HSA 3111 EXAM 1 2025 UPDATE!!
What 3 things around WW2 brought insurance to the US - ANSWER1.Women
offered insurance to work
2.Leading cause for insurance in US Organized labor was given the right to
negotiate (allowed to strike)
3.Taxes. Provide insurance to employers then they would get a tax deductible
Who is a gatekeeper? - ANSWERPrimary Care
What does HIPAA do? - ANSWERProtect
Telemedicine technology that allows a specialist located at a distance to directly
interview and examine a patient is referred to as: - ANSWERSynchronous
(back and forth like live feed two-way)
Why is the US system a mess? - ANSWERIt is all about the 3rd party--insurance and
$$$
What is risk? - ANSWERThe possibility of a substantial financial loss from some
event
what is the #1 reason for bankruptcy in the US? - ANSWERmedical bills
Components of risk - ANSWERunpredictable
key component to insurance
can be predicted with a reasonable degree
Risk Averse - ANSWERIf everyone pays $200 to insurance then you can pay the
cost of getting sick. People are more risky when they have insurance
Deciding whether to pay a low or high premium - ANSWERVery Sick: high premium
because they know they will need to see a doctor meaning they will meet their
deductible and the health insurance will pay the bills
Capitation - ANSWER"per head"
has the potential to lower premiums
What is the most restrictive type of health insurance? - ANSWERMCO.
The most restrictive of the MCO is HMO
What has a strong gatekeeper? - ANSWERHMO
Diff between HMO and PPO - ANSWERHMO: contract w/ certain doctors. If you go
out of the network you have to pay
PPO: you can choose the doctor
, Pooling of losses - ANSWERpool money together to pay for a risky persno
payment only for random losses (accident)
risk has to be transferred (to insurance company away from ourselves)
What happens when health insurance companies have people with pre existing
conditions? - ANSWERRaise their premiums and rates
Why would you want to have cost sharing? What will it reduce? - ANSWERReduces
utilization
Managed care is trying to control what? And act as a what? - ANSWERcontrol
utilization
Act as a gatekeeper
ex. Join our HMO or PPO so you agree to go to doctors on our list and you pay if you
dont go to one approved by us
What drives payment structure? - ANSWERcoding
Hill-Burton Act - ANSWERGave us all these hospitals in the US. Need equal access
for everybody. Rural didnt have access as much as urban areas
Why are some rural hospitals suffering because of the ACA? - ANSWERMore
people that need to be covered
Insurance companies (third party providers) would be interested in controlling...? -
ANSWERUtilization
Who does not want cost sharing? - ANSWERThe insured
The ACA is primarily what? - ANSWERsocial justice
Insurance is not based on one person it is based on what? - ANSWERa group
Adverse Selection - ANSWERInsurance companies are not covering sick and
disabled
(under ACA this is changed)
Community Rating - ANSWERThe basis of ACA. Cant kick people out with existing
conditions. When setting premiums for a group you adjust for the healthy and sick
within the group
A company has received a letter from an insurance company. Raising premiums by
X amount. What could the company do to reduce their costs? - ANSWERShift the
burden (cost increase) to the employee
What is under the umbrella of an MCO? - ANSWERHMO and PPO
What type of companies have self insurance? - ANSWERLarge companies
What 3 things around WW2 brought insurance to the US - ANSWER1.Women
offered insurance to work
2.Leading cause for insurance in US Organized labor was given the right to
negotiate (allowed to strike)
3.Taxes. Provide insurance to employers then they would get a tax deductible
Who is a gatekeeper? - ANSWERPrimary Care
What does HIPAA do? - ANSWERProtect
Telemedicine technology that allows a specialist located at a distance to directly
interview and examine a patient is referred to as: - ANSWERSynchronous
(back and forth like live feed two-way)
Why is the US system a mess? - ANSWERIt is all about the 3rd party--insurance and
$$$
What is risk? - ANSWERThe possibility of a substantial financial loss from some
event
what is the #1 reason for bankruptcy in the US? - ANSWERmedical bills
Components of risk - ANSWERunpredictable
key component to insurance
can be predicted with a reasonable degree
Risk Averse - ANSWERIf everyone pays $200 to insurance then you can pay the
cost of getting sick. People are more risky when they have insurance
Deciding whether to pay a low or high premium - ANSWERVery Sick: high premium
because they know they will need to see a doctor meaning they will meet their
deductible and the health insurance will pay the bills
Capitation - ANSWER"per head"
has the potential to lower premiums
What is the most restrictive type of health insurance? - ANSWERMCO.
The most restrictive of the MCO is HMO
What has a strong gatekeeper? - ANSWERHMO
Diff between HMO and PPO - ANSWERHMO: contract w/ certain doctors. If you go
out of the network you have to pay
PPO: you can choose the doctor
, Pooling of losses - ANSWERpool money together to pay for a risky persno
payment only for random losses (accident)
risk has to be transferred (to insurance company away from ourselves)
What happens when health insurance companies have people with pre existing
conditions? - ANSWERRaise their premiums and rates
Why would you want to have cost sharing? What will it reduce? - ANSWERReduces
utilization
Managed care is trying to control what? And act as a what? - ANSWERcontrol
utilization
Act as a gatekeeper
ex. Join our HMO or PPO so you agree to go to doctors on our list and you pay if you
dont go to one approved by us
What drives payment structure? - ANSWERcoding
Hill-Burton Act - ANSWERGave us all these hospitals in the US. Need equal access
for everybody. Rural didnt have access as much as urban areas
Why are some rural hospitals suffering because of the ACA? - ANSWERMore
people that need to be covered
Insurance companies (third party providers) would be interested in controlling...? -
ANSWERUtilization
Who does not want cost sharing? - ANSWERThe insured
The ACA is primarily what? - ANSWERsocial justice
Insurance is not based on one person it is based on what? - ANSWERa group
Adverse Selection - ANSWERInsurance companies are not covering sick and
disabled
(under ACA this is changed)
Community Rating - ANSWERThe basis of ACA. Cant kick people out with existing
conditions. When setting premiums for a group you adjust for the healthy and sick
within the group
A company has received a letter from an insurance company. Raising premiums by
X amount. What could the company do to reduce their costs? - ANSWERShift the
burden (cost increase) to the employee
What is under the umbrella of an MCO? - ANSWERHMO and PPO
What type of companies have self insurance? - ANSWERLarge companies
