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PSI EXAM REVIEW QUESTIONS WITH COMPLETE ANSWERS
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PSI EXAM REVIEW QUESTIONS WITH COMPLETE ANSWERS
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PSI EXAM REVIEW QUESTIONS WITHCOMPLETE ANSWERS
Coinsurance - Answer-refers to a co-sharing agreement that is between an insured and
an insures which provides that the insured will pay for a certain percentage of the
covered expenses incurred.
Non-Contributory - Answer-In a non-contributory plan, the employer pays the entire
amount of the premium. Therefore, all eligible employees in the group must enroll in the
group insurance plan. Employee Retirement Income Security Act (ERISA) The acronym
ERISA stands for the Employee Retirement Income Security Act of 1974. This act
protects the retirement assets of Americans by implementing rules that qualified
retirement plans must follow in order to ensure that plan fiduciaries do not misuse plan
assets. This act is the more important federal standard in place for employee benefits.
Although ERISA does not
COBRA - Answer-As previously discussed, COBRA stands for the Consolidated
Omnibus Reconciliation Act. This act, passed in 1986, provides continuing coverage of
group health insurance benefits to employees and their qualifying dependents upon the
occurrence of certain qualifying events where the coverage would otherwise be
terminated.
Americans with Disabilities Act (ADA) - Answer-The Americans with Disabilities Act was
passed in 1990. This act prohibits discrimination against people who have disabilities.
Under the ADA, discrimination against a disabled person is illegal in employment, public
accommodations, transportation, communications, and government activities.
Patient Protect and Affordable Care Act (PPACA) - Answer-AKA THE ACT - also
referred to simply as the Affordable Care Act - was enacted on March 23, 2010. This
Act is now a federal law with a focus on ensuring that all Americans have access to
quality and affordable health care. Along with its focus on access to quality and
affordable care, the Patient Protection and Affordable Care Act helps in containing the
overall cost of health care for both individuals and the health care system alike.
Eligibility for Medi-Cal - Answer-includes individuals age 19 through 64 qualifying with
household income up to 138 percent of the Federal Poverty Level (FPL). Children under
age 19 qualify if household income is up to 266 percent FPL
MAGI - Answer-Modified Adjusted Gross Income.
MAGI eligibility for CSR - Answer-consumers qualify for varying CSRs between 138 and
250 percent FPL
Guaranteed Issue - Answer-The guaranteed issue laws require insurance companies to
issue a health plan to any applicant - regardless of the applicant's health status or other
,factors. In the small group market, HIPAA (the Health Insurance Portability and
Accountability Act) requires all health plans for small groups - employers with 2 to 50
employees - to be guaranteed issue.
Cost Sharing Reductions - Answer-Eligible Californians who buy health care coverage
through an exchange will have a cap on their total out-of-pocket spending, including
deductibles, co- payments, and coinsurance. These limits are based on the out-of-
pocket limits that apply to high deductible plans used with Health Savings Accounts.
People with incomes under 400% of the Federal Poverty Level (FPL) will get subsidies
to lower those caps based on their incomes.
Define Health Plan Metal Tiers - Answer-The metal plans are distinguished from one
another by their "actuarial value." Actuarial value refers to the average amount of
insurance expenses that would be paid for by the plan. The higher the actuarial value of
a plan, the lower the out-of- pocket costs for the plan member. With respect to the plan
names, the most expensive the metal, the higher the actuarial value. For example, the
Platinum Plan covers 90% of covered medical expenses, while a Bronze Plan only
covers 60%.
Bronze Plan - Answer-The Bronze Plan is intended to have the lowest premium, and
charge the highest out-of-pocket costs for health care services. With this plan,
insurance companies will typically pay 60% of covered health care expenses, with the
remaining 40% to be paid by consumers.
Silver Plan - Answer-The Silver Plan has the insurance company pay 70% of covered
health care expenses, and the remaining 30% of expenses are paid out-of-pocket by
the policy holder
Gold Plan - Answer-The Gold Plan has the insurance company pay 80% of covered
health care expenses, and the remaining 20% of expenses are paid out-of-pocket by
the policy holder.
Platinum Plan - Answer-The Platinum Plan has the insurance company pay 90% of the
covered health care expenses, and the remaining 10% will be paid by the policy holder
out-of- pocket.
MLR - Answer-Medical Loss Ratio requires that health insurers in the group or individual
market - including plans that are grandfathered - provide an annual rebate to enrollees if
the insurer's "medical loss ratio" fails to meet minimum requirements of 85% in group
and 80% in individual markets.
Benefits - Answer-Plans a - coinsurance for hospital days and cost of 365 more hospital
days in lifetime. Pan B - 20% of doctor bills and 50% mental health services, first three
pints of blood. Plans A-L offer basic benefits along with various additions depending on
the medigap plan. M and N just added.
, Which part of Medicare covers prescription drugs? - Answer-Part D
Which part of Medicare helps to pay for doctors' services? - Answer-Part B
Medicare Part C - Answer-combines Part A and Part B. Private insurance companies
approved by Medicare provide this coverage. Generally, an insured must see doctors in
the plan, however, their costs may be lower than in Medicare Parts A and B, and they
may get extra benefits.
Medicare Part C is also referred to as - Answer-"Medicare Advantage" and works
similar to an HMO or PPO plan.
Medicare Part C plans include - Answer-Medicare Preferred Provider Organization
(PPO) Plans - Medicare Advantage PPO plans also provide a network of doctors and
health care providers for their members.
Medicare Health Maintenance Organization (HMO) Plans - Answer-A Medicare
Advantage HMO plan will typically require that members receive their health care
services from in- network providers and facilities. Patients may not be covered if they
receive service from outside of the network, unless they first receive a referral from their
primary care doctor.
Medicare Part A - Answer-Hospital Insurance
Medicare PPO - Answer-also provide a network of doctors and health care providers.
Still covered if they receive out of network services.
Medicare HMO - Answer-in-ntwork providers and facilitates. may not be covered if they
receive service from outside the network, unless receive referral.
Medicare PFFS plans - Answer-Private Fee-For-Service plans. Can go to Medicare
approved hospital or health care provider. Insurance plan decides how much it will pay
rather than medicare.
Medicare SNP - Answer-Special needs plan. Specialized Medicare Advantage plan.
limit their members to specific groups. People who reside in institutions, nursing homes
or nursing care at home, those eligible for medicare and medicaid benefits and are
known as dual eligibles (Medi-Medi), individuals with certain chronic or disabling health
conditions, heart failure, cardiovascular disease, HIV or diabetes.
Medicare ESRD - Answer-cannot enroll with Medicare advantage plan if they have
ESRD and dialysis
Enrollment in a stand-alone prescription drug plan will... - Answer-automatically
terminate an individuals enrollment in a medicare advantage plan.
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