CFP 512 - Module 4 UPDATED ACTUAL
Questions and CORRECT Answers
Events Causing a Change in Coverage - CORRECT ANSWER - Marriage
- Divorce
- Death
- Disability
- Losing or changing jobs
- Reducing the number of hours worked
- Moving (even within the same state)
- Birth: 30 days old
- Age 26
- Age 65
Heath Insurance Portability and Accountability Act of 1996 (HIPAA) - CORRECT
ANSWER Eliminated the previously detrimental aspects of changing jobs and enrolling in
a new employer group health insurance plan that included a pre-existing conditions clause.
Consolidated Omnibus Reconciliation Act of 1985 (COBRA) - CORRECT
ANSWER Provides for continuation of health care benefits when an employee leaves
work (whether voluntary or involuntary).
Patient Protection and Affordable Care Act of 2010 (PPACA) - CORRECT ANSWER law
aims to eliminate barriers on individuals' ability to acquire coverage throughout their lifetime.
Small Business Health Options Program (SHOP) - CORRECT ANSWER Open to
employers (including nonprofit organizations) with fewer than 50 full-time equivalent
employees.
, Medicaid - CORRECT ANSWER a government insurance program for persons of all ages
whose income and resources are insufficient to pay for health care.
Children's Health Insurance Program (CHIP) - CORRECT ANSWER A program that
provides medical insurance for minimal premiums to children from low-income families.
Internal Limits - CORRECT ANSWER excluded treatments or controls that limit the
extent to which certain benefits may be used and paid for by the plan.
Case Management - CORRECT ANSWER another form of utilization review that is used
to control costs and ptimize patient benefits in the treatment of expensive illness such as
diabetes, hypertension, AIDS, cancer, or heart disease.
Deductible - CORRECT ANSWER the initial amount of covered expenses the insured
must pay before the health plan begins to pay.
Coinsurance - CORRECT ANSWER a splitting of the costs of medical care between the
insurance company and the insured.
Maximum-out-of-pocket - CORRECT ANSWER the limit insured will pay out of pocket
for care.
Prepayment plans - CORRECT ANSWER Managed care plans in which payments for
services are negotiated and paid to health care providers.
Capitation fee - CORRECT ANSWER a fixed annual payment for each plan member
regardless of the frequency or type of service provided
Post-payment plans - CORRECT ANSWER pay for covered expenses once they are
incurred
Questions and CORRECT Answers
Events Causing a Change in Coverage - CORRECT ANSWER - Marriage
- Divorce
- Death
- Disability
- Losing or changing jobs
- Reducing the number of hours worked
- Moving (even within the same state)
- Birth: 30 days old
- Age 26
- Age 65
Heath Insurance Portability and Accountability Act of 1996 (HIPAA) - CORRECT
ANSWER Eliminated the previously detrimental aspects of changing jobs and enrolling in
a new employer group health insurance plan that included a pre-existing conditions clause.
Consolidated Omnibus Reconciliation Act of 1985 (COBRA) - CORRECT
ANSWER Provides for continuation of health care benefits when an employee leaves
work (whether voluntary or involuntary).
Patient Protection and Affordable Care Act of 2010 (PPACA) - CORRECT ANSWER law
aims to eliminate barriers on individuals' ability to acquire coverage throughout their lifetime.
Small Business Health Options Program (SHOP) - CORRECT ANSWER Open to
employers (including nonprofit organizations) with fewer than 50 full-time equivalent
employees.
, Medicaid - CORRECT ANSWER a government insurance program for persons of all ages
whose income and resources are insufficient to pay for health care.
Children's Health Insurance Program (CHIP) - CORRECT ANSWER A program that
provides medical insurance for minimal premiums to children from low-income families.
Internal Limits - CORRECT ANSWER excluded treatments or controls that limit the
extent to which certain benefits may be used and paid for by the plan.
Case Management - CORRECT ANSWER another form of utilization review that is used
to control costs and ptimize patient benefits in the treatment of expensive illness such as
diabetes, hypertension, AIDS, cancer, or heart disease.
Deductible - CORRECT ANSWER the initial amount of covered expenses the insured
must pay before the health plan begins to pay.
Coinsurance - CORRECT ANSWER a splitting of the costs of medical care between the
insurance company and the insured.
Maximum-out-of-pocket - CORRECT ANSWER the limit insured will pay out of pocket
for care.
Prepayment plans - CORRECT ANSWER Managed care plans in which payments for
services are negotiated and paid to health care providers.
Capitation fee - CORRECT ANSWER a fixed annual payment for each plan member
regardless of the frequency or type of service provided
Post-payment plans - CORRECT ANSWER pay for covered expenses once they are
incurred
