AHIP BUNDLED EXAMS COMPLETE QUESTIONS
AND VERIFIED SOLUTIONS STUDY GUIDE
◉ Group health insurance.
Answer: Health coverage provided by employers to members of a
group.
◉ Group health insurance - types of coverage.
Answer: You can choose among several or just one depending on
your employer
* dental, vision, medical benefits, managed care, fee-for-service
insurance
- dental:
* basic/preventative services, restorative services, comprehensive or
stand-alone, ACA (children, some adults)
- vision:
* basic exams and prescription glasses, ACA (children, some adults)
^ both are employer-sponsored voluntary group plans
◉ Premium tax-credit.
,Answer: a subsidy that reduces the amount that consumers must
pay
* tax credit that will lower monthly premium based on income and
household info
* advanced premium tax-credit (aptc)
◉ self employed workers.
Answer: can deduct health insurance premiums from their federal
taxable income - important tax savings
◉ contracts/health insurance policy.
Answer: between insurer and insured
- consideration: specifically termed agreement w/ promise to do
something in return for a valuable benefit (employer/insured
premium payments to the insurer)
◉ Covered services.
Answer: insurance policy will clearly state their covered services
and their exlusions
- proactive, preventative, and reactive services
◉ cost-sharing.
Answer: a situation where insured individuals pay a portion of the
healthcare costs, such as deductibles, coinsurance or co-payments
,- insured is reimbursed for some but not all of the costs
- reimbursement depends on policy
◉ Deductible/coinsurance.
Answer: Money paid out of pocket before insurance covers the
remaining costs.
% of medical bill that insured pays out of pocket
◉ copay.
Answer: a fixed fee you pay for specific medical services
◉ government sponsored plans.
Answer: federal and state gov
* medicare and medicaid
- medicare --> 65+ or younger w/ disabilities or severe kidney
problems
- medicaid --> low-income individuals
◉ employer sponsored plans.
Answer: - employer determines coverage
- company's HR dept answers employee questions
, ◉ excluded services.
Answer: services not covered in a medical insurance contract like
experimental or non-contracted providers, elective or cosmetic
surgery
◉ Health Care Philosophy.
Answer: * good quality = cost effective
- more expensive does not mean good healthcare
* cost vs care balance
- good benefits priced appropriately
* less cost, more quality
triangle --> cost, access, quality
*more medical care does not mean better outcomes
◉ managed care improves cost/access/quality.
Answer: cost: limited provider networks, inventing new ways to pay
physicians, requiring referrals for specialty care
AND VERIFIED SOLUTIONS STUDY GUIDE
◉ Group health insurance.
Answer: Health coverage provided by employers to members of a
group.
◉ Group health insurance - types of coverage.
Answer: You can choose among several or just one depending on
your employer
* dental, vision, medical benefits, managed care, fee-for-service
insurance
- dental:
* basic/preventative services, restorative services, comprehensive or
stand-alone, ACA (children, some adults)
- vision:
* basic exams and prescription glasses, ACA (children, some adults)
^ both are employer-sponsored voluntary group plans
◉ Premium tax-credit.
,Answer: a subsidy that reduces the amount that consumers must
pay
* tax credit that will lower monthly premium based on income and
household info
* advanced premium tax-credit (aptc)
◉ self employed workers.
Answer: can deduct health insurance premiums from their federal
taxable income - important tax savings
◉ contracts/health insurance policy.
Answer: between insurer and insured
- consideration: specifically termed agreement w/ promise to do
something in return for a valuable benefit (employer/insured
premium payments to the insurer)
◉ Covered services.
Answer: insurance policy will clearly state their covered services
and their exlusions
- proactive, preventative, and reactive services
◉ cost-sharing.
Answer: a situation where insured individuals pay a portion of the
healthcare costs, such as deductibles, coinsurance or co-payments
,- insured is reimbursed for some but not all of the costs
- reimbursement depends on policy
◉ Deductible/coinsurance.
Answer: Money paid out of pocket before insurance covers the
remaining costs.
% of medical bill that insured pays out of pocket
◉ copay.
Answer: a fixed fee you pay for specific medical services
◉ government sponsored plans.
Answer: federal and state gov
* medicare and medicaid
- medicare --> 65+ or younger w/ disabilities or severe kidney
problems
- medicaid --> low-income individuals
◉ employer sponsored plans.
Answer: - employer determines coverage
- company's HR dept answers employee questions
, ◉ excluded services.
Answer: services not covered in a medical insurance contract like
experimental or non-contracted providers, elective or cosmetic
surgery
◉ Health Care Philosophy.
Answer: * good quality = cost effective
- more expensive does not mean good healthcare
* cost vs care balance
- good benefits priced appropriately
* less cost, more quality
triangle --> cost, access, quality
*more medical care does not mean better outcomes
◉ managed care improves cost/access/quality.
Answer: cost: limited provider networks, inventing new ways to pay
physicians, requiring referrals for specialty care
