Ahip - Final Exam

AHIP - FINAL EXAM WITH 100% CORRECT ANSWERS Insurer vs Insured - correct answer - insurer is a company that provides plan - insured are the people that buy into the plan Group health insurance - correct answer Health coverage provided by employers to members of a group. Group health insurance - types of coverage - correct 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 - correct 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 - correct answer can deduct health insurance premiums from their federal taxable income - important tax savings contracts/health insurance policy - correct 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 - correct answer insurance policy will clearly state their covered services and their exlusions - proactive, preventative, and reactive services cost-sharing - correct 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 - correct answer Money paid out of pocket before insurance covers the remaining costs. % of medical bill that insured pays out of pocket copay - correct answer a fixed fee you pay for specific medical services government sponsored plans - correct 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 - correct answer - employer determines coverage - company's HR dept answers employee questions excluded services - correct answer services not covered in a medical insurance contract like experimental or non-contracted providers, elective or cosmetic surgery Health Care Philosophy - correct 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 - correct answer cost: limited provider networks, inventing new ways to pay physicians, requiring referrals for specialty care quality: credentialing providers, evidence-based medical policies, grading providers on their quality outcomes, comparing providers to their peers access: reigning in premium increases and reducing unnecessary care to make additional provider time available annual increase in premiums - correct answer - result from consumer/government limitations placed on managed care - other factors: higher provider fees, increased use of tech in delivery of care, health