CCHI – Insurance exam latest 2023/24

CCHI – Insurance exam latest 2023/24 Affordable Care Act (ACA)/ Health Care Reform; Obamacare - The comprehensive federal health care reform law enacted in March 2010. Health Insurance - A contract that requires an individual's health insurer to pay some or all of their health care costs in exchange for a premium. Health Insurance Marketplace/ Exchange - State- or federally run and regulated market where an individual can shop, compare, and buy health care coverage. Eligibility requirements - Conditions that must be met in order for an individual or group to be considered eligible for insurance coverage. Open enrollment (period) - A period of time each year when an individual can purchase or change health coverage. Medicaid - Health insurance provided by the government to some low-income people, families and children, pregnant women, the elderly, and people with disabilities. In some states the program covers all adults below a certain income level. Medicaid programs must follow federal guidelines, but coverage and costs may be different from state to state. Children's Health Insurance Program (CHIP) - Health insurance provided by the government to children in families that earn too much money to qualify for Medicaid. In some states, CHIP covers parents and pregnant women. Each state works closely with its state Medicaid program. In many cases, if an individual qualifies for Medicaid your children will qualify for either Medicaid or CHIP. Medicare - A federal health insurance program, administered by the Social Security Administration, that provides health care for most people over 65 and certain other eligible individuals. Health plan - A benefit an individual's employer, union or other group sponsor provides to that individual to pay for their health care services. Secondary coverage - When a person is covered under more than one health insurance plan, this term describes the health insurance plan that provides payment on claims after the primary coverage (i.e. main plan). Managed care - A general term used to describe a variety of health care and health insurance systems that attempt to guide a patient's use of benefits, typically by requiring that a patient coordinate his or her health care through a primary care physician, or by encouraging the use of a specific network of healthcare providers. The management of health care is intended to keep costs -and monthly premiums- as low as possible. Examples of managed care plans include: • Health maintenance organizations (HMOs), • Preferred provider organizations (PPOs), • Exclusive provider organizations (EPOs), and • Point of service plans (POSs). Premium - The amount that must be paid for an individual's health insurance or plan. The individual and/or their employer usually pay it monthly, quarterly or yearly. Dependent - A spouse, child, or domestic partner who is covered under a policyholder or subscriber's plan, depending on applicable law and the plan's terms and conditions. Covered services - Health care services that are included in and paid for by an individual's health insurance or plan. Excluded services - Health care services that an individual's health insurance or plan doesn't pay for or cover. Pre-existing condition - A medical condition that a person has before being enrolled in a health plan. Service area - The geographic area in which a health insurance plan's benefits are made available. Some health insurance plans will not provide coverage outside of a plan's service area.