Exam 15: Individual Health Insurance Coverages

Some physicians,hospitals,and other health care organizations agree to make medical services available to insureds at discounted prices.Insureds are not required to use these entities,but if they do,care costs are less than if these entities are not used.Such health care entities are called

Which of the following statements about eligibility requirements for qualified Health Savings Accounts (HSAs)is (are)true? I.Only individuals who are eligible for Medicare benefits can establish a qualified HSA. II.You must be covered by a high deductible health plan and not be covered by any other comprehensive health plan to establish a qualified HSA.

Which of the following statements about the dual definition of total disability typically found in many individual disability income policies is (are)true? I.During the initial period of disability,the insured must be unable to perform the duties of any gainful occupation. II.After the initial period of disability,the insured must be unable to perform the duties of any occupation for which he or she is reasonably fitted by education,training,and experience.

Barb was injured in an auto accident.She was totally disabled and collected disability income benefits for 8 months.She would like to return to work on a part-time basis to see if her recovery is complete.During this period,her insurer will pay reduced disability income benefits.This type of disability is called

One long-term care insurance benefit trigger considers whether the insured needs supervision to protect against threats to health or safety due to memory loss or disorientation.This benefit trigger is referred to as a(n)

Which of the following statements about a common accident provision in a major medical insurance policy is true?

Which of the following statements about high deductible health insurance plans is (are)true? I.Coverage under a high deductible health plan is necessary to establish a qualified health savings account (HSA). II.High deductible health plans provide a maximum limit on annual out-of-pocket expenses.

Kristen has a major medical insurance policy with a $500 calendar-year deductible,a $5,000 out-of-pocket limit,and 80-20 coinsurance.Kristen was hospitalized for a surgical procedure in March,her first health care treatment received during the year.The total bill was $20,000.Considering the deductible and coinsurance,how much of this amount must Kristen pay?

Which of the following statements about provisions in individual health insurance policies is true?

Ellen purchased a health insurance policy.Under the renewal provision in the policy,the insurer has the right to terminate coverage on the policy anniversary date.This renewal provision is

Which of the following statements is (are)typically covered under the inpatient hospital services coverage under major medical insurance? I.The cost of a semi-private hospital room II.Miscellaneous hospital expenses,such as X-rays and lab tests

Dirk suffered a heart attack and was rushed to the hospital where heart surgery was performed.His total bill for medical services was $50,000.Dirk has a major medical policy with 80-20 coinsurance,a $1,000 calendar-year deductible,and a $5,000 out-of-pocket limit.The out-of-pocket limit applies to coinsurance only.Assuming this hospitalization was the first medical care that Dirk received during the year and that all of the hospital services were eligible for coverage under the policy,how much of the $50,000 bill will the insurer pay?

Kevin has an individual major medical policy that his insurer agrees to keep in force until age 65.However,the company has the right to increase the premium each year for the underwriting class in which Kevin has been placed.Which renewal provision is found in Kevin's policy?

Which of the following statements about shopping for health insurance is (are)true? I.Always select the policy with the lowest premium. II.Consider group health insurance first.

Marcus does not have any health insurance.All of the following are guidelines that Marcus should follow when shopping for individual health insurance EXCEPT

Which of the following statements about major medical insurance policies that reimburse physicians on the basis of reasonable and customary charges is (are)true? I.To determine if a fee for a medical procedure is reasonable and customary,it is compared to what other physicians in the same area charge for the procedure. II.A schedule of surgical procedures and dollar amounts payable is included in the policy and all surgeons are paid the scheduled amount for the same procedure.

An individual health insurance policy provision excluding coverage for impairments that were present or were treated during a specified period prior to the effective date of the policy is called a(n)

Which of the following statements is (are)true concerning benefit payments under long-term care insurance? I.Reimbursement policies pay for actual charges up to a specified daily limit. II.Per diem policies pay a specified daily benefit regardless of the charges incurred.

Martin purchased a health insurance policy.In exchange for $10,the policy will pay $100 per-day for up to 60 days if Martin is hospitalized.The type of health insurance Martin purchased is called

Consumer experts generally recommend all of the following when shopping for individual health insurance EXCEPT