Self insured plans - Study guides, Class notes & Summaries

Healthcare Financing Correct Ans the system that a society uses to pay for healthcare services. USA does not have a single-payer system like Europe and Canada We have insurance plans which both patients and providers benefit from. (Patient gets a discount while Provider gets reimbursed). Financing increase the demand for service and the supply of professionals. Insurance (Insurer or Underwriter) Correct Ans Protects the insured against risk. Companies do not want to lose money so try to ...

CRCR EXAM WITH CORRECT CHOICES, CERTIFIED AND VERRIFIED What are collection agency fees based on? - CORRECT ANSWER-A percentage of dollars collected Self-funded benefit plans may choose to coordinate benefits using the gender rule or what other rule? - CORRECT ANSWER-Birthday In what type of payment methodology is a lump sum or bundled payment negotiated between the payer and some or all providers? - CORRECT ANSWER-Case rates What customer service improvements might improve the patie...

Interim Coverage - short-term policies that can be purchased on an interim basis when in between jobs or waiting for a new policy to start how is health insurance calculated? - Interest,expense,types of benefits and morbidity, or the expected incidence of sickness or disability within given age group during the given period of time. Health insurance - broad field of insurance plans that provide protection against the financial consequences of illness, accidents, injury and disability What ...

Under a traditional IRA, interest is taxed: Only if withdrawn prior to age 59 1/2 According to the capital gains rate Upon distribution During the accumulation phase - ANSWER-Upon distribution Which of these statements concerning Traditional IRAs is CORRECT? Earnings are not taxable when withdrawn Earnings are taxable when withdrawn Contribution are never tax deductible Contributions are always made by the employer - ANSWER-Earnings are taxable when withdrawn Wh...

According to the RAND Health Insurance Experiment, which variable has the greatest power in explaining health expenditures? A.) Welfare eligibility B.) Prior utilization C.) Physical health (based on self-reported measures) D.) General health (based on self-reported measures) E.) Mental health (based on self-reported measures) - ANSWERB.) Prior utilization A provision in some group life insurance plans that provides for the payment of all or part of the death benefit in the event...

Indiana Navigator Exam Questions and Answers Already Passed Auto Assignment the process by which an individual who does not select a Hoosier Healthwise (HHW) or HIP Managed Care Entity (MCE) at the time of the HHW or HIP application, or within 14 days of the submission of the application, is automatically assigned to a Managed Care Entity (MCE) Certificate of Coverage a list of benefits, services, cost sharing, exclusions, and limits applied by a particular health insurance policy. ...

An organization outside the members of a self-insurance group which, for a fee, processes claims, completes benefits paperwork and often analyzes claims information is known as the: 1) primary administrator (PA). 2) second-party administrator (SPA) 3) third party administrator (TPA) 4) administrator. -Correct Answer According to the NAIC Model Health Insurance Policy Provisions, under the _________________________ provision, the insurer is prohibited from denying a claim on the basis...

Which of the following types of health insurance covers the cost of providing non-medical custodial care to individuals with cognitive problems? A. Disability income insurance B. Long-term care insurance C. Hospital expense coverage D. Medical Expense coverage B All of the following are characteristics of a group health insurance plan EXCEPT: A. Only group members may be covered. B. There is one master contract B. Each person has a policy D. Benefits are essentially the same for al...

ACA requirements for insurers - ANSWER(a) Insurers may no longer exclude members based on preexisting conditions. (b) Insurers may not place annual or lifetime caps on coverage. (c) All fully insured products must comply with a medical loss ratio (MLR) requirement. It mandates that health insurance issuers in the individual and small group markets and in the large group market spend at least 80% and 85% of premiums, respectively, on health care activities (as opposed to administrative func...

Which of the following types of health insurance covers the cost of providing non-medical custodial care to individuals with cognitive problems? A. Disability income insurance B. Long-term care insurance C. Hospital expense coverage D. Medical Expense coverage B All of the following are characteristics of a group health insurance plan EXCEPT: A. Only group members may be covered. B. There is one master contract B. Each person has a policy D. Benefits are essentially the same for al...