Actuarial Analyst Health Insurance Coverage Options Assignment Set Nine
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D.A. Degree College for Women**We aren't endorsed by this school
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ACCOINTUN JJN
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Accounting
Date
Dec 17, 2024
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3
Uploaded by LieutenantFangLemur47
Actuarial Analyst Health Insurance Coverage Options Assignment Set Nine1.Which of the following best describes a Health Maintenance Organization (HMO)?–A) A plan that allows members to see any healthcare provider without a referral–B) A plan that requires members to choose a primary care physician and get referrals for specialists–C) A plan that offers coverage only for emergency services–D) A plan that pays for services rendered by out-of-network providers at a higher rate2.What is a key feature of Preferred Provider Organizations (PPOs)?–A) Higher out-of-pocket costs for in-network providers–B) No need for a primary care physician–C) Mandatory referrals for specialists–D) Coverage limited to in-network services3.In the context of actuarial analysis, what does the term 'risk adjustment' refer to?–A) Modifying the premium rates based on the health status of the insured–B) Adjusting the benefits offered in a health insurance plan to reduce costs–C) Using statistical models to predict the likelihood of claims–D) Increasing the deductible to lower premiums4.When evaluating a new health insurance plan, which factor is most important for determining its sustainability?
–A) Marketing strategies and promotional offers–B) The expected medical loss ratio–C) The number of enrollees in the first year–D) The popularity of the plan among healthcare providers5.What role does 'actuarial value' play in health insurance plans?–A) It measures the total cost of premiums over a policy’s lifetime–B) It indicates the percentage of total healthcare expenses that a plan will cover–C) It represents the expected number of claims per year–D) It defines the amount of out-of-pocket maximums for policyholders6.Which of the following is a common method to control costs in health insurance plans?–A) Increasing the number of covered services–B) Implementing high-deductible health plans (HDHPs)–C) Offering unlimited out-of-pocket expenses–D) Reducing the number of in-network providers7.What is the primary purpose of conducting a benefit design analysis in health insurance?–A) To maximize the number of claims processed–B) To determine the most attractive premiums for customers–C) To balance cost-sharing features while meeting regulatory requirements–D) To ensure that all healthcare providers are covered8.In actuarial terms, what does 'moral hazard' imply in health insurance?–A) The risk of policyholders underutilizing healthcare services
–B) The tendency for insured individuals to engage in riskier health behaviors–C) The likelihood that policyholders will overuse medical services when they have coverage–D) The potential for fraudulent claims to increase9.Which of the following best describes a High Deductible Health Plan (HDHP)?–A) A plan that has a low premium and high out-of-pocket costs–B) A plan that covers all medical expenses with no deductible–C) A plan that requires a high deductible before coverage kicks in, often paired with Health Savings Accounts (HSAs)–D) A plan that offers unlimited access to specialists without any cost-sharing10.What is the significance of the Affordable Care Act (ACA) in health insurance coverage options?–A) It eliminated the need for actuarial analyses in health plans–B) It introduced mandates for essential health benefits and protections for pre-existing conditions–C) It allowed insurers to deny coverage based on age and gender–D) It reduced the overall number of health insurance providers in the market