State RegulationsOH specificDifficulty 1/5
Under the optional expense-incurred benefits provision of an individual A&H policy, benefits are payable on what basis?
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Answer & full 3-part explanation (select an option above, or peek)
Why B is correct
ORC 3923.05 lists expense-incurred benefits among the optional provisions for Ohio individual accident and sickness policies. On the expense-incurred basis, the insurer reimburses the medical expenses the insured actually incurs for covered care, in contrast to the other-than-expense-incurred (indemnity) basis, which pays scheduled sums without regard to actual charges. The Ohio Department of Insurance presents these two benefit bases as the alternative reimbursement structures an A&H policy may use.
Why the other options are wrong
- A) A flat scheduled indemnity regardless of bills describes the other-than-expense-incurred basis, the opposite of what the stem asks.
- C) The benefit is tied to expenses actually incurred during the claim, not a lump sum locked in at application.
- D) Exhaustion of other coverage relates to other-insurance coordination provisions, not the expense-incurred benefit basis under ORC 3923.05.
Memory hook
Expense-incurred means pay the bills you actually ran up.