

Answer: Employee funds the HRA entirely

HRA plans are employer-funded medical reimbursement plans

Question: Which of the following phrases refers to the fees charged by a healthcare professional?

Answer: Usual, customary, and reasonable expenses

Question: 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

Answer: In this situation, $2,000 + 20% of the remaining bill = $3,600

10000-2000=8000 8000x20%=1600+2000

Question: Which of the following statements BEST describes the intent of a Coinsurance clause in a Major Medical policy?

Answer: Discourages overutilization of the insurance coverage

A purpose of the Coinsurance clause in a Major Medical Policy is to discourage overutilization of the insurance coverage.

Question: S wants to open a tax-exempt Health Savings Account. To qualify for this type of account, Federal law dictates that S must be enrolled in a

Answer: High-deductible health plan

To be eligible for a Health Savings Account, an individual must be covered by a high-deductible health plan (HDHP), must not be covered by other health insurance (does not apply to accident insurance, disability, dental care, vision care, long-term care), must not be eligible for Medicare, and can’t be claimed as a dependent on someone else’s tax return.

Question: Major Medical policies typically

Answer: contain a deductible and coinsurance

Question: Which of the following BEST desscribes a Hospital Indemnity policy?

Answer: Coverage that pays a stated amount per day of a covered hospitalization

The typical Hospital Indemnity policy pays a stated amount per day of a covered hospitalization.

Question: Which of the following statements BEST defines usual, customary, and reasonable (UCR) charges?

Answer: The correct answer is “The maximum amount considered eligible for reimbursement by an insurance company under a health plan”. Usual, customary, and reasonable (UCR) charges are the maximum amount the insurer will consider eligible for reimbursement under a health insurance plan.