1. Major medical coverage differs from basic medical coverage primarily by offering what?

Higher limits and broader coverage with deductibles and coinsurance

Major medical provides broad, high-limit coverage with cost sharing, unlike limited basic plans with first-dollar but low limits.

2. The stop-loss feature of a major medical plan benefits the insured by doing what?

Limiting the insured's total out-of-pocket cost in a period

The stop-loss feature caps the insured's cumulative cost sharing, after which the plan pays covered expenses in full.

3. A point-of-service (POS) plan is best described as a blend of which two models?

HMO and PPO features

A POS plan combines HMO features, like a primary care gatekeeper, with PPO-style out-of-network options.

4. In a managed care plan, the primary care physician who coordinates and authorizes care is often called the what?

Gatekeeper

The primary care physician acting as a gatekeeper coordinates care and provides referrals to specialists in many managed care plans.