AHIP - FINAL EXAM Questions and
Answers Graded A+ 2026
Insurer vs Insured - Correct answer-- insurer is a company that provides plan
- insured are the people that buy into the plan
Group health insurance - Correct answer-Health coverage provided by employers
to members of a group.
Group health insurance - types of coverage - Correct 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)
,^ both are employer-sponsored voluntary group plans
Premium tax-credit - Correct 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 - Correct answer-can deduct health insurance premiums
from their federal taxable income - important tax savings
contracts/health insurance policy - Correct 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 - Correct answer-insurance policy will clearly state their covered
services and their exlusions
- proactive, preventative, and reactive services
cost-sharing - Correct 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 - Correct answer-Money paid out of pocket before
insurance covers the remaining costs.
% of medical bill that insured pays out of pocket
copay - Correct answer-a fixed fee you pay for specific medical services
government sponsored plans - Correct 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 - Correct answer-- employer determines coverage
- company's HR dept answers employee questions
excluded services - Correct answer-services not covered in a medical insurance
contract like experimental or non-contracted providers, elective or cosmetic
surgery
Health Care Philosophy - Correct 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 - Correct 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
access: reigning in premium increases and reducing unnecessary care to make
additional provider time available
annual increase in premiums - Correct answer-- result from consumer/government
limitations placed on managed care
Answers Graded A+ 2026
Insurer vs Insured - Correct answer-- insurer is a company that provides plan
- insured are the people that buy into the plan
Group health insurance - Correct answer-Health coverage provided by employers
to members of a group.
Group health insurance - types of coverage - Correct 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)
,^ both are employer-sponsored voluntary group plans
Premium tax-credit - Correct 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 - Correct answer-can deduct health insurance premiums
from their federal taxable income - important tax savings
contracts/health insurance policy - Correct 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 - Correct answer-insurance policy will clearly state their covered
services and their exlusions
- proactive, preventative, and reactive services
cost-sharing - Correct 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 - Correct answer-Money paid out of pocket before
insurance covers the remaining costs.
% of medical bill that insured pays out of pocket
copay - Correct answer-a fixed fee you pay for specific medical services
government sponsored plans - Correct 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 - Correct answer-- employer determines coverage
- company's HR dept answers employee questions
excluded services - Correct answer-services not covered in a medical insurance
contract like experimental or non-contracted providers, elective or cosmetic
surgery
Health Care Philosophy - Correct 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 - Correct 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
access: reigning in premium increases and reducing unnecessary care to make
additional provider time available
annual increase in premiums - Correct answer-- result from consumer/government
limitations placed on managed care
