Texas Life & Health Insurance Exam Prep Correct 100%

Basic Medical Expense policies - ANSWERProvide coverage for Hospital, Surgical and Physicians Medical Expense. -Purchased as a individual or group policy. -provide first dollar coverage (no deductibles). -limited benefit periods and low coverage limits. Major Medical Expense Policy - ANSWER-A supplement (in addition) to Basic Medical or as a stand-alone policy. -individual or group policy. -Take over when the Basic Policy runs out Hospital Expenses - ANSWER-Pay for covered expenses incurred during a hospital stay. 1. Daily hospital benefit - Room and Board 2. Miscellaneous expenses - Other Medical Expenses (X-Rays, MRI, Prescriptions, Doctor Visits) Daily Hospital Benefit - ANSWER-Cost of a hospital room, up to a daily $ limit. The limit may be expressed either as a dollar amount, e.g. $500 per day, or it may be expressed as the Usual, Customary and Reasonable (UCR) and Charge Usual, Customary and Reasonable (UCR) - ANSWERInsurance company will pay an amount for a given procedure based upon the average charge for that procedure in that specific geographic area. The coverage is subject to a maximum amount or number of days. Benefit Schedule - ANSWER-Specifically states what is covered in the plan and for how much. The coverage is subject to a maximum amount or number of days. Indemnity - ANSWERInsured pays the bill and is reimbursed by the insurance company up to a specified limit amount. Medical expense policies that pay a fixed rate provide the insured with a stated benefit amount for each day of hospital confinement. Reimbursement - ANSWERPolicyowners obtain medical treatment from whatever source they want and submit their charges to their insurer for reimbursement (actual amount). Service Based Contracts - ANSWER-Pay doctors and hospitals directly according to the # of days of coverage that is provided in the contract for each event and are prepayment plans. Once a claim is settled, the insured will receive an Explanation of Benefit (EOB), which is a written confirmation that the claim