Cebs gba 2 stuvia 2024 - Study guides, Class notes & Summaries

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...

Categorize the broad approaches to health care reimbursement methodologies. - ANSWERA limited number of payment methodologies are used to reimburse providers. Payment methodologies fall into two broad classifications: fee-for-service and capitation. Under fee-for-service, of which many variations exist, the greater the amount of services provided, the higher the amount of reimbursement. Under capitation, a fixed payment is made to providers for each covered life, or enrollee, independent of the ...

Sick pay - ANSWERWith the exception of a few jurisdictions that mandate nonoccupational disability insurance, employers have had no statutory responsibility to pay individuals who are sick or injured and missing work for reasons other than those that qualify for workers' compensation benefits. This regulatory landscape is slowly shifting as states and cities enact laws mandating paid sick leave. Salary continuation program - ANSWERA salary continuation program is an informal program th...

attraction of private exchanges for employers - ANSWEROne big attraction of private exchanges for employers is the opportunity to change from a traditional premium contribution model, where the employer typically pays 75-80% of the premium, or premium equivalent rate, to a defined contribution model. Because private exchanges provide a wider array of choices to employees, the employer can more easily change from the traditional contribution model to a defined contribution model where a flat...

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...

ACA's guaranteed availability of insurance raise concerns of adverse selection, why? - ANSWERWith the guaranteed availability of insurance, consumers who are most in need of health care may be more likely to purchase insurance. Such an outcome would create an adverse selection problem. It could lead to higher average premiums, thereby disrupting the insurance market and undermining the goals of reform. Uncertainty about the health status of enrollees could also make insurers cautious abou...

Adjusted community rating - ANSWERNot giving credit to a plan for favorable risk attributes associated with a healthy population. This makes health insurance more affordable for those with higher risk. Administrative enhancements when opting to self-fund - ANSWERMore transparency and use of bundled pricing and direct contracting to reduce claims costs Aggregate stop-loss insurance - ANSWERThis policy caps how much an employer is obligated to pay for all its claims across a full plan year. ...