LESSON 13: MEDICAL EXPENSE INSURANCE

Because benefits are paid up front without the patient having to first satisfy a deductible, which of the following is also referred to as "First Dollar Insurance?"

	a)	A Comprehensive Major Medical plan
	b)	A Medical Indemnity plan
	c)	Coinsurance
	d)	Basic Medical Expense insurance
CORRECTTRY AGAIN (Lesson 13.1)

Basic Medical Expense Plans

Basic Medical insurance limits coverage to specific medical care. Match the following with their respective benefits.

a)	Hospital expenses	Choose... Private duty nursing care Office visits and non-surgical care by a physician while hospitalized Skilled nursing facility expenses Daily room and board and miscellaneous expenses Cost of surgeon's services and anesthesiologist
b)	Surgical expenses	Choose... Private duty nursing care Office visits and non-surgical care by a physician while hospitalized Skilled nursing facility expenses Daily room and board and miscellaneous expenses Cost of surgeon's services and anesthesiologist
c)	Physicians' expenses	Choose... Private duty nursing care Office visits and non-surgical care by a physician while hospitalized Skilled nursing facility expenses Daily room and board and miscellaneous expenses Cost of surgeon's services and anesthesiologist
d)	Nurses' expenses	Choose... Private duty nursing care Office visits and non-surgical care by a physician while hospitalized Skilled nursing facility expenses Daily room and board and miscellaneous expenses Cost of surgeon's services and anesthesiologist
e)	Convalescent Care expenses	Choose... Private duty nursing care Office visits and non-surgical care by a physician while hospitalized Skilled nursing facility expenses Daily room and board and miscellaneous expenses Cost of surgeon's services and anesthesiologist
a) Daily room and board and miscellaneous expenses. b) Cost of surgeon's services and anesthesiologist. c) Office visits and non-surgical care by a physician while hospitalized. d) Private duty nursing care. e) Skilled nursing facility expenses. (Lesson 13.2)

Which of the following would most likely NOT be covered under Miscellaneous expenses in a Hospital Expense plan?

	a)	Anesthesia
	b)	Non-surgical doctors' fees
	c)	X-rays
	d)	Dressings
CORRECTTRY AGAIN (Lesson 13.2.1)

The Relative Value Scale assigns points to surgical procedures instead of dollar amounts.

	a)	True
	b)	False
CORRECTTRY AGAIN (Lesson 13.2.2)

Match the following different methods of Basic Surgical Expense coverage.

a)	Every surgical procedure is assigned a dollar amount by the insurer. The patient can be billed for the difference between the cost allotted and the cost charged.	Choose... Reasonable and Customary Approach Method Relative Value Scale Method Surgical Schedule Method
b)	Surgical expenses are compared to what is typically charged in the geographical part of the country where the surgery was performed rather than stating a specific dollar amount.	Choose... Reasonable and Customary Approach Method Relative Value Scale Method Surgical Schedule Method
c)	Assigns points to surgical procedures instead of dollar figures. The dollar figure depends upon the conversion factor which assigns a specific dollar figure to the points.	Choose... Reasonable and Customary Approach Method Relative Value Scale Method Surgical Schedule Method
a) Surgical Schedule Method b) Reasonable and Customary Approach Method c) Relative Value Scale Method (Lesson 13.2.2)

Major Medical Expense Plans

Match the following Medical Expense deductibles with their corresponding definition.

a)	Whatever amount the basic medical expense covers is applied to the deductible.	Choose... Flat Deductible Corridor Deductible Integrated Deductible
b)	A stated amount that the insured must pay before policy benefits become payable.	Choose... Flat Deductible Corridor Deductible Integrated Deductible
c)	The basic medical expense policy pays its limit first, then the deductible is applied and, finally, the supplementary policy picks up the remainder.	Choose... Flat Deductible Corridor Deductible Integrated Deductible
a) Integrated Deductible b) Flat Deductible c) Corridor Deductible (Lesson 13.3.1)

Preexisting condition clauses protect insurers from:

	a)	risk pooling.
	b)	adverse selection.
	c)	substandard risks.
	d)	limited risks.
CORRECTTRY AGAIN (Lesson 13.3.3)

Cindy has a Major Medical policy with a $2,000 deductible and an 80/20 coinsurance. If Cindy's medical bills totaled $6,000, how much would the insurer pay?

	a)	$2,000
	b)	$3,200
	c)	$4,000
	d)	$6,000
CORRECTTRY AGAIN $6,000 less $2,000 (deductible) times 80% (coinsurance) = $3,200

An HSA is a tax-favored vehicle for accumulating funds to cover medical expenses. For an individual, a qualified high-deductible plan is one with a minimum deductible of _________ (2009).

	a)	$1,100
	b)	$1,150
	c)	$2,200
	d)	$11,200
CORRECTTRY AGAIN (Lesson 13.3.4)

For a family, a qualified high-deductible plan is one with a minimum deductible of _________ in 2009.

	a)	$1,100
	b)	$2,300
	c)	$2,400
	d)	$5,800
CORRECTTRY AGAIN (Lesson 13.3.4)

For a family, a qualified high-deductible plan is one with a(n) _________ cap on out-of-pocket expenses (2009).

	a)	$2,900
	b)	$5,600
	c)	$5,800
	d)	$11,600
CORRECTTRY AGAIN (Lesson 13.3.4)

For an individual, a qualified high-deductible health plan is one with a(n) _________ cap on out-of-pocket expenses (2009).

	a)	$1,100
	b)	$2,200
	c)	$5,800
	d)	$11,200
CORRECTTRY AGAIN (Lesson 13.3.4)

Annual contributions of up to 100% of an individual's health plan deductible can be made to an HSA. The maximum annual contribution in 2009 is _________ for individual policies.

	a)	$1,100
	b)	$1,200
	c)	$2,200
	d)	$3,000
CORRECTTRY AGAIN (Lesson 13.3.4)

The maximum HSA annual contribution in 2009 is ______ for family policies.

	a)	$2,900
	b)	$5,600
	c)	$5,950
	d)	$11,200
CORRECTTRY AGAIN (Lesson 13.3.4)

If HSA funds are used for any other purpose than qualified medical expenses, funds become taxable and a ______ penalty fee may be imposed.

	a)	5%
	b)	10%
	c)	15%
	d)	20%
CORRECTTRY AGAIN (Lesson 13.3.4)

Other Types of Medical Expense Coverage

Limited Risk policies are also known as ____________ policies.

	a)	high risk
	b)	dread disease
	c)	fixed-rate
	d)	reimbursement
CORRECT - CONGRATULATIONS on completing Lesson 13. Now complete the Florida study manual Chapter 17 Questions for Review.TRY AGAIN (Lesson 13.4)