Question 6033 of 287 · Texas Life, Accident and Health Agent Exam
An insured has a $1,000 deductible and a 20 percent coinsurance clause with a $3,000 out-of-pocket (stop-loss) cap on a major medical policy. Which statement is true?
Exactly one answer is correct.
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Correct answer to question 6033
- D: Once the insured's share reaches the cap, the insurer pays 100 percent of covered expenses
Explanation
A stop loss limit caps the insured's annual cost sharing. Premiums are not usually counted toward the cap.
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