MHA 706 - MODULE 1 PART 2 A&B EXAM QUESTIONS AND
ANSWERS WITH COMPLETE SOLUTIONS VERIFIED
For insurance to "work", it must have these basic characteristics (4)
-pooling of losses
-payment only for random losses
-risk transfer
-Indemnification
Two problems that often arise in insurance
-Adverse selection - there is a risk that those with high risk lifestyles or who are predisposed to have
higher risk are more likely to purchase insurance.
-Moral hazard- is the risk of overuse of healthcare services because the insured does not bear the full
cost of the consequences
Insurers use the following techniques to protect themselves
-deductibles
-copayments
-coinsurance
-stop loss limits
-policy restrictions
Coinsurance
, requires an individual to pay for a certain percentage of the eligible medical expenses.
Stop-loss limit
policy designed to limit the claim or the coverage loss to a specific amount.
Community rating underwriter provision requires
health insurance providers to offer health insurance policies within a given territory, at the same price to
all person without medical underwriting regardless of their health status.
Experience rating underwriter provision is based
on the presumption that your historical loss or expense, predicts future loss or expense.
Under ACA insurers are
requires to use community ratings, and no longer allowed to factor in preexisting conditions.
Medicare provides
medical benefits to individuals aged 65 or older.
Medicare 4 major coverages
-Part A (hospital)
-Part B (physician)
-Part C (managed care)
-Part D (rx drugs)
Medicaid is
federal/state joint program aimed at providing s medical safety-net for low-income mothers and
children.
ANSWERS WITH COMPLETE SOLUTIONS VERIFIED
For insurance to "work", it must have these basic characteristics (4)
-pooling of losses
-payment only for random losses
-risk transfer
-Indemnification
Two problems that often arise in insurance
-Adverse selection - there is a risk that those with high risk lifestyles or who are predisposed to have
higher risk are more likely to purchase insurance.
-Moral hazard- is the risk of overuse of healthcare services because the insured does not bear the full
cost of the consequences
Insurers use the following techniques to protect themselves
-deductibles
-copayments
-coinsurance
-stop loss limits
-policy restrictions
Coinsurance
, requires an individual to pay for a certain percentage of the eligible medical expenses.
Stop-loss limit
policy designed to limit the claim or the coverage loss to a specific amount.
Community rating underwriter provision requires
health insurance providers to offer health insurance policies within a given territory, at the same price to
all person without medical underwriting regardless of their health status.
Experience rating underwriter provision is based
on the presumption that your historical loss or expense, predicts future loss or expense.
Under ACA insurers are
requires to use community ratings, and no longer allowed to factor in preexisting conditions.
Medicare provides
medical benefits to individuals aged 65 or older.
Medicare 4 major coverages
-Part A (hospital)
-Part B (physician)
-Part C (managed care)
-Part D (rx drugs)
Medicaid is
federal/state joint program aimed at providing s medical safety-net for low-income mothers and
children.
