AHIP FINAL QUIZ QUESTIONS AND CORRECT ANSWERS 2024
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Course
Oncology Nursing
Institution
Oncology Nursing
AHIP FINAL QUIZ QUESTIONS AND CORRECT ANSWERS 2024
AHIP FINAL QUIZ QUESTIONS AND CORRECT ANSWERS 2024
AHIP FINAL QUIZ QUESTIONS AND CORRECT ANSWERS 2024
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
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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