Illinois Health Insurance Practice Exam

Which type of insurance usually excludes expenses covered by Workers' Compensation?

1. Private insurance

2. Blue Cross/Blue Shield plans

3. Health Maintenance Organizations (HMOs)

4. Preferred Provider Organization (PPO) plans

The correct answer is: Blue Cross/Blue Shield plans

The correct answer focuses on the nature of health insurance plans and their relationship with Workers' Compensation. Generally, health insurance plans, including those provided by Blue Cross and Blue Shield, have provisions that exclude coverage for expenses that fall under Workers' Compensation. This is because Workers' Compensation is designed to provide specific benefits for workplace-related injuries or illnesses and typically has its own set of regulations and benefits that serve as the primary source for those types of claims. Private insurance, HMOs, and PPO plans also generally share this exclusion, but the language often used in Blue Cross/Blue Shield plans makes this distinction particularly clear. These plans typically state explicitly that they will not cover expenses that are covered by Workers' Compensation to prevent duplicating benefits. By doing so, they ensure that the responsibilities pertaining to workplace injuries remain with the Workers' Compensation system. In summary, the focus on Blue Cross/Blue Shield plans highlights the clear delineation in coverage for expenses by Workers' Compensation, making the choice particularly relevant when discussing exclusions in health insurance.