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Exam (elaborations)

Cigna Terms Exam Questions with Correct Answers

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Cigna Terms Exam Questions with Correct Answers Employee Status: Retiree - Answer-employers may elect to over retirees that are over the age of 65. Less risk because the primary insurer will be medicare. Employee Status: COBRA - Answer-Employers must offer to temporarily prolong coverage after the employees time with the company ends. Employee will have to pay 100% of the premiums. Packaging: Products - Answer-Refers to the network of physicians and health care providers that have agreements in place with an insurer. Packaging: Benefits - Answer-refers to the actual covered services Packaging: Benefit Design - Answer-refers to the copays, deductibles, and out of pocket minimums Packaging: Provider - Answer-used to describe the health professionals who provide the services. physicians, chiropractors. Packaging: Network - Answer-refers to a group of providers or health care facilities that are contracted with Cigna at various negotiated discounts. "in-network" Claims: Claim occurrence - Answer-the patient gets a service from a provider Claims: Claims submission - Answer-the provider submits a claim to the insurance company Claims: Claims Processing - Answer-the insurance processes the claim according to the insured's plan benefits Claims: EOB communication - Answer-Explanation of Benefits. it shows exactly what the insurance company has paid for the service and what will be paid by the health care provider.

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Institution
Cigna
Course
Cigna

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Uploaded on
March 3, 2024
Number of pages
3
Written in
2023/2024
Type
Exam (elaborations)
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Cigna Terms Exam Questions with
Correct Answers
Insurer - Answer-An entity which provides insurance.

Insured - Answer-A person who buys insurance. Also known as a policyholder or a
subscriber.

Contract - Answer-Called the insurance policy. Details conditions and circumstances
under which the insurer will compensate he insured.

Premium - Answer-The amount of money charged by the insurer to the insured for
coverage.

Name the 4 Core Insurance Principles - Answer-Pooling of Losses, Spread of Risk,
Fortuitous Loss, Adverse Selection.

Pooling of losses - Answer-"law of large numbers" The larger the population the easier it
is to predict future losses. It helps to create more precise premium rates.

Spread of Risk - Answer-as the group gets bigger the insurer can more accurately
predict future losses within a group.

Fortuitous Loss - Answer-a loss that is unforeseen and unexpected.

Adverse Selection - Answer-the social phenomenon where persons with higher than
average risk seek greater insurance than those with less risk. Must be mitigated by
underwriting.

Eligibility - Answer-describes the employee population that is permitted to elect or
decline coverage. Full time= 30+ hours p/w

Subscriber - Answer-The primary policy holder

Customers - Answer-all covered employees and their dependents.

Dependents - Answer-coverage will generally be offered to an employee's legal spouse
and dependent children up to the age of 26 (PPACA)

Employee Status: Active - Answer-and subscriber that is currently enrolled in coverage.

Employee Status: Waiting periods - Answer-the period time which must pass before
some or all healthcare coverage can begin. ACA says it has to be less than 90 days.

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