Question 1

An example of an "alternative treatment" that would not likely be covered by a health insurance policy is:

Accepted Answer

An example of an "alternative treatment" that would not likely be covered by a health insurance policy is cosmetic surgery for elective reasons. This would not likely be covered as such a procedure is not considered to be a typical medical treatment. In addition, this type of procedure is most often not considered a necessary procedure.

Question 2

If an individual suffers an injury due to an act of war that requires several months of rehab therapy, will this therapy likely be covered under his or her individual health insurance policy?

Accepted Answer

If an individual suffers an injury due to an act of war that requires several months of rehab therapy, this therapy will not likely be covered under his or her individual health insurance policy. This is because injuries that result from an act of war are not covered by such policies. In many cases, however, the government may cover the cost of such services through health care via the Veteran's Administration.

Question 3

In most cases, unless it is otherwise stated, it is assumed that the applicant on a health insurance policy is also the __________.

Accepted Answer

In most cases, unless it is otherwise stated, it is assumed that the applicant on a health insurance policy is also the prospective insured. However, on some types of insurance policies the applicant and the insured may be different. One example of this is with life insurance, where the applicant and the insured may be two separate individuals (or entities).

Question 4

The __________ in an insurance policy is the statement that sets out the element of insurance to pay for losses that are covered in the policy by the issuing insurance company.

Accepted Answer

The insuring clause in an insurance policy is the statement that sets out the element of insurance to pay for losses that are covered in the policy by the issuing insurance company. This promise of covering losses is in exchange for the premium that is paid by the insured and the complies with policy terms. This is considered to be contractual language, as insurance policies are true contracts between the insurance company and the insured.
Question: wondering if the word "element" is supposed to be "amount?"

Question 5

Insurance policies are considered to be __________, meaning that they are dependent on an uncertain or chance event or outcome so that one of the parties may receive more in value than they give in value to the other party to the contract.

Accepted Answer

Insurance policies are considered to be aleatory. This means that they are dependent on an uncertain or chance event or outcome so that one of the parties may receive more in value than they give in value to the other party to the contract. This is primarily due to the element of uncertainty.

Question 6

The type of health plan that allows insureds to choose which doctor and other medical services providers they will use is:

Accepted Answer

The type of health plan that allows insureds to choose which doctor and other medical service providers they will use is fee-for-service. A fee-for-service plan is another name for an individual health insurance policy. These types of policies will allow an insured much more freedom to choose their providers than do managed care options such as HMOs and PPOs.

Question 7

Once the out-of-pocket maximum has been reached in a given year, an insured's health insurer will compensate them for __________ of their health care costs.

Accepted Answer

Once the out-of-pocket maximum has been reached in a given year, an insured's health insurer will compensate them for 100% of their health care costs. This out-of-pocket maximum protects the insured in that the insurance company will take care of all of the remaining covered charges once the maximum has been reached. The insured may, however, still face other out-of-pocket costs that are not considered covered charges by the insurance policy.

Question 8

A(n) __________ is considered to be an official request for money from an insurer.

Accepted Answer

A claim is considered to be an official request for money from an insurer. If a policy holder incurs a covered expense or loss, they must make a claim in order to receive compensation from the insurance company. This goes along with the premise that insurance policies are technically contracts.

Question 9

Doctors and other health care providers that accept an insured's health insurance plan are considered to be __________ providers.

Accepted Answer

Doctors and other health care providers that accept an insured's health insurance plan are considered to be in-network providers. These health care providers are responsible for submitting health insurance claims to the policy holder's insurer. In certain types of plans, an insured may obtain the services of an out-of-network provider, however, these services will likely be obtained at a higher cost that those from in-network providers.

Question 10

When an insured visits their doctor for an annual check-up, typically the cost of their __________ will be paid at the time of the office visit.

Accepted Answer

When an insured visits their doctor for an annual check-up, typically the cost of their copayment, or co-pay, will be paid at the time of the office visit. The remaining balance will then be invoiced to the health insurance company as an ordinary office visit claim. Copayments should not be confused with deductibles, which represent the amount that an insured must pay out-of-pocket for expenses before the insurance company will cover the remaining costs.

Question 11

Health insurance policies that have __________ provisions will require their policy holders to share a certain percentage of the cost of their medical or health care treatment.

Accepted Answer

Health insurance policies that have coinsurance provisions will require their policy holders to share a certain percentage of the cost of their medical or health care treatment. Copayments, or co-pays, are typically a fixed percentage of the total cost of the services that the insured receives. Coinsurance should not be confused with deductibles, which is represents amount that an insured must pay out-of-pocket for expenses before the insurance company will cover the remaining costs.

Question 12

When putting together a major medical insurance plan, what factors must be established?

Accepted Answer

When putting together a major medical insurance plan, both the deductible and the maximum out-of-pocket amount must be established. Both of these factors will affect what the insured will be required to pay for their care. Typically, a major medical plan will have a higher deductible than most other types of health insurance coverage.

Question 13

Insurance policy __________ help(s) to protect insurers from having to pay for small losses.

Accepted Answer

Insurance policy deductibles help to protect insurers from having to pay for small losses. This is because the deductible is paid by the insured. In the event that a loss occurs, the policy holder will be required to pay the initial amount of the loss, up to the deductible amount. A higher amount of deductible will usually reduce the amount of premium that is required to be paid by the insured. This also reduces the risk to the insurance company.

Question 14

The limitation of coverage to in-network providers and non-payment of claims for self-inflicted injuries are examples of policy __________.

Accepted Answer

The limitation of coverage to in-network providers and non-payment of claims for self-inflicted injuries are examples of policy limitations. By spelling out the limitations of coverage, an insurance company can help reduce its risk of large claims. Limitations should not be confused with exclusions which are specific conditions or circumstances that are not covered at all by a policy.

Question 15

Individuals who are covered by an HMO will have their __________ serve as their provider for all basic healthcare services.

Accepted Answer

Individuals who are covered by an HMO will have their PCP serve as their provider for all basic health care services. PCP stands for primary care provider. The PCP will also typically provide referrals for visits to specialists.

Question 16

What type of plan does not require that a participant obtain a referral prior to visiting another provider in the network?

Accepted Answer

A PPO plan does not require that a participant obtain a referral prior to visiting another provider in the network. PPO stands for preferred provider network. Likewise, those who are participants in a PPO plan will not need to select a primary care physician.

Question 17

__________ plans focus a great deal on preventive care and early detection and treatment.

Accepted Answer

HMO plans focus a great deal on preventive care and early detection and treatment. HMO stands for health maintenance organization. This focus on preventive care will oftentimes prevent additional costs from incurring due to early detection of various conditions that if not caught early, may require expensive treatment and therapies.

Question 18

The type of long-term care insurance policy that pays a policy holder a fixed amount of dollars per day, up to a specific amount of total benefits, regardless of the expense that is incurred is considered a(n) __________ plan.

Accepted Answer

The type of long-term care insurance policy that pays a policy holder a fixed amount of dollars per day, up to a specific amount of total benefits, regardless of the expense that is incurred is considered an indemnity plan. Indemnity plans pay an insured a fixed amount of dollars rather than reimbursing them for the actual expenses that were incurred. For example, if an insured owns an indemnity-type of long-term care policy that pays $100 per day in benefits and the care that the insured receives costs $75 per day, the insurance company will still pay the insured $100 per day in benefits.

Question 19

With regard to group health insurance, a company must have at least __________ employees in order to qualify as a "group"

Accepted Answer

With regard to group health insurance, a company must have at least two employees in order to qualify as a "group." In addition to actual employers, "groups" such as members of the VFW or other types of associations may also qualify for group insurance coverage as an association. It is important, however, that the group must be formed for purposes other than simply obtaining group insurance.

Question 20

Which type(s) of policies fall under the health insurance category?

Accepted Answer

There are many types of health insurance policies on the market today. These can include disability insurance, long-term care insurance, and group health insurance plans. Other types of insurance that fall under the health insurance category include Medicare supplement coverage, as well as individual health insurance policies.

Quiz 3: Health: Health and Dental