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MHA 707 EXAM C | FREQUENTLY TESTED
QUESTIONS WITH CORRECT ANSWERS | BRAND
NEW!
Benchmarking - ✔✔✔ Correct Answer > current starting point of
stat/data
Determines quality access equity cost and efficiency
Employer Managed Care Plans - ✔✔✔ Correct Answer > HMO
PPO
POS
EPO
Other permutations
HMO (Health Maintenance Organization) - ✔✔✔ Correct Answer > A
managed care organization that provides comprehensive medical
services for a predetermined annual fee per enrollee.
PPO (Preferred Provider Organization) - ✔✔✔ Correct Answer > A type
of health plan that contracts with medical providers, such as
hospitals and doctors, to create a network of participating
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providers. You pay less if you use providers that belong to the
plan's network.
POS (Point of Service) - ✔✔✔ Correct Answer > health insurance plan
provides access to health care services at a lower overall cost,
but with fewer choices. Plans may vary, but in general, POS plans
are considered a combination of Health Maintenance
Organization (HMO) and Preferred Provider Organization (PPO)
plans
EPO (Exclusive Provider Organization) - ✔✔✔ Correct Answer > A
managed care plan where services are covered only if you go to
doctors, specialists, or hospitals in the plan's network (except in
an emergency)
Largest MCO (manager care org) - ✔✔✔ Correct Answer >
UnitedHealth Group is the largest with almost 50 M members
just over $201 B in revenue.
66% of people under the age of 65 age covered through private
insurance
Private health insurance paid about 36% of health consumption
8% of people under the age of 65 were uninsured in 2019
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Private health insurance is generally governed by - ✔✔✔ Correct
Answer > The state
MCO takes on the risk of contract
Contracts must be approved for sale in each state with the
associated regulatory requirements
Larger Employers are typically - ✔✔✔ Correct Answer > Self insured
Employer pays for the actual health care cost of employees
Re-insurance picks up large overruns (Lloyds of London)
Out of Pocket Cost for Patients - ✔✔✔ Correct Answer > Copayments
Coinsurance
Deductibles
Copayment - ✔✔✔ Correct Answer > a small fixed fee paid by the
patient at the time of an office visit
Coinsurance - ✔✔✔ Correct Answer > a type of insurance in which the
insured pays a share of the payment made against a claim.
Ex 80/20
MHA 707 EXAM C | FREQUENTLY TESTED
QUESTIONS WITH CORRECT ANSWERS | BRAND
NEW!
Benchmarking - ✔✔✔ Correct Answer > current starting point of
stat/data
Determines quality access equity cost and efficiency
Employer Managed Care Plans - ✔✔✔ Correct Answer > HMO
PPO
POS
EPO
Other permutations
HMO (Health Maintenance Organization) - ✔✔✔ Correct Answer > A
managed care organization that provides comprehensive medical
services for a predetermined annual fee per enrollee.
PPO (Preferred Provider Organization) - ✔✔✔ Correct Answer > A type
of health plan that contracts with medical providers, such as
hospitals and doctors, to create a network of participating
,Page 2 of 21
providers. You pay less if you use providers that belong to the
plan's network.
POS (Point of Service) - ✔✔✔ Correct Answer > health insurance plan
provides access to health care services at a lower overall cost,
but with fewer choices. Plans may vary, but in general, POS plans
are considered a combination of Health Maintenance
Organization (HMO) and Preferred Provider Organization (PPO)
plans
EPO (Exclusive Provider Organization) - ✔✔✔ Correct Answer > A
managed care plan where services are covered only if you go to
doctors, specialists, or hospitals in the plan's network (except in
an emergency)
Largest MCO (manager care org) - ✔✔✔ Correct Answer >
UnitedHealth Group is the largest with almost 50 M members
just over $201 B in revenue.
66% of people under the age of 65 age covered through private
insurance
Private health insurance paid about 36% of health consumption
8% of people under the age of 65 were uninsured in 2019
, Page 3 of 21
Private health insurance is generally governed by - ✔✔✔ Correct
Answer > The state
MCO takes on the risk of contract
Contracts must be approved for sale in each state with the
associated regulatory requirements
Larger Employers are typically - ✔✔✔ Correct Answer > Self insured
Employer pays for the actual health care cost of employees
Re-insurance picks up large overruns (Lloyds of London)
Out of Pocket Cost for Patients - ✔✔✔ Correct Answer > Copayments
Coinsurance
Deductibles
Copayment - ✔✔✔ Correct Answer > a small fixed fee paid by the
patient at the time of an office visit
Coinsurance - ✔✔✔ Correct Answer > a type of insurance in which the
insured pays a share of the payment made against a claim.
Ex 80/20
