#1
What does Medical Expense Insurance Coverage primarily cover?
Emergency medical expenses
ExplanationEmergency expenses are the primary focus.
#2
Which of the following is not typically covered by Medical Expense Insurance?
Elective cosmetic procedures
ExplanationCosmetic procedures are usually excluded.
#3
Which federal program provides health insurance coverage for individuals over the age of 65 in the United States?
Medicare
ExplanationMedicare serves individuals aged 65+.
#4
What does the term 'network provider' refer to in Medical Expense Insurance?
A provider that has a contractual agreement with the insurance company
ExplanationProviders with contracts with insurers.
#5
Which federal program provides Medical Expense Insurance coverage to individuals aged 65 and older?
Medicare
ExplanationMedicare covers those aged 65+.
#6
What is a deductible in Medical Expense Insurance?
The amount the insured person must pay before insurance coverage kicks in
ExplanationIt's the initial payment required from the insured.
#7
What is the purpose of coinsurance in Medical Expense Insurance?
To share the medical expenses between the insured person and the insurance company
ExplanationIt splits costs between the insured and insurer.
#8
What is the purpose of a pre-existing condition clause in Medical Expense Insurance?
To exclude coverage for conditions that existed before the insurance policy was purchased
ExplanationIt denies coverage for existing conditions.
#9
What is the role of a copayment in Medical Expense Insurance?
To share the cost of medical services between the insured person and the insurance company
ExplanationIt splits the service cost between parties.
#10
In Medical Expense Insurance, what does the term 'out-of-pocket maximum' refer to?
The maximum amount the insured person has to pay for covered services in a policy period
ExplanationIt's the maximum cost to the insured in a period.
#11
What is the difference between an HMO and a PPO in Medical Expense Insurance?
HMOs require referrals for specialists, while PPOs do not
ExplanationReferrals are needed in HMOs but not PPOs.
#12
What is the main difference between traditional indemnity plans and managed care plans?
Managed care plans typically have network restrictions and require referrals for specialist visits
ExplanationManaged care plans have networks and need referrals.
#13
In Medical Expense Insurance, what is the purpose of a pre-authorization requirement?
To ensure that medical services meet coverage criteria
ExplanationIt verifies service necessity for coverage.
#14
What does the term 'coordination of benefits' refer to in Medical Expense Insurance?
Determining the order in which insurance policies pay claims
ExplanationDetermining claim payment precedence.