AHIP - FINAL EXAM QUESTIONS
AND CORRECT ANSWERS
(VERIFIED ANSWERS) A GRADE
"self-funded" - correct answer- self insurance
4 most common functions preformed by health plan
medical departments - correct answer- 1)
clinical quality
2) utilization management
3) population health management
4) pharmacy benefit
21st Century Cures Act - correct answer- -
provides substantial funding to national institute of health
for precision medicine and biomedical research, initiatives
to conquer cancer
ACA - correct answer- Affordable Care Act
,*requirement to allow coverage for dependent children
under a parent's policy until 26
...............
account managers - correct answer-
maintenance and renewal of existing accounts
Accreditation - correct answer- undergoes
examination of operating procedures to determine if they
meet designated criteria and ensure that they meet
specified level of quality
actuarial dept - correct answer- stats, math and
financial theory
- financial safeguards
- analyze company's financial consequences
* design plan benefits
* determine insurance premiums
* monitor company profit
* recommend corrective action
,* ensure funds are set aside to pay claims
* produces "book rate" for plan premiums
- finalizing specific premium rates once book rate is
established and health plan can notify a specific employer
group or individual insurance purchaser of his premium
amount
Affordable Care Act (ACA) - correct answer- -
group underwriting, some states allow individual medical
underwriting
- insurers are prohibited from discrimination due to pre-
existing conditions
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 care fraud and other admin
costs
, appeals - correct answer- request that health
plan reconsider coverage decision
- may be tied to UM dept
bending the heatlhcare cost curve - correct
answer- - making changes to healthcare delivery
system to try to decrease rate at which spending goes up
- need to grab line moving up, reverse the trend and bend
it downward
board - correct answer- customer of the health
plan
brokers - correct answer- work w sales dept of
health plan
Care Management - correct answer- cross
between case management and population health
management
- handled by medical professionals
- act as proactive/reactive resources to insured
AND CORRECT ANSWERS
(VERIFIED ANSWERS) A GRADE
"self-funded" - correct answer- self insurance
4 most common functions preformed by health plan
medical departments - correct answer- 1)
clinical quality
2) utilization management
3) population health management
4) pharmacy benefit
21st Century Cures Act - correct answer- -
provides substantial funding to national institute of health
for precision medicine and biomedical research, initiatives
to conquer cancer
ACA - correct answer- Affordable Care Act
,*requirement to allow coverage for dependent children
under a parent's policy until 26
...............
account managers - correct answer-
maintenance and renewal of existing accounts
Accreditation - correct answer- undergoes
examination of operating procedures to determine if they
meet designated criteria and ensure that they meet
specified level of quality
actuarial dept - correct answer- stats, math and
financial theory
- financial safeguards
- analyze company's financial consequences
* design plan benefits
* determine insurance premiums
* monitor company profit
* recommend corrective action
,* ensure funds are set aside to pay claims
* produces "book rate" for plan premiums
- finalizing specific premium rates once book rate is
established and health plan can notify a specific employer
group or individual insurance purchaser of his premium
amount
Affordable Care Act (ACA) - correct answer- -
group underwriting, some states allow individual medical
underwriting
- insurers are prohibited from discrimination due to pre-
existing conditions
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 care fraud and other admin
costs
, appeals - correct answer- request that health
plan reconsider coverage decision
- may be tied to UM dept
bending the heatlhcare cost curve - correct
answer- - making changes to healthcare delivery
system to try to decrease rate at which spending goes up
- need to grab line moving up, reverse the trend and bend
it downward
board - correct answer- customer of the health
plan
brokers - correct answer- work w sales dept of
health plan
Care Management - correct answer- cross
between case management and population health
management
- handled by medical professionals
- act as proactive/reactive resources to insured
