life and Health Insurance
Abu khaled
assignment20chapter20thirteen26fourteen20fin203660.docxAssignment Chapters 13 and 14
FIN 3660 NAME ____________________________
Please be sure to include a citation and a copy of any informational source you use. Copy and paste your cited information at the end of this assignment.
1. Many consumers have a misconception of several key programs and terms relating to health insurance. Please define and distinguish between the following:
a. Medicare and Medicaid
b. Basic Medical Expense Policy with a Major Medical Expense policy
2. Using a U.S. government website such as the Department of Labor, provide FIVE key facts about the Affordable Care Act. Provide a citation for your source.
a.
b.
c.
d.
e.
3. LJ Jones is covered by a comprehensive major medical expense policy that specifies a $700 calendar-year deductible, a 15% coinsurance requirement, and a $5,000 maximum out-of-pocket provision. In March 2010, Mr. Jones was hospitalized for four days for treatment of pneumonia. During that period of hospitalization, Mr. Jones incurred $12,500 in covered medical expenses. If Mr. Jones incurs no other medical expenses during 2010, then his out-of-pocket medical expenses for 2010 will total____________.
4. One individual health insurance policy provision limits the time during which a claimant who disagrees with the insurer’s claim decision has the right to sue the insurer to collect the amount the claimant believes she is owed under the policy. By definition, this provision is known as
a. a claims provision
b. a legal actions provision
c. a stop-loss provision
d. an overinsurance provision
5. The Skywater Company provides group medical expense and disability income insurance coverage to its employees through a self-insured plan. Skywater purchased stop-loss coverage to protect itself from the risk of having several catastrophic medical claims in a given year. Under the terms of the stop-loss coverage, the insurer will become responsible for paying claims when Skywater’s total claims exceed $1 million within the contract year. This information indicates that Skywater purchased the type of stop-loss coverage known as
a. specific stop-loss coverage
b. aggregate stop-loss coverage
c. individual stop-loss coverage
d. salary continuation coverage
