LIFE & HEALTH INSURANCE EXAM 2025 WITH
100% ACCURATE SOLUTIONS
Basic Medical Expense policies - Precise Answer ✔✔Provide 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 - Precise 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 - Precise 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 - Precise 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) - Precise Answer
✔✔Insurance 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 - Precise 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 - Precise Answer ✔✔Insured 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 - Precise Answer ✔✔Policyowners obtain medical
treatment from whatever source they want and submit their charges to
their insurer for reimbursement (actual amount).
Service Based Contracts - Precise 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 was paid. Blue Cross and Blue
Shield, Health Service Corporations and Medicare coverage are all
provided on a Service Basis.
,Miscellaneous Expense Benefits - Precise Answer ✔✔-Secondary
benefits (inside benefits) because they occur inside the hospital for
charges related to the stay. X-rays, prescriptions, MRI's, anesthesia and
lab fees are usually separate fees incurred during a stay. Miscellaneous
Expense Benefits have separate limits, referred to as Inside Limits. The
are expressed usually as a multiple of the daily amount (UCR)
Surgical Expense - Precise Answer ✔✔A schedule of procedures lists
the amount allowable for each procedure. If a surgical procedure is not
found in the schedule, it will still be payable. The amount payable for a
procedure not listed is based on its relative value to a procedure of
similar difficulty. There are usually no deductibles.
Surgical Schedule - Precise Answer ✔✔Is simply a price list. Each
procedure is listed and a dollar amount assigned and if a procedure is not
listed in the schedule it is still paid.
Relative Value - Precise Answer ✔✔scientific method of paying
different benefits based on the region of the country an insured lives. It
is based on assigning a value to each procedure and using a conversion
factor. A schedule of assigned points for each procedure must be
included in the policy.
Physicians Medical Expense - Precise Answer ✔✔Pays for visits to the
doctor (office hospital) plus post operation care. There may be a per-visit
benefit, or the coverage is based on UCR.
-May or may not be a deductible . This policy is usually written as an
indemnity plan and has first dollar coverage (no deductible).
, -usually written as an indemnity plan and has first dollar coverage
Major Medical Expense - Precise Answer ✔✔-Cover "catastrophic" or
huge loss. A Catastrophic loss is defined as whenever Basic coverage
runs out and not a specific dollar amount.
-High Maximum Limits ($2,000,000)
-Deductibles (per person or per family ea yr))
-Co- insurance (Usually 80/20%)
-Stop Loss
-Miscellaneous Expense Benefits - x-rays, MRI, lab tests, etc.
Coinsurance - Precise Answer ✔✔- Once the deductible is met the
insured and the insurance company share in the expenses in what is
called coinsurance. It is written as 80/20, 70/30, etc. Also called
percentage participation requirement.
Flat Deductible - Precise Answer ✔✔-Portion of medical expenses that
are paid by the insured each year before benefits start. The higher the
deductible the lower the annual premium will be.
-If a medical incident occurs in the last three months of any plan year
and the annual deductible has met the yearly requirement then the
medical treatment for that incident only would be covered in the new
plan year. Thus a "carryover" into the next year of the paid deductible
has occurred.
Per Cause Deductible - Precise Answer ✔✔A separate deductible for
each separate illness or accident.
100% ACCURATE SOLUTIONS
Basic Medical Expense policies - Precise Answer ✔✔Provide 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 - Precise 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 - Precise 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 - Precise 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) - Precise Answer
✔✔Insurance 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 - Precise 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 - Precise Answer ✔✔Insured 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 - Precise Answer ✔✔Policyowners obtain medical
treatment from whatever source they want and submit their charges to
their insurer for reimbursement (actual amount).
Service Based Contracts - Precise 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 was paid. Blue Cross and Blue
Shield, Health Service Corporations and Medicare coverage are all
provided on a Service Basis.
,Miscellaneous Expense Benefits - Precise Answer ✔✔-Secondary
benefits (inside benefits) because they occur inside the hospital for
charges related to the stay. X-rays, prescriptions, MRI's, anesthesia and
lab fees are usually separate fees incurred during a stay. Miscellaneous
Expense Benefits have separate limits, referred to as Inside Limits. The
are expressed usually as a multiple of the daily amount (UCR)
Surgical Expense - Precise Answer ✔✔A schedule of procedures lists
the amount allowable for each procedure. If a surgical procedure is not
found in the schedule, it will still be payable. The amount payable for a
procedure not listed is based on its relative value to a procedure of
similar difficulty. There are usually no deductibles.
Surgical Schedule - Precise Answer ✔✔Is simply a price list. Each
procedure is listed and a dollar amount assigned and if a procedure is not
listed in the schedule it is still paid.
Relative Value - Precise Answer ✔✔scientific method of paying
different benefits based on the region of the country an insured lives. It
is based on assigning a value to each procedure and using a conversion
factor. A schedule of assigned points for each procedure must be
included in the policy.
Physicians Medical Expense - Precise Answer ✔✔Pays for visits to the
doctor (office hospital) plus post operation care. There may be a per-visit
benefit, or the coverage is based on UCR.
-May or may not be a deductible . This policy is usually written as an
indemnity plan and has first dollar coverage (no deductible).
, -usually written as an indemnity plan and has first dollar coverage
Major Medical Expense - Precise Answer ✔✔-Cover "catastrophic" or
huge loss. A Catastrophic loss is defined as whenever Basic coverage
runs out and not a specific dollar amount.
-High Maximum Limits ($2,000,000)
-Deductibles (per person or per family ea yr))
-Co- insurance (Usually 80/20%)
-Stop Loss
-Miscellaneous Expense Benefits - x-rays, MRI, lab tests, etc.
Coinsurance - Precise Answer ✔✔- Once the deductible is met the
insured and the insurance company share in the expenses in what is
called coinsurance. It is written as 80/20, 70/30, etc. Also called
percentage participation requirement.
Flat Deductible - Precise Answer ✔✔-Portion of medical expenses that
are paid by the insured each year before benefits start. The higher the
deductible the lower the annual premium will be.
-If a medical incident occurs in the last three months of any plan year
and the annual deductible has met the yearly requirement then the
medical treatment for that incident only would be covered in the new
plan year. Thus a "carryover" into the next year of the paid deductible
has occurred.
Per Cause Deductible - Precise Answer ✔✔A separate deductible for
each separate illness or accident.
