{"id":113811,"date":"2023-08-16T18:56:16","date_gmt":"2023-08-16T18:56:16","guid":{"rendered":"https:\/\/learnexams.com\/blog\/?p=113811"},"modified":"2023-08-16T18:56:18","modified_gmt":"2023-08-16T18:56:18","slug":"medical-expense-insurance-exam-questions-and-answers-2023-with-complete-solution","status":"publish","type":"post","link":"https:\/\/www.learnexams.com\/blog\/2023\/08\/16\/medical-expense-insurance-exam-questions-and-answers-2023-with-complete-solution\/","title":{"rendered":"Medical Expense Insurance Exam Questions and Answers 2023 with complete solution"},"content":{"rendered":"\n<p class=\"wp-block-paragraph\">Medical Expense Insurance Exam<br>Questions and Answers 2023 with<br>complete solution<br>A fee for service health insurance plan will normally cover<br>vitamins and natural remedies<br>cosmetic procedures<br>gym membership<br>a disease Answer- a disease<br>Low frequency diseases can be exclusively covered by what kind of health insurance<br>policies?<br>Limited policies<br>Blanket policies<br>Employer policies<br>Restricted policies Answer- Limited policies<br>All of the following plans allow for employee contributions to be taken on a pre-tax basis<br>EXCEPT<br>Section 125 Plan<br>Premium Only Plan<br>Cafeteria Plan<br>Health Reimbursement Arrangement Plan Answer- Health Reimbursement<br>Arrangement Plan<br>A health insurance policy will typically cover<br>injuries obtained from war<br>elective cosmetic surgery<br>preventative health services<br>work related injuries Answer- preventative health services<br>Medical Expense Insurance would cover<br>an injury occurring at the insured&#8217;s residence<br>an injury occurring at work<br>an injury caused by war<br>elective surgeries Answer- an injury occurring at the insured&#8217;s residence<br>The elimination period under a hospital indemnity plan is<br>the period in which pre-existing conditions are not taken into consideration<br>the period in which all deductibles are eliminated<br>the specified number of days after an insurance policy&#8217;s issue date during which<br>coverage is not afforded for sickness<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">the specified number of days an insured must wait before becoming eligible to receive<br>benefits for each hospitalization Answer- the specified number of days an insured must<br>wait before becoming eligible to receive benefits for each hospitalization<br>Which type of coverage pays an amount per day for hospitalization directly to the<br>insured regardless of the insured&#8217;s other health insurance?<br>MEWA<br>Mutual<br>Group<br>Hospital indemnity Answer- hospital indemnity<br>An indemnity plan<br>pays both the insured and health care provider<br>provides the insured a specific dollar amount for services<br>pays the health care provider directly for services rendered<br>is typically issued as a group plan Answer- provides the insured a specific dollar<br>amount for services<br>When an insured has a major medical plan with first dollar coverage, how does this<br>impact the benefits paid?<br>No deductible payment is required<br>Deductible specified in the contract is payable by the insured<br>Insured must pay a percentage of covered losses<br>An initial deductible plus a percentage of the remaining covered loss is owed by the<br>insured Answer- No deductible payment is required<br>How is a health provider reimbursed if they do NOT have an agreement in place with<br>the insurance company?<br>With a contingent fee<br>With a scheduled fee<br>With a usual, customary, and reasonable fee<br>With a reasonably appropriate fee Answer- With a usual, customary, and reasonable<br>fee<br>&#8220;Maximum benefits&#8221; refers to the<br>upper limit of the total lifetime benefits the insurance company will pay<br>upper limit percentage of what the insurance company will pay for coinsurance<br>upper limits of what the insured will pay in out-of-pocket expenses<br>upper limits of what an insurance company will pay for any particular claim Answerupper limit of the total lifetime benefits the insurance company will pay<br>An insured under a Major Medical expense plan with a zero deductible and 80\/20<br>coinsurance provision files a $1,000 claim. How much of this claim is the insured<br>responsible for?<br>$160<br>$200<br><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A fee for service health insurance plan will normally cover<br>vitamins and natural remedies<br>cosmetic procedures<br>gym membership<br>a disease<br>a disease<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Low frequency diseases can be exclusively covered by what kind of health insurance policies?<br>Limited policies<br>Blanket policies<br>Employer policies<br>Restricted policies<br>Limited policies<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">All of the following plans allow for employee contributions to be taken on a pre-tax basis EXCEPT<br>Section 125 Plan<br>Premium Only Plan<br>Cafeteria Plan<br>Health Reimbursement Arrangement Plan<br>Health Reimbursement Arrangement Plan<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A health insurance policy will typically cover<br>injuries obtained from war<br>elective cosmetic surgery<br>preventative health services<br>work related injuries<br>preventative health services<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Medical Expense Insurance would cover<br>an injury occurring at the insured&#8217;s residence<br>an injury occurring at work<br>an injury caused by war<br>elective surgeries<br>an injury occurring at the insured&#8217;s residence<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The elimination period under a hospital indemnity plan is<br>the period in which pre-existing conditions are not taken into consideration<br>the period in which all deductibles are eliminated<br>the specified number of days after an insurance policy&#8217;s issue date during which coverage is not afforded for sickness<br>the specified number of days an insured must wait before becoming eligible to receive benefits for each hospitalization<br>the specified number of days an insured must wait before becoming eligible to receive benefits for each hospitalization<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Which type of coverage pays an amount per day for hospitalization directly to the insured regardless of the insured&#8217;s other health insurance?<br>MEWA<br>Mutual<br>Group<br>Hospital indemnity<br>hospital indemnity<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">An indemnity plan<br>pays both the insured and health care provider<br>provides the insured a specific dollar amount for services<br>pays the health care provider directly for services rendered<br>is typically issued as a group plan<br>provides the insured a specific dollar amount for services<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">When an insured has a major medical plan with first dollar coverage, how does this impact the benefits paid?<br>No deductible payment is required<br>Deductible specified in the contract is payable by the insured<br>Insured must pay a percentage of covered losses<br>An initial deductible plus a percentage of the remaining covered loss is owed by the insured<br>No deductible payment is required<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">How is a health provider reimbursed if they do NOT have an agreement in place with the insurance company?<br>With a contingent fee<br>With a scheduled fee<br>With a usual, customary, and reasonable fee<br>With a reasonably appropriate fee<br>With a usual, customary, and reasonable fee<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">&#8220;Maximum benefits&#8221; refers to the<br>upper limit of the total lifetime benefits the insurance company will pay<br>upper limit percentage of what the insurance company will pay for coinsurance<br>upper limits of what the insured will pay in out-of-pocket expenses<br>upper limits of what an insurance company will pay for any particular claim<br>upper limit of the total lifetime benefits the insurance company will pay<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">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?<br>$160<br>$200<br>$600<br>$800<br>$200<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">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?<br>$35<br>$75<br>$100<br>$140<br>$140. Because the insured has previously met her deductible, the eligible expenses for a claim is the entire $175. The insurance company pays 80% of $175, or $140.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Who is the individual paid on a fee-for-service basis?<br>Subscriber<br>Administrator<br>Insured<br>Provider<br>Provider<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A dread disease policy is considered to be a type of<br>hospital expense policy<br>group health insurance policy<br>major medical insurance policy<br>limited health insurance policy<br>limited health insurance policy<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Which of the following statements is NOT true regarding a Critical Illness Plan?<br>Pays a lump sum to the insured upon the diagnosis of a critical illness<br>The insurer may have a list of critical illnesses they will cover<br>Coverage is limited to a single devastating disease<br>Also known as Specified Disease Plans<br>Coverage is limited to a single devastating disease<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Which of the following is NOT included under a health benefit plan?<br>Major medical policy<br>Basic hospital policy<br>Hospital indemnity plan<br>Surgical expense policy<br>Hospital indemnity plan<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Amy has a group medical policy through her employer with a $500 deductible and a 90% coinsurance provision. She incurs $1,500 in covered health care services. How much will her group insurance carrier pay?<br>$500<br>$900<br>$1,000<br>$1,350<br>$900. Insurance will pay 90% after deductible has been applied<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">All of these are characteristics of a major medical expense policy EXCEPT<br>large benefit maximums<br>deductibles<br>elimination periods<br>coinsurance<br>elimination period<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A pharmacy benefit covers prescription drugs derived from a list called a(n)<br>administrative drug list<br>drug formulary<br>controlled substance list<br>generic benefit manager<br>drug formulary<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Kim has health insurance with a deductible of $500 and an 80\/20 coinsurance. How much will she pay if she incurs a loss of $1,500?<br>$200<br>$500<br>$700<br>$1,300<br>$700<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">An insured has a stop-loss limit of $5,000, a deductible of $500, and an 80\/20 coinsurance. The insured incurs $25,000 of covered losses. How much will the insured have to pay?<br>$500<br>$5,000<br>$5,400<br>$5,600<br>$5000<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Major Medical expense plans provide coverage for each of the following EXCEPT<br>Medically necessary surgery<br>Diagnostic tests<br>Blood and urine lab screens<br>Work-related injuries<br>work-related injuries<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Ted has a health insurance plan that requires him to pay a specific sum out of pocket before any benefits are paid in a calendar year. Which of these does his health plan have?<br>Calendar-year deductible<br>Coinsurance provision<br>Stop-loss feature<br>Integrated deductible<br>calendar-year deductible<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">An insured has a health plan that pays established amounts in accordance with a list of injuries, surgical procedures, or other losses. This list is called a<br>loss chart<br>benefit summary<br>benefit schedule<br>coverage menu<br>benefit schedule<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Jennifer is required to pay a specific sum out of pocket before any benefits are paid in a year. Her health policy most likely contains a(n)<br>stop-loss provision<br>deductible<br>copayment<br>out of pocket provision<br>deductible<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A proposed insured for a health insurance policy was treated for heart disease within the past year. When applying for health insurance, the heart disease treatment<br>does not count as a preexisting condition<br>is not required to be reported on the application<br>indicates a preexisting condition<br>is irrelevant to underwriting<br>indicates a preexisting condition<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Which of the following types of deductibles would apply a single deductible to both medical and dental insurance coverage?<br>Standard deductible<br>Combined deductible<br>Integrated deductible<br>Blended deductible<br>Integrated deductible<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The focus of major medical insurance is providing coverage for<br>critical illnesses only<br>preventative care<br>medical and hospitalization expenses<br>doctor&#8217;s visits<br>medical and hospitalization expenses<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Kate has a Major Medical Plan with a 75\/25 coinsurance and a deductible of $25. How much will she have to pay if she, not having met any of her deductible, visits the doctor and receives a bill for $125?<br>$25.00<br>$50.00<br>$75.00<br>$100.00<br>In this situation, the insured will have to pay $25 deductible plus $25 coinsurance = $50.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">All of the following are qualifications for establishing a health savings account (HSA) EXCEPT<br>Enrolled in a high deductible health plan<br>Be under the age of 65 (not enrolled in Medicare)<br>Enrolled in a health plan with a prescription drug benefit<br>Enrolled in a health plan that limits out of pocket expenses<br>Enrolled in a health plan with a prescription drug benefit.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">What type of policy would only provide coverage for specific types of illnesses (cancer, stroke, etc)?<br>MEWA<br>Blanket insurance<br>Dread disease insurance<br>Disability insurance<br>Dread disease insurance<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">What is the tax liability for employer contributions in Health Savings Accounts (HSA&#8217;s)?<br>Taxable as regular income to the employee<br>Tax-deductible expense to the employee<br>No tax payment needed<br>Taxable to the employee when they exceed 7 1\/2 % AGI<br>No tax payment needed<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A payment system for health care in which the provider is paid for each service given is called<br>a blanket plan<br>lump sum<br>fee-for-service<br>a prepaid arrangement<br>fee-for-service<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Medical Expense Insurance ExamQuestions and Answers 2023 withcomplete solutionA fee for service health insurance plan will normally covervitamins and natural remediescosmetic proceduresgym membershipa disease Answer- a diseaseLow frequency diseases can be exclusively covered by what kind of health insurancepolicies?Limited policiesBlanket policiesEmployer policiesRestricted policies Answer- Limited policiesAll of the following plans allow for employee contributions to [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"site-sidebar-layout":"default","site-content-layout":"","ast-site-content-layout":"default","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","ast-disable-related-posts":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"default","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"ast-content-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"footnotes":""},"categories":[25],"tags":[],"class_list":["post-113811","post","type-post","status-publish","format-standard","hentry","category-exams-certification"],"_links":{"self":[{"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/posts\/113811","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/comments?post=113811"}],"version-history":[{"count":0,"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/posts\/113811\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/media?parent=113811"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/categories?post=113811"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/tags?post=113811"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}