CCHI – Insurance Exam 2023/2024 with Complete Solutions Graded A+ Affordable Care Act (ACA)/ Health Care Reform; Obamacare - Correct Answer The comprehensive federal health care reform law enacted in March 2010.Health Insurance - Correct Answer A contract that requires an individual's health insurer to pay some or all of their health care costs in exchange for a premium.Health Insurance Marketplace/ Exchange - Correct Answer State- or federally run and regulated market where an individual can shop, compare, and buy health care coverage.Eligibility requirements - Correct Answer Conditions that must be met in order for an individual or group to be considered eligible for insurance coverage.Open enrollment (period) - Correct Answer A period of time each year when an individual can purchase or change health coverage.Medicaid - Correct Answer Health insurance provided by the government to some low- income people, families and children, pregnant women, the elderly, and people with disabilities. In some states the program covers all adults below a certain income level.Medicaid programs must follow federal guidelines, but coverage and costs may be different from state to state.Children's Health Insurance Program (CHIP) - Correct Answer Health insurance provided by the government to children in families that earn too much money to qualify for Medicaid. In some states, CHIP covers parents and pregnant women. Each state works closely with its state Medicaid program. In many cases, if an individual qualifies for Medicaid your children will qualify for either Medicaid or CHIP.Medicare - Correct Answer A federal health insurance program, administered by the Social Security Administration, that provides health care for most people over 65 and certain other eligible individuals.Health plan - Correct Answer A benefit an individual's employer, union or other group sponsor provides to that individual to pay for their health care services.Secondary coverage - Correct Answer When a person is covered under more than one health insurance plan, this term describes the health insurance plan that provides payment on claims after the primary coverage (i.e. main plan).Managed care - Correct Answer A general term used to describe a variety of health care and health insurance systems that attempt to guide a patient's use of benefits, typically by requiring that a patient coordinate his or her health care through a primary 1 / 2
care physician, or by encouraging the use of a specific network of healthcare providers.The management of health care is intended to keep costs -and monthly premiums- as
low as possible. Examples of managed care plans include:
• Health maintenance organizations (HMOs), • Preferred provider organizations (PPOs), • Exclusive provider organizations (EPOs), and • Point of service plans (POSs).Premium - Correct Answer The amount that must be paid for an individual's health insurance or plan. The individual and/or their employer usually pay it monthly, quarterly or yearly.Dependent - Correct Answer A spouse, child, or domestic partner who is covered under a policyholder or subscriber's plan, depending on applicable law and the plan's terms and conditions.Covered services - Correct Answer Health care services that are included in and paid for by an individual's health insurance or plan.Excluded services - Correct Answer Health care services that an individual's health insurance or plan doesn't pay for or cover.Pre-existing condition - Correct Answer A medical condition that a person has before being enrolled in a health plan.Service area - Correct Answer The geographic area in which a health insurance plan's benefits are made available. Some health insurance plans will not provide coverage outside of a plan's service area.Network - Correct Answer The facilities, providers and suppliers an individual's health insurer or plan has contracted with to provide health care services.Provider - Correct Answer A physician (M.D.- Medical Doctor or D.O.- Doctor of Osteopathic Medicine), health care professional or health care facility licensed, certified or accredited as required by state law.Primary Care Provider/ Physician (PCP) - Correct Answer A physician (M.D. - Medical Doctor or D.O.- Doctor of Osteopathic Medicine), nurse practitioner, clinical nurse specialist or physician assistant, as allowed under state law, who provides, coordinates or helps a patient access a range of health care services.Specialist - Correct Answer A physician specialist focuses on a specific area of medicine or a group of patients to diagnose, manage, prevent or treat certain types of symptoms and conditions. A non-physician specialist is a provider who has more training in a specific area of health care.
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