AHIP Final UPDATED ACTUAL Exam Questions and CORRECT Answers | Guaranteed Pass

AHIP Final UPDATED ACTUAL Exam Questions and CORRECT
Answers | 100% Verified

Question 1.
Group health insurance

Correct Answer: Health coverage provided by employers to members of a
group.


Question 2.
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


Question 3.
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)


Question 4.
self employed workers

Correct Answer: can deduct health insurance premiums from their federal
taxable income - important tax savings


Question 5.
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)


Question 6.
Covered services

Correct Answer: insurance policy will clearly state their covered services and
their exlusions - proactive, preventative, and reactive services

,Question 7.
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


Question 8.
Deductible/coinsurance

Correct Answer: Money paid out of pocket before insurance covers the
remaining costs.
% of medical bill that insured pays out of pocket


Question 9.
copay

Correct Answer: a fixed fee you pay for specific medical services
• government sponsored plans -✓✓federal and state gov * medicare and
medicaid - medicare --> 65+ or younger w/ disabilities or severe kidney
problems - medicaid --> low-income individuals


Question 10.
employer sponsored plans

Correct Answer: - employer determines coverage - company's HR dept
answers employee questions


Question 11.
excluded services

Correct Answer: services not covered in a medical insurance contract like
experimental or non-contracted providers, elective or cosmetic surgery


Question 12.
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

, Question 13.
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


Question 14.
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


Question 15.
Provider network

Correct Answer: * to assure quality/cost control and addressing population
health issues
1. closed network (specific providers)
2. open network (not set of providers)
3. defined network w/ out-of-network coverage (specific providers but any
out-of-network services = larger portion of costs) quality control -
credentialing providers (Verify and review licenses to avoid malpractices)
cost control - negotiate fee payments w/ in-network providers = high patient
volume for lower per-unit costs * makes costs of plans more predictable
addressing population health issues - focus network on certain population
issues such as obesity - providers do this w/ communication or w/
action/outcome based payment incentives


Question 16.
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


Question 17.
Clinical quality

Correct Answer: * determines health plans medical policies, determines what
the right care is, determines timing of right care - turn data into quality