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QUESTION: 46

Regarding medical plans, what is the out-of-pocket maximum?

The most that the member will be liable for in relation to co-insurance
The maximum the plan will pay if the member is covered by another insurance plan
The limit the member will be required to pay at each doctor visit
The lifetime limit for benefits to any one employee

Answer(s): A

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QUESTION: 47

What are usual, customary and reasonable charges (UCR)?

The charges that an insurance carrier determines are normal for a particular medical procedure within a specific geographical area
The charges that are published annually in the Global Insurers' Medical Cost Comparison Guide
The charges that are allowable for any given medical procedure with no pre-treatment authorization
The charges that are typically paid up front by a plan participant for services rendered.

Answer(s): A

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QUESTION: 48

A medical benefits plan provision ensuring that the correct plan is paying expenses when the member is covered under more than one plan is known as what?