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Florida Life and Health Insurance Exam Prep
By ExamNavigator
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Florida Life and Health Insurance Exam Prep
- Basic Medical Expense policies
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
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
Answer: -Pay for covered expenses incurred during a hospital stay.
- Daily hospital benefit - Room and Board
- Miscellaneous expenses - Other Medical Expenses (X-Rays, MRI, Prescriptions, Doctor
Visits)
- Daily Hospital Benefit
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)
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
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
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
Answer: Policyowners obtain medical treatment from whatever source they want and submit their charges to their insurer for reimbursement (actual amount). 2 / 3
- Service Based Contracts
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
Answer: -Secondary benefits (inside benefits) be- cause 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
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
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
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
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
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
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