chapter 3- Health

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Basic Medical Expense insurance…

normally has a deductible and coinsurance

covers an illness but not an accident

pays for lost wages while hospitalized

has lower benefit limits than Major Medical insurance

has lower benefit limits than Major Medical insurance

Which of the following is NOT a limited benefit plan?

cancer policies

life insurance policies

dental policies

critical illness policies

life insurance policies

N has a Major Medical policy that only pays a portion of N’s medical expenses. N is responsible for paying the remaining balance. This provision is known as

Assignment of Benefits





Deductibles are used in health policies to lower…

the incidents of fraud

the coinsurance amount

overuse of medical services

adverse selection

overuse of medical services

Which of the following statements BEST describes the intent of a Coinsurance clause in a Major Medical policy?

Discourages overutilization of the insurance coverage

Minimizes the need for deductibles

Discourages adverse selection

Minimizes the waiting period

Discourages over-utilization of the insurance coverage

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

All of the following are limited benefit plans EXCEPT:

cancer policies

life insurance policies

dental policies

critical illness policies

life insurance policies

The first portion of a covered Major Medical insurance expense that the insured is required to pay is called the:

corridor deductible

initial deductible

stop-loss deductible

coinsurance deductible

initial deductible

Which of the following policy features allows an insured to defer current health charges to the following year’s deductible instead of the current year’s deductible?

Deferral provision

Carryover provision

Stop Loss provision

Corridor provision

Carryover provision

Basic Hospital and Surgical policy benefits are:

lower than the actual expenses incurred

higher than the actual expenses incurred

normally subject to deductibles

normally subject to coinsurance

lower than the actual expenses incurred

Which of the following costs would a Basic Hospital/Surgical policy likely cover?

Surgically removing a facial birthmark

Care given at a nursing home

Treating a wound from a soldier injured at war

Lost income caused by a hospital stay

surgically removing a facial birthmark

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 state amount per day of covered hospitalization

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 request a corrected application

deny coverage and increase premiums

continue coverage but exclude the heart condition

rescind the coverage and return the premiums

Continue coverage but exclude the heart condition

M is insured under a basic Hospital/Surgical Expense policy. A physician performs surgery on M. What determines the claim M is eligible for?

Claim payment is equal to physician’s actual charges

Claim payment is negotiated between physician and patient

Determined by the schedule of benefits from the hospital

Determined by the terms of the policy

Determined by the terms of the policy

Which of the following medical expenses does Cancer insurance NOT cover?


Radiation treatment

Physician visit



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