Health Insurance Fundamentals: Types, Risks, and Payment Models Exam UPDATED ACTUAL QUESTIONS AND CORRECT ANSWERS

Health Insurance Fundamentals: Types,
Risks, and Payment Models Exam
UPDATED ACTUAL QUESTIONS AND
CORRECT ANSWERS
Capitation - CORRECT ANSWER A form of reimbursement that pays the provider a flat fee
for a set period.



Coordination of Benefits - CORRECT ANSWER Common situation in marriages where both
spouses have employment-based insurance.



Primary Coverage - CORRECT ANSWER Policy by insured person seeking services.



Secondary Coverage - CORRECT ANSWER Other coverage when there is primary coverage.



Birthday Rule - CORRECT ANSWER For children with dual parent coverage, the insured
parent whose birthday is the earliest is the primary insurer.



Actuarial Adjustment - CORRECT ANSWER Actuarial analysis considers demographic factors
and past medical care utilization rates.



Moral Hazard - CORRECT ANSWER Insurance problem caused by financially irresponsible
behavior regarding insurance.



First-Dollar Coverage - CORRECT ANSWER Coverage that begins at the start of the plan year.



Deductible - CORRECT ANSWER Amount of money to be paid out of pocket by the
beneficiary.



Co-Payment - CORRECT ANSWER A flat fee paid by the beneficiary each time a health care
service is utilized.