AHIP - FINAL EXAM QUESTIONS AND ANSWERS 100% CORRECT AND ACCURATE!

Insurer vs Insured - ANSWER- insurer is a company that provides plan - insured are the people that buy into the plan Group health insurance - ANSWERHealth coverage provided by employers to members of a group. Group health insurance - types of coverage - ANSWERYou 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 - ANSWERa 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 - ANSWERcan deduct health insurance premiums from their federal taxable income - important tax savings contracts/health insurance policy - ANSWERbetween 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 - ANSWERinsurance policy will clearly state their covered services and their exlusions - proactive, preventative, and reactive services Deductible/coinsurance - ANSWERMoney paid out of pocket before insurance covers the remaining costs. % of medical bill that insured pays out of pocket copay - ANSWERa fixed fee you pay for specific medical services government sponsored plans - ANSWERfederal and state gov * medicare and medicaid - medicare -- 65+ or younger w/ disabilities or severe kidney problems - medicaid -- low-income individuals employer sponsored plans - ANSWER- employer determines coverage - company's HR dept answers employee questions excluded services - ANSWERservices not covered in a medical insurance contract like experimental or non-contracted providers, elective or cosmetic surgery Health Care Philosophy - 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