journal article
The Deductible in Medical Expense InsuranceJournal of the American Association of University Teachers of Insurance
Vol. 20, No. 1, Proceedings of the 17th Annual Meeting (Mar., 1953)
, pp. 107-116 (10 pages)
Published By: American Risk and Insurance Association
//doi.org/10.2307/250176
//www.jstor.org/stable/250176
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The American Risk and Insurance Association (ARIA) is a worldwide group of academic, professional, and regulatory leaders in insurance, risk management, and related areas, joined together to advance the study and understanding of the field. Founded in 1932, ARIA emphasizes research relevant to the operational concerns and functions of insurance and risk management professionals and provides resources, information, and support on important insurance and risk management issues. Two main goals of the organization are 1) to expand and improve academic instruction of risk management and insurance, and, 2) to encourage research on all significant aspects of risk management and insurance.
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M is insured under a Basic Hospital/Surgical Expense policy. A physician performs surgery on M. What determines the claim amount M is eligible for? Determined by the terms of the policy
Which of the following can an individual use their medical flexible spending account to pay for?
Vitamins and supplements
Prescription drugs
Household expenditures
Cosmetic procedures
The first portion of a covered expense that the insured is required to pay before Major Medical Coverage applies is called the
Which of the following BEST describes a Hospital Indemnity policy?
Coverage that reimburses an insured for surgeon expenses
Coverage that pays a stated amount per day of a covered hospitalization
Coverage that replaces lost income due to hospitalization
Coverage that pays for hospital room and board
Coverage that pays a stated amount per day of a covered hospitalization
M has a Major Medical insurance policy with a $200 flat deductible and an 80% Coinsurance clause. If M incurs a $2,200 claim for an eligible medical expense, how much will M receive in payment for this claim?
$1,600. In this situation, $2,200 - $200 deductible x 80% = $1,600.
Which of these is NOT a characteristic of a Health Reimbursement Arrangement (HRA)?
Employee funds the HRA entirely
Employer funds the HRA entirely
HRA's can be offered with other health plans
HRA's allow reimbursement for eligible medical expenses
Employee funds the HRA entirely. This is inaccurate. HRA plans are employer-funded medical reimbursement plans.
Which of the following health insurance coverages is BEST suited for meeting the expenses of catastrophic illness?
Major Medical
Hospital Expense
Surgical Expense
Hospital Income
The phrase "This policy will only pay for a semi-private room" is an example of a(n)
internal limit. Certain types of expenses may have limits placed on the dollar amount of certain services or on the type of service provided.
Which of the following individual health insurance policies will provide the broadest protection?
Hospital Expense
Surgical Expense
Major Medical
Limited Sickness
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
Continue Coverage but exclude the heart condition. If the insured did not cite the condition on the application and the insurer did not exclude the condition, the pre-existing condition provision still applies. Exclusions are subject to the "time limit on certain defenses" provision, however.
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
High-deductible health plan. To be eligible for a Health Savings Account, an individual must be covered by a high-deductible health plan (HDHP), must not be covered by other health insurance (does not apply to accident insurance, disability, dental care, vision care, long-term care), must not be eligible for Medicare, and can't be claimed as a dependent on someone else's tax return.
Which of the following statements BEST describes dental care indemnity coverage?
Services are reimbursed before the insurer receives the invoice
Services are reimbursed after insurer receives the bill
In-network dentists must always be used
Very limited list of providers
Services are reimbursed after insurer receives the bill
Which of the following phrases refers to the fees charged by a healthcare professional?
Deductible
Coinsurance
Usual, customary, and reasonable expenses
Hospital expense
Usual, customary, and reasonable expenses
All of the following statements about Major Medical benefits are true EXCEPT
The deductible can be expressed as a fixed dollar amount
The benefit period begins only after a specified amount of expenses have accrued
Benefits are generally expressed as a percentage of eligible expenses
Benefits have no maximum limit
Benefits have no maximum limit, They do have a limit
A Health Reimbursement Arrangement MUST be established
By the employer. HRAs are employer-established benefit plans that must be funded by the employer.
What type of policy would only provide coverage for specific types of illnesses (cancer, stroke, etc)?
Dread disease insurance. Dread disease insurance provides benefits for ONLY specific types of illnesses such as cancer or stroke.
Which of the following types of policies frequently uses the term "deductible"?
Major Medical policy
Basic Surgical policy
Basic Hospital policy
Worker's Compensation
Major Medical policy. Most major medical benefits begin to be paid after the deductible is satisfied.
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?
$3,000. In this situation, the insured is responsible for $1,000 deductible + 20% of the remaining bill = $3,000.
In Major Medical Expense policies, what is the intent of a Stop Loss provision?
Limits an insured's out-of-pocket medical expenses
A characteristic of Preferred Provider Organizations (PPOs) would be
Discounted fees for the patient. Under Preferred Provider Organizations, patient fees are discounted in return for using listed providers.