Exam Fx Health Study Guide Questions With Complete Solutions

In the event of a loss after your notice of claim is made To the provider who is responsible claims form parties. correct answer: Insurer to the insured What is the purpose of coinsurance provisions? correct answer: To help the insurance company overutilazation to the policy. Under the mandatory uniform provision Notice of Claim, the first notice of injury or sickness covered under an accident and r policy must contain what? correct answer: A statement that is sufficiently clear to identify the insured and the nature of the claim. Which of the following terms describes the specified dollar amount beyond which the insured no longer participates in the sharing of expenses. correct answer: Stop-loss limit Which of the following will vary the length of the grace period in health insurance policies? correct answer: The mode of the premium payment payment. Which provision allows the policyholder a period of time, while coverage is in force, to examine a health insurance policy and determine whether or not to keep it? correct answer: Free look period An insured has endured multiple surgeries and hospitalizations for an illness during the last few months. Her insurer no longer bills her for medical expenses. Which of the following allows for that? correct answer: Stop loss limit The provision which prevents the insured from bringing any legal action against the company for at least 60 days after proof of loss is known correct answer: Legal actions What is the main difference between coinsurance and copayments? correct answer: Copayment is a set dollar amount. A Health insurance policy lapses but is reinstated within an acceptable timeframe. How soon from the reinstatement date will coverage for accidents become effective? correct answer: Immediately L has a major medical policy with a $500 deductible and 80/20 coinsurance. L is hospitalized and sustains a $2,500 loss. What is the maximum amount that L will have to pay? correct answer: $900 (deductible + 20% of the bill after the deductible [20% of