Deeagles - Stuvia US
AHIP - FINAL EXAM | 141 QUESTIONS &
100% CORRECT ANSWERS (VERIFIED) |
LATEST UPDATE | GRADED A+ |
ALREADY GRADED
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)
, Deeagles - Stuvia US
^ both are employer-sponsored voluntary group plans
Premium tax-credit
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)
self employed workers
ANSWER: can deduct health insurance premiums from their federal taxable
income - important tax savings
contracts/health insurance policy
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)
Covered services
ANSWER: insurance policy will clearly state their covered services and their
exlusions
- proactive, preventative, and reactive services
cost-sharing
, Deeagles - Stuvia US
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
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 w/ disabilities or severe kidney problems
- medicaid --> low-income individuals
employer sponsored plans
ANSWER: - employer determines coverage -
company's HR dept answers employee questions
, Deeagles - Stuvia US
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
managed care improves cost/access/quality
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
AHIP - FINAL EXAM | 141 QUESTIONS &
100% CORRECT ANSWERS (VERIFIED) |
LATEST UPDATE | GRADED A+ |
ALREADY GRADED
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)
, Deeagles - Stuvia US
^ both are employer-sponsored voluntary group plans
Premium tax-credit
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)
self employed workers
ANSWER: can deduct health insurance premiums from their federal taxable
income - important tax savings
contracts/health insurance policy
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)
Covered services
ANSWER: insurance policy will clearly state their covered services and their
exlusions
- proactive, preventative, and reactive services
cost-sharing
, Deeagles - Stuvia US
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
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 w/ disabilities or severe kidney problems
- medicaid --> low-income individuals
employer sponsored plans
ANSWER: - employer determines coverage -
company's HR dept answers employee questions
, Deeagles - Stuvia US
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
managed care improves cost/access/quality
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
