AHIP - FINAL EXAM Questions with 100%
CORRECT ANSWERS (Verified |
Updated2025/2026 RATED A+
Insurer vs Insured - CORRECT ANSWERS - insurer is a company that provides plan
- insured are the people that buy into the plan
Group health insurance - CORRECT ANSWERS Health coverage provided by employers to
members of a group.
Group health insurance - types of coverage - CORRECT ANSWERS 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
Premium tax-credit - CORRECT ANSWERS 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 - CORRECT ANSWERS can deduct health insurance premiums from their
federal taxable income - important tax savings
contracts/health insurance policy - CORRECT ANSWERS 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 - CORRECT ANSWERS insurance policy will clearly state their covered services
and their exlusions
- proactive, preventative, and reactive services
cost-sharing - CORRECT ANSWERS 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 - CORRECT ANSWERS Money paid out of pocket before insurance
covers the remaining costs.
% of medical bill that insured pays out of pocket
copay - CORRECT ANSWERS a fixed fee you pay for specific medical services
government sponsored plans - CORRECT ANSWERS federal and state gov
* medicare and medicaid
- medicare --> 65+ or younger w/ disabilities or severe kidney problems
- medicaid --> low-income individuals
, employer sponsored plans - CORRECT ANSWERS - employer determines coverage
- company's HR dept answers employee questions
excluded services - CORRECT ANSWERS services not covered in a medical insurance contract
like experimental or non-contracted providers, elective or cosmetic surgery
Health Care Philosophy - CORRECT ANSWERS * 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 - CORRECT ANSWERS 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
CORRECT ANSWERS (Verified |
Updated2025/2026 RATED A+
Insurer vs Insured - CORRECT ANSWERS - insurer is a company that provides plan
- insured are the people that buy into the plan
Group health insurance - CORRECT ANSWERS Health coverage provided by employers to
members of a group.
Group health insurance - types of coverage - CORRECT ANSWERS 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
Premium tax-credit - CORRECT ANSWERS 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 - CORRECT ANSWERS can deduct health insurance premiums from their
federal taxable income - important tax savings
contracts/health insurance policy - CORRECT ANSWERS 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 - CORRECT ANSWERS insurance policy will clearly state their covered services
and their exlusions
- proactive, preventative, and reactive services
cost-sharing - CORRECT ANSWERS 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 - CORRECT ANSWERS Money paid out of pocket before insurance
covers the remaining costs.
% of medical bill that insured pays out of pocket
copay - CORRECT ANSWERS a fixed fee you pay for specific medical services
government sponsored plans - CORRECT ANSWERS federal and state gov
* medicare and medicaid
- medicare --> 65+ or younger w/ disabilities or severe kidney problems
- medicaid --> low-income individuals
, employer sponsored plans - CORRECT ANSWERS - employer determines coverage
- company's HR dept answers employee questions
excluded services - CORRECT ANSWERS services not covered in a medical insurance contract
like experimental or non-contracted providers, elective or cosmetic surgery
Health Care Philosophy - CORRECT ANSWERS * 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 - CORRECT ANSWERS 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
