PEARSON VUE - TYPES OF HEALTH
AND ACCIDENT POLICIES REVIEW
EXAM QUESTIONS AND ANSWERS
A prospective insured completes and signs an application for health
insurance but intentionally conceals information about a pre-
existing heart condition. The company issues the policy. Two
months later, the insured suffers a heart attack and submits a claim.
While processing the claim, the company discovers the pre-existing
condition. In this situation, the company will: -
correct answer ✅continue coverage but exclude the heart
condition
Which of the following statements BEST defines usual, customary,
and reasonable (UCR) charges? -
correct answer ✅The maximum amount considered eligible for
reimbursement by an insurance company under a health plan
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: -
correct answer ✅High-deductible health plan
Which of the following services is NOT included under
hospitalization expense coverage? -
correct answer ✅surgical fees
,PEARSON VUE - TYPES OF HEALTH
AND ACCIDENT POLICIES REVIEW
EXAM QUESTIONS AND ANSWERS
A Hospital/Surgical Expense policy was purchased for a family of
four in March of 2013. The policy was issued with a $500
deductible and a limit of four deductibles per calendar year. Two
claims were paid in September 2013, each incurring medical
expenses in excess of the deductible. Two additional claims were
filed in 2014, each in excess of the deductible amount as well. What
would be this family's out-of-pocket medical expenses for 2013? -
correct answer ✅$1,000
The individual Health Insurance policy that offers the broadest
protection is a(n) _______ _______ policy -
correct answer ✅Major Medical
This type of deductible provision waives the deductible for all
family members after some of them have satisfied individual
deductibles within the same year: -
correct answer ✅Family maximum deductible
Which of the following phrases refers to the fees charged by a
healthcare professional? -
correct answer ✅Usual, customary, and reasonable expenses
, PEARSON VUE - TYPES OF HEALTH
AND ACCIDENT POLICIES REVIEW
EXAM QUESTIONS AND ANSWERS
A Major Medical policy typically contains a provision that requires
the insurer to pay only part of a loss, while the balance is paid by
the insured. This provision is called -
correct answer ✅Coinsurance
Which provision allows a portion of any used medical benefits to be
restored following a particular amount of benefit has been used, or
after the policy has been in effect for a particular period of time? -
correct answer ✅Restoration of used benefit
Which of the following medical expenses does Cancer insurance
NOT cover? -
correct answer ✅Arthritis
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? -
correct answer ✅$3,000
AND ACCIDENT POLICIES REVIEW
EXAM QUESTIONS AND ANSWERS
A prospective insured completes and signs an application for health
insurance but intentionally conceals information about a pre-
existing heart condition. The company issues the policy. Two
months later, the insured suffers a heart attack and submits a claim.
While processing the claim, the company discovers the pre-existing
condition. In this situation, the company will: -
correct answer ✅continue coverage but exclude the heart
condition
Which of the following statements BEST defines usual, customary,
and reasonable (UCR) charges? -
correct answer ✅The maximum amount considered eligible for
reimbursement by an insurance company under a health plan
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: -
correct answer ✅High-deductible health plan
Which of the following services is NOT included under
hospitalization expense coverage? -
correct answer ✅surgical fees
,PEARSON VUE - TYPES OF HEALTH
AND ACCIDENT POLICIES REVIEW
EXAM QUESTIONS AND ANSWERS
A Hospital/Surgical Expense policy was purchased for a family of
four in March of 2013. The policy was issued with a $500
deductible and a limit of four deductibles per calendar year. Two
claims were paid in September 2013, each incurring medical
expenses in excess of the deductible. Two additional claims were
filed in 2014, each in excess of the deductible amount as well. What
would be this family's out-of-pocket medical expenses for 2013? -
correct answer ✅$1,000
The individual Health Insurance policy that offers the broadest
protection is a(n) _______ _______ policy -
correct answer ✅Major Medical
This type of deductible provision waives the deductible for all
family members after some of them have satisfied individual
deductibles within the same year: -
correct answer ✅Family maximum deductible
Which of the following phrases refers to the fees charged by a
healthcare professional? -
correct answer ✅Usual, customary, and reasonable expenses
, PEARSON VUE - TYPES OF HEALTH
AND ACCIDENT POLICIES REVIEW
EXAM QUESTIONS AND ANSWERS
A Major Medical policy typically contains a provision that requires
the insurer to pay only part of a loss, while the balance is paid by
the insured. This provision is called -
correct answer ✅Coinsurance
Which provision allows a portion of any used medical benefits to be
restored following a particular amount of benefit has been used, or
after the policy has been in effect for a particular period of time? -
correct answer ✅Restoration of used benefit
Which of the following medical expenses does Cancer insurance
NOT cover? -
correct answer ✅Arthritis
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? -
correct answer ✅$3,000
