Nevada · Accident & Health SampleInteractive Mind Map
Major Medical Insurance (Indemnity Plans)
A visual breakdown of Major Medical Insurance (Indemnity Plans) — one of the concepts you can count on seeing on the exam.
The TESTivity Interactive Mind Mapping Graphic we picked for the Nevada Health Insurance sample is Major Medical Insurance (Indemnity Plans) — and this is a concept you can count on seeing on your pre-licensing exam. Get the structure straight once and those questions turn into free points.
So explore it. Click through, see how the pieces relate, and let the layout do some of the remembering for you.
Explore by topic
Choose a Cluster to Study
Major medical is the firewall against financial catastrophe from serious illness or injury.
Broad coverage, high limits, and reimbursement based on actual costs. Traditional indemnity plans add the headline perk: see any licensed provider — you just pay a higher premium for that freedom.
🏥
High Limits, Broad Coverage
Covers most medically necessary care — hospital, physician, surgery, diagnostics, drugs, mental health, preventive care. Very high (often unlimited) maximums. ACA-compliant plans cannot impose lifetime or annual dollar limits on essential health benefits.
🧾
Deductible + Coinsurance
Always shares cost through a deductible ($500–$5,000+, higher for HDHPs) and coinsurance (typically 80/20). Reimburses actual covered expenses, not fixed scheduled amounts.
👤
Freedom of Provider Choice
The defining indemnity feature: any licensed provider, no network restrictions, no PCP gatekeeper. That flexibility costs more in premium than managed care.
🧱 Basic + Supplemental Major Medical
🧩 Comprehensive Major Medical
Structure
An older two-layer design: a basic plan (common, lower-cost services) plus a major medical layer on top for catastrophic costs.
Structure
A single integrated plan with one deductible and coinsurance structure — the dominant modern design.
Watch for
A corridor deductible sits between the basic and major medical layers.
Watch for
Simplicity — basic and major medical merged into one policy.
How they test thisThe indemnity tell is “may use any licensed physician or hospital” — freedom of choice, no network. PCP gatekeepers and capitation are HMO features, not indemnity. And remember the ACA ban on lifetime dollar limits on essential health benefits (deductibles, coinsurance, and copays are still allowed).
“Comprehensive” still has edges — some services are capped, and some are flatly excluded.
The single most tested line: custodial care is NOT a health-insurance benefit — it belongs to long-term care insurance.
⚠️ Limited (capped)
Skilled nursing facility — limited days per benefit period.
Home health visits — capped per year.
DME (wheelchairs, CPAP, prosthetics) — limits or prior authorization.
Drug tiers — different cost-sharing by formulary tier.
❌ Excluded
Cosmetic procedures (not illness/injury-related).
Experimental / investigational treatment.
Custodial care (bathing, dressing, feeding) → LTC insurance.
Older plans capped mental health at, say, 30 inpatient days / 60 outpatient visits. MHPAEA now requires parity — mental health limits can’t be more restrictive than medical/surgical limits.
🎯
The custodial-care line, drilled
Help with activities of daily living (bathing, dressing, eating) that needs no skilled medical supervision is NOT covered by major medical — that’s long-term care insurance. Health insurance pays for skilled medical care; LTC pays for custodial personal care. This distinction shows up constantly.
A handful of provisions quietly move the insured’s real-world cost up or down.
They soften year-end deductible resets, cap family exposure, and reward network use even inside an indemnity plan.
📅
Deductible Carryover
Expenses in the last three months of the year may be credited toward next year’s deductible — softening the year-end “fresh start” for someone with late-year claims.
👪
Family Deductible
Once the family hits the aggregate deductible, remaining members are covered with no further individual deductibles that year.
🛡️
Out-of-Pocket Maximum
The annual cap on cost-sharing — once reached, the insurer pays 100% of covered services for the rest of the year.
🏥
Network Discounts (Hybrid Indemnity)
Even traditional indemnity plans may offer a preferred provider list — the insured pays less in-network, creating an indemnity/managed-care hybrid.
How they test thisDeductible carryover scenario: $800 of covered expenses in Nov/Dec that didn’t finish this year’s deductible can be applied to next year’s deductible, lowering the amount owed before benefits resume in January. It does not vanish on Jan 1, and it doesn’t double the deductible.
🎯
Top Exam Tips — Major Medical (Indemnity)
1. Indemnity tell: any licensed provider, no network, no PCP gatekeeper — freedom of choice at a higher premium. 2. Always uses deductible + coinsurance and reimburses actual costs (not fixed schedules). 3. ACA bans lifetime/annual dollar limits on essential health benefits; deductibles, coinsurance, and copays are still allowed. 4. Custodial care is NOT covered by health insurance — that’s long-term care insurance. (Skilled care = health; custodial = LTC.) 5. Common exclusions: cosmetic, experimental, custodial, workers’ comp, dental/vision, routine hearing. 6. Deductible carryover: late-year expenses credit toward next year’s deductible. MHPAEA requires mental-health parity.
Exam vocabulary
Key Terms to Know
Major Medical Insurance
Comprehensive coverage for most medically necessary services; high limits; deductible and coinsurance; the broadest protection.
Indemnity Plan
A plan that reimburses actual medical expenses with no network restrictions; the patient may see any licensed provider.
Comprehensive Major Medical
A single integrated plan combining basic and major medical coverage under one deductible and coinsurance structure.
Basic + Supplemental Major Medical
An older two-layer design: a basic plan plus a major medical layer, with a corridor deductible between them.
Corridor Deductible
An additional deductible between the basic and major medical layers in a two-layer plan design.
Deductible Carryover
A provision crediting expenses from the last 3 months of the year toward next year’s deductible.
Custodial Care
Personal care (bathing, dressing, feeding) needing no skilled supervision; excluded from health insurance, covered by LTC insurance.
Durable Medical Equipment (DME)
Home-use medical devices (wheelchairs, CPAP, prosthetics); covered with limits or prior authorization in most plans.
Formulary
The insurer’s approved drug list, organized in tiers with different cost-sharing levels.
Lifetime Maximum
The total benefit cap over an insured’s lifetime; prohibited for essential health benefits in ACA-compliant plans.
MHPAEA Parity
Mental health and substance use limits cannot be more restrictive than medical/surgical limits.
Like learning this way? There's a whole library of them.
If the old manual you inherited from the office breakroom isn't cutting it and this
format fits how your brain actually works, you'll want the rest. There are
52 Interactive Mind Maps like this one in the
TESTivity Platinum Accident & Health package — covering the full curriculum, right alongside
the practice questions, exam simulators, and study guides.
