Traditional insurance concepts

Question 1

Most individuals over age 65 are covered by

Answer 1

government (medicare)

Question 2

What are the other people who aren’t on medicare?

Answer 2

medicaid (for those qualified)
Uninsured
Private insurance (group/self)

Question 3

Key players in insurance?

Answer 3

Consumers
Providers
Insurance companies
Employers

Question 4

possibility of substantial financial loss from event which probability of occurrence is small?

Answer 4

risk

Question 5

Purpose of health insurance?

Answer 5

to pool people together to spread cost generated by small number of ppl

Question 6

Fundemental principles of insurance

Answer 6

1: Risk unpredictable to individual
2: risk can be predicted in group
3: risk transferred from infividual to group by pooling of resources
4: all members share losses

Question 7

Requirement that insurance be sold without regard to health status?

Answer 7

guaranteed issue

Question 8

Premiums determined by groups own medical claims experience ?

Answer 8

experience rating

Question 9

Risk spreading among members, premiums set without regard to health status, determined by utilization experience of larger community

Answer 9

community rating

Question 10

what are the 3 risk options for insurance?

Answer 10

guaranteed issue
experience issue
community rating

Question 11

When less healthy people disproportionately enroll in riskk pool of health insurance?

Answer 11

adverse selection.

Question 12

Process insurers use to evaluate risk of applicants?

Answer 12

medical underwriting

Question 13

Charging premiums based on individuals likely healthcare needs?

Answer 13

risk-based rating

Question 14

coverage exclusion, high cost sharing, cherry picking

Answer 14

benefit design

Question 15

how do insurers manage adverse selection?

Answer 15

Medical underwriting
Pre-existing condition exclusion
Risk-based rating
Benefit design

Question 16

Who are people always denied?

Answer 16

Cancer
HIV
Diabetes
MS
Pregnancy
Stroke

Question 17

Who are people often denied?

Answer 17

Overweight
History of cancer
HTN
Asthma

Question 18

who are sometimes denied?

Answer 18

Acne

Hay fever

Question 19

Coverage options can change with

Answer 19

loss/change of job
change in family status
Birthday
Moving
change in health

Question 20

types of covered benefits?

Answer 20

ACA:Essential benefits
mandated benefits
benefit limit

Question 21

Types of cost-sharing?

Answer 21

deductibles, co-pays, co-insurance

Question 22

Terms of coverage include

Answer 22

Provider networks

care authorization/review

Question 23

Cost of health insurance costs depend on

Answer 23

who is covered
Whats covered
Insurer profits
Subsidies
inflation

Question 24

This applies to job-based plans sponsored by employers with >20 employees

Answer 24

Cobra federal law

Question 25

under cobra law, what is the temporary continuation of coverage after event?

buy why does it get costly?

Answer 25

losing job: 18 months
change in family: 36 months
Disability: 29 months

employer premium contribution not required.

Question 26

Why are there entitlement programs?

Answer 26

groups at risk unable to access employer-based health care

Question 27

What are groups that apply for entitlement programs?

Answer 27

Elderly and poor

Question 28

Types of military coverage

Answer 28

US department of defense
Military treatment facilities
TRICARE: managed HC plan

Question 29

Veterans coverage covers

Answer 29

veterans and family .

giving access to services determined by assigned priority levels.

Question 30

Military and veterans coverage are 2 different systems funded by

Answer 30

Congressional action.

conflict between 2

Question 31

insurance for current and retired federal employees and families?

Answer 31

Federal employee health benefits program (FEHBP)

Question 32

Indian healthcare provider?

Answer 32

Indian health services.

Question 33

Partnership between federal and states to provide health insurance coverage for targeted low-income children under 19 who are not eligible for medicaid?

Answer 33

State children health insurance program (CHIP)

Question 34

Who has oversight of CHIP and what do they do?

Who designs it?

Answer 34

CMS

establish broad eligibility and benefit guidelines.

state designs it.