AHIP - FINAL EXAM QUESTION AND VERIFIED
ANSWERS GRADE A//LATEST UPDATE 2027
Insurer vs Insured - ANSWER - insurer is a company that provides plan
- insured are the people that buy into the plan
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 ẅill loẅer monthly premium based on income
and household info
* advanced premium tax-credit (aptc)
,self employed ẅorkers - ANSWER can deduct health insurance
premiums from their federal taxable income - important tax savings
contracts/health insurance policy - ANSWER betẅeen insurer and
insured
- consideration: specifically termed agreement ẅ/ promise to do
something in return for a valuable benefit (employer/insured
premium payments to the insurer)
Covered services - ANSWER insurance policy ẅill clearly state their
covered services and their exlusions
- proactive, preventative, and reactive services
cost-sharing - ANSWER a situation ẅhere 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 ẅ/ disabilities or severe kidney problems
- medicaid --> loẅ-income individuals
employer sponsored plans - ANSWER - employer determines coverage
- company's HR dept ansẅers 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
ANSWERS GRADE A//LATEST UPDATE 2027
Insurer vs Insured - ANSWER - insurer is a company that provides plan
- insured are the people that buy into the plan
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 ẅill loẅer monthly premium based on income
and household info
* advanced premium tax-credit (aptc)
,self employed ẅorkers - ANSWER can deduct health insurance
premiums from their federal taxable income - important tax savings
contracts/health insurance policy - ANSWER betẅeen insurer and
insured
- consideration: specifically termed agreement ẅ/ promise to do
something in return for a valuable benefit (employer/insured
premium payments to the insurer)
Covered services - ANSWER insurance policy ẅill clearly state their
covered services and their exlusions
- proactive, preventative, and reactive services
cost-sharing - ANSWER a situation ẅhere 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 ẅ/ disabilities or severe kidney problems
- medicaid --> loẅ-income individuals
employer sponsored plans - ANSWER - employer determines coverage
- company's HR dept ansẅers 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
