[SVL] Insurance 16

Traditional fee for service plans refer to their customers as
A. insureds
B. participants
C. subscribers
D. plan members

Which of the following terms describes a medical expense policy that pays a provider a set fee for their services regardless of the charge?
A. Specified coverages
B. Benefit schedule
C. Usual, reasonable, and customary
D. Fee for service

Major medical benefits usually begin after the insured has incurred an initial annual amount of out-of-pocket expense called a

A. coinsurance limit
B. maximum out of pocket limit
C. deductible
D. stop loss limit

All of the following are typically excluded from medical expense plans EXCEPT

A. self-inflicted injuries
B. care covered by workers' compensation
C. mental illness treatment
D. cosmetic surgery

The out-of-pocket limit is also known as the

A. co-payment
B. stop-loss limit
C. deductible
D. maximum benefit

Which of the following is least likely to be covered by a major medical expense?

A. Outpatient services
B. Prescription drugs administered in a hospital
C. Blood and blood plasma
D. Dental care

A type of health insurance that provides a much broader range of medical expenses and higher benefit amounts is a

A. prepaid medical expense policy
B. simple medical expense policy
C. basic medical expense policy
D. major medical expense policy

Hospice care is used to

A. alleviate pain and suffering for terminally ill patients, but does not attempt to cure
B. treat diseases only, not accident-related medical issues
C. control pain and suffering as well as to treat illness
D. cure mental illness

The dollar limit beyond which the insured is no longer required to pay coinsurance the

A. maximum benefit
B. stop-loss limit
C. deductible
D. coinsurance

The sharing of expenses between the insured and the insurer is an example of the

A. maximum benefit
B. deductible
C. stop-loss limit
D. coinsurance

A deductible that falls between two periods where the insurance company pays is known
as a
A. stop-loss deductible
B. capitated deductible
C. limited deductible
D. corridor deductible

Prepaid medical expense plans refer to their
customers as


A. subscribers/participants
B. members
C. policyholders
D. insureds

Sarah has a $200 deductible and a 20% coinsurance for her medical expense plan. Her first medical bill of the year is $1200. Sarah will pay the $200 deductible. How much money will Sarah still need to pay?
A. $240
B. $1000
C. $800
D. $200

Which of the following terms describes the limits that a person will have to pay in any calendar year for covered medical expenses?
A. Coinsurance
B. Maximum out of pocket
C. Stop-loss limit
D. Deductible