Medical Expense Insurance Exam Questions and Answers
2023 with complete solution
A fee for service health insurance plan will normally cover
vitamins and natural remedies
cosmetic procedures
gym membership
a disease
a disease
Low frequency diseases can be exclusively covered by what kind of health
insurance policies?
Limited policies
Blanket policies
Employer policies
Restricted policies
Limited policies
All of the following plans allow for employee contributions to be taken on a pre-
tax basis EXCEPT
Section 125 Plan
Premium Only Plan
Cafeteria Plan
Health Reimbursement Arrangement Plan
Health Reimbursement Arrangement Plan
A health insurance policy will typically cover
injuries obtained from war
elective cosmetic surgery
preventative health services
work related injuries
preventative health services
Medical Expense Insurance would cover
an injury occurring at the insured's residence
an injury occurring at work
an injury caused by war
elective surgeries
an injury occurring at the insured's residence
The elimination period under a hospital indemnity plan is
the period in which pre-existing conditions are not taken into consideration
the period in which all deductibles are eliminated
the specified number of days after an insurance policy's issue date during which
coverage is not afforded for sickness
the specified number of days an insured must wait before becoming eligible to
receive benefits for each hospitalization
the specified number of days an insured must wait before becoming eligible to receive
benefits for each hospitalization
, Which type of coverage pays an amount per day for hospitalization directly to the
insured regardless of the insured's other health insurance?
MEWA
Mutual
Group
Hospital indemnity
hospital indemnity
An indemnity plan
pays both the insured and health care provider
provides the insured a specific dollar amount for services
pays the health care provider directly for services rendered
is typically issued as a group plan
provides the insured a specific dollar amount for services
When an insured has a major medical plan with first dollar coverage, how does
this impact the benefits paid?
No deductible payment is required
Deductible specified in the contract is payable by the insured
Insured must pay a percentage of covered losses
An initial deductible plus a percentage of the remaining covered loss is owed by
the insured
No deductible payment is required
How is a health provider reimbursed if they do NOT have an agreement in place
with the insurance company?
With a contingent fee
With a scheduled fee
With a usual, customary, and reasonable fee
With a reasonably appropriate fee
With a usual, customary, and reasonable fee
"Maximum benefits" refers to the
upper limit of the total lifetime benefits the insurance company will pay
upper limit percentage of what the insurance company will pay for coinsurance
upper limits of what the insured will pay in out-of-pocket expenses
upper limits of what an insurance company will pay for any particular claim
upper limit of the total lifetime benefits the insurance company will pay
An insured under a Major Medical expense plan with a zero deductible and 80/20
coinsurance provision files a $1,000 claim. How much of this claim is the insured
responsible for?
$160
$200
$600
$800
$200
A policyholder has a major medical plan with a 80%/20% coinsurance and a
deductible of $75. If the insured has previously met her deductible and receives a
bill for $175, how much will the insurer pay?
$35
2023 with complete solution
A fee for service health insurance plan will normally cover
vitamins and natural remedies
cosmetic procedures
gym membership
a disease
a disease
Low frequency diseases can be exclusively covered by what kind of health
insurance policies?
Limited policies
Blanket policies
Employer policies
Restricted policies
Limited policies
All of the following plans allow for employee contributions to be taken on a pre-
tax basis EXCEPT
Section 125 Plan
Premium Only Plan
Cafeteria Plan
Health Reimbursement Arrangement Plan
Health Reimbursement Arrangement Plan
A health insurance policy will typically cover
injuries obtained from war
elective cosmetic surgery
preventative health services
work related injuries
preventative health services
Medical Expense Insurance would cover
an injury occurring at the insured's residence
an injury occurring at work
an injury caused by war
elective surgeries
an injury occurring at the insured's residence
The elimination period under a hospital indemnity plan is
the period in which pre-existing conditions are not taken into consideration
the period in which all deductibles are eliminated
the specified number of days after an insurance policy's issue date during which
coverage is not afforded for sickness
the specified number of days an insured must wait before becoming eligible to
receive benefits for each hospitalization
the specified number of days an insured must wait before becoming eligible to receive
benefits for each hospitalization
, Which type of coverage pays an amount per day for hospitalization directly to the
insured regardless of the insured's other health insurance?
MEWA
Mutual
Group
Hospital indemnity
hospital indemnity
An indemnity plan
pays both the insured and health care provider
provides the insured a specific dollar amount for services
pays the health care provider directly for services rendered
is typically issued as a group plan
provides the insured a specific dollar amount for services
When an insured has a major medical plan with first dollar coverage, how does
this impact the benefits paid?
No deductible payment is required
Deductible specified in the contract is payable by the insured
Insured must pay a percentage of covered losses
An initial deductible plus a percentage of the remaining covered loss is owed by
the insured
No deductible payment is required
How is a health provider reimbursed if they do NOT have an agreement in place
with the insurance company?
With a contingent fee
With a scheduled fee
With a usual, customary, and reasonable fee
With a reasonably appropriate fee
With a usual, customary, and reasonable fee
"Maximum benefits" refers to the
upper limit of the total lifetime benefits the insurance company will pay
upper limit percentage of what the insurance company will pay for coinsurance
upper limits of what the insured will pay in out-of-pocket expenses
upper limits of what an insurance company will pay for any particular claim
upper limit of the total lifetime benefits the insurance company will pay
An insured under a Major Medical expense plan with a zero deductible and 80/20
coinsurance provision files a $1,000 claim. How much of this claim is the insured
responsible for?
$160
$200
$600
$800
$200
A policyholder has a major medical plan with a 80%/20% coinsurance and a
deductible of $75. If the insured has previously met her deductible and receives a
bill for $175, how much will the insurer pay?
$35
