Exam 9: Insuring Your Health

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INSTRUCTIONS: Choose the word or phrase in [ ] which will correctly complete the statement. -Medicare [hospital | supplemental medical] insurance requires that those covered pay a monthly premium.

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B

Nick and Sheila Preston are married and have purchased a comprehensive major medical policy which covers them and their two sons,Wally and Brent.The policy has a $500 calendar year family deductible,a $2,500 stop-loss provision,and an 80% coinsurance clause.The following losses occur: On January 1,2004 Sheila was treated for an infection at a cost of $200,on July 1,2004 Wally was treated for an injury suffered while waterskiing at a cost of $10,000,on December 5,2004 Nick underwent eye surgery at a cost of $1,500,and on January 5,2005 Brent was treated for a broken leg at a cost of $2,000. How much will the insurer pay for each of these losses?

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January 1,2004 loss: ($200 - $200 of deductible)= $0. July 1,2004 loss: ($10,000 - $300 remaining deductible)*.80 coinsurance = $7,760. December 5,2004 loss: ($1,500 - $0 deductible)* .80 = $1,200.However,the stop loss kicks in and causes more to be paid.So far the Nick and Sheila have paid $200 + $2,240 = $2,440.The $2,500 stop loss would result in Nick and Sheila only needing to pay $60.Therefore,the insurance company should pay $1,440. January 5,2005 loss: New deductible and stop loss,therefore (2,000 - $500)*.8 = $1,200.

Which of the following is(are)characteristic of Social Security disability income benefits?

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C

Some surgical expense insurance pays a specific amount for a list of various types of surgery.

(True/False)
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INSTRUCTIONS: Choose the word or phrase in [ ] which will correctly complete the statement. -Dependent children [regardless of age | up to a stated maximum age] will usually be covered by your health insurance policy.

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Increasing the stop loss provision is likely to lower the premium on a comprehensive major medical policy.

(True/False)
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A group HMO employs a group of doctors to provide healthcare services to members in a central facility.

(True/False)
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INSTRUCTIONS: Choose the word or phrase in [ ] which will correctly complete the statement. -Medicare and Medicaid cover [more | less] than half of the total cost of long-term care.

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A comprehensive major medical insurance would not

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Health insurance coverage can include

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INSTRUCTIONS: Choose the word or phrase in [ ] which will correctly complete the statement. -If an employee could afford additional health insurance coverage in addition to group coverage,most should purchase [dental | disability income] insurance.

(Multiple Choice)
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Supplementary Medical Insurance (SMI)provides health care protection beyond basic hospital coverage for

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Miscellaneous sources of health care coverage include

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INSTRUCTIONS: Choose the word or phrase in [ ] which will correctly complete the statement. -When purchasing a long-term care policy,the [guaranteed renewability | optional renewability] provision is recommended.

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You would have a better chance to choose your own doctor with a PPO rather than an HMO.

(True/False)
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All of the following except a ____ are highly recommended for a long-term disability income policy.

(Multiple Choice)
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INSTRUCTIONS: Choose the word or phrase in [ ] which will correctly complete the statement. -The amount of health insurance reimbursement actually paid may be reduced by [internal limits | co-payment caps].

(Multiple Choice)
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INSTRUCTIONS: Choose the word or phrase in [ ] which will correctly complete the statement. -Medicare would pay [the entire | part of the] hospital bill for a covered person.

(Multiple Choice)
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Insurers are required under the law to cover the children of those they insure up to the age of 21.

(True/False)
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Most disabilities are permanent.

(True/False)
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