General Insurance 7-8

Assignment 7, Chapter 15 NAME _______________________________

FIN 3610

1. a. Explain the various definitions of disability that are found in disability-income insurance.

b. Briefly explain the following disability-income insurance provisions: Residual disability, Benefit period, Elimination period, Waiver of premium.

2. Identify five major provisions of the Affordable Care Act that will have an impact on individuals and families. Document your source and attach a copy of your information.

3. a. Describe the basic characteristics of individual medical insurance.

b. Why are deductibles and coinsurance used in medical expense policies?

4. Briefly explain the major characteristics of a health savings account (HSA).

5. Identify the optional benefits that can be added to a disability-income policy.

6. Explain the following renewal provisions that may appear in individual health insurance policies:

a. Guaranteed renewable

b. Noncancellable

c. Conditionally renewable

7. James, age 28, is insured under an individual medical expense policy that is part of a preferred provider organization (PPO) network. The policy has a calendar-year deductible of $1000, 75/25 percent coinsurance, and an annual out-of-pocket limit of $2000. James recently had outpatient arthroscopic surgery on his knee, which he injured in a skiing accident. The surgery was performed in an outpatient surgical center. James incurred the following medical expenses. (Assume that the charges shown are the charges approved my James’s insurer and that all providers are in the PPO network.)

· Outpatient X-rays and diagnostic tests $800

· Covered charges in the surgical center $12,000

· Surgeon’s fee $3000

· Outpatient prescription drugs $400

· Physical therapy expenses $1200

In addition, James could not work for two weeks and lost $2000 in earnings.

a. Based on the above information, how much of the expenses will be paid by the insurance company?

b. How much of the expenses will James have to pay? Explain your answer.

c. Assume that a surgeon who is not in the PPO network actually performed the surgery. Will James’s policy cover this fee? Explain your answer.