Ahm 250 - Fall - Part 1 Updated Actual Questions And Correct Answers

AHM 250 - FALL - PART 1 UPDATED ACTUAL QUESTIONS
AND CORRECT ANSWERS

Question:
1. A health plan can best be described as an organization that
Answer:
Integrates the delivery and financing of health care and seeks to manage health care costs, access, and
quality

Question:
2. The earliest versions of health plans appeared
Answer:
In the early 1900s

Question:
3. Which is a very early type of health plan?
Answer:
Prepaid group practice

Question:
4. Which was a provision of the hmo act of 1973?
Answer:
Federally qualified HMOs had access to federal funding

Question:
5. In the 1990s, HMOs were
Answer:
Popular because they held down costs, but people objected to the lack of provider choice

Question:
6. To receive benefits from her plan, Janine must first go to here PCP and remain within her plan's network
for other health services. Janine is most likely covered by a
Answer:
Traditional HMO plan

Question:
7. Jacob must pay $5,000 in health care expenses each year before he receives benefits from his health
plan, but he can use money from a tax-advantaged savings account. Jacob has a
Answer:
Consumer Directed Health Plan

Question:
8. What is the involvement of the state and federal government in health plans?
Answer:
They legislate and regulate in this area and purchase health coverage

,Question:
9. Under the fee-for-service compensation method, healthcare providers have a financial incentive to
provide
Answer:
More services

Question:
10. Which of these do health plans generally seek to replace?
Answer:
Fee for service compensation

Question:
11. A consumer directed health plan seeks to lower premiums through
Answer:
A high deductible

Question:
12. In relation to health plans, over the years the definition of quality
Answer:
Has become broader

Question:
13. Which is an organization accrediting health plans?
Answer:
NCQA

Question:
14. Why is it useful in studying health plans to learn about indemnity insurance?
Answer:
Some features of today's health plans are inherited from indemnity insurance or designated to address its
problems

Question:
15. Andy and his family are cover by his employer's group health insurance policy. Who is the (are) the
policy holder(s) of this policy?
Answer:
The employer

Question:
16. Who pays the premium of an employer sponsored group policy?
Answer:
Employees may pay part or all of the premium, but they do so through the employer.

Question:
17. What happens in adverse selection?

, Answer:
People who need health care enroll in greater numbers than average people

Question:
18. Which employee group is most likely to have a higher than average loss rate?
Answer:
A group made up of mostly women

Question:
19. Which employee group presents a high risk of adverse selection?
Answer:
In Company A, a small percentage of employees enroll

Question:
20. In traditional indemnity health insurance, insureds
Answer:
Can go to any provider they choose

Question:
21. In traditional indemnity health insurance, how are providers compensated?
Answer:
Fee-for-service

Question:
22. Owen pays 20% of the cost of health care services covered by his policy. This describes
Answer:
Coinsurance

Question:
23. Which is not common in traditional indemnity health insurance?
Answer:
Copayment

Question:
24. Coordination of Benefits is designed to
Answer:
Prevent duplication of benefits when a person is covered by more than one health insurance policy

Question:
25. Increased cost sharing
Answer:
All of the above (shifts cost from insurer to insured, can help to lower the level of premium increases,
helps hold down health care expenditures through insured incentives)

Question:
26. According to the text, cost containment helps hold down death insurance premiums primarily by