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AHIP FINAL QUIZ QUESTIONS AND CORRECT ANSWERS 2024

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AHIP FINAL QUIZ QUESTIONS AND CORRECT ANSWERS 2024 AHIP FINAL QUIZ QUESTIONS AND CORRECT ANSWERS 2024 AHIP FINAL QUIZ QUESTIONS AND CORRECT ANSWERS 2024

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  • September 6, 2024
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  • 2024/2025
  • Exam (elaborations)
  • Questions & answers
  • Oncology Nursing
  • Oncology Nursing
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AHIP FINALQUIZ QUESTIONS AND CORRECT
ANSWERS

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

- other factors: higher provider fees, increased use of tech in delivery of care, health care fraud and
other admin costs



Provider network - Correct Answer: * to assure quality/cost control and addressing population health
issues



1. closed network (specific providers)

2. open network (not set of providers)

3. defined network w/ out-of-network coverage

(specific providers but any out-of-network services = larger portion of costs)



quality control - credentialing providers (Verify and review licenses to avoid malpractices)

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