Podcast
Play an AI-generated podcast conversation about this lesson
Questions and Answers
Which action will an insurance company take if an applicant, who has diabetes, applies for a Disability Income policy?
Which action will an insurance company take if an applicant, who has diabetes, applies for a Disability Income policy?
- Issue the policy with a rating (correct)
- Decline the applicant (correct)
- Issue the policy with a diabetes exclusion (correct)
Which of the following are managed care organizations? (Select all that apply)
Which of the following are managed care organizations? (Select all that apply)
- Fee-for-Service plan
- Health Maintenance Organization (HMO) (correct)
- Preferred Provider Organization (PPO) (correct)
- Point-of-Service plan (POS) (correct)
Which of the following BEST describes how pre-admission certifications are used?
Which of the following BEST describes how pre-admission certifications are used?
Used to prevent nonessential medical costs
Which type of plan normally includes hospice benefits?
Which type of plan normally includes hospice benefits?
Signup and view all the answers
Pre-hospitalization authorization is considered an example of what?
Pre-hospitalization authorization is considered an example of what?
Signup and view all the answers
Flashcards are hidden until you start studying
Study Notes
Health Insurance Underwriting Overview
- Insurance companies may issue a Disability Income policy to an applicant with diabetes under specific conditions:
- Policy can include a diabetes exclusion.
- The applicant may receive a higher rating based on risk factors.
- The policy may be declined altogether depending on the assessment of risk.
Managed Care Organizations
- Three primary types of managed care organizations include:
- Point-of-Service (POS) plan: Offers flexibility in choosing healthcare providers.
- Preferred Provider Organization (PPO): Allows access to a network of preferred providers and covers out-of-network services at a higher cost.
- Health Maintenance Organization (HMO): Requires members to choose a primary care physician and get referrals for specialists.
Pre-Admission Certifications
- Pre-admission certifications help manage healthcare costs by:
- Assessing the necessity of planned medical treatments before they occur.
- Aiming to eliminate nonessential medical expenses.
Hospice Benefits in Plans
- Managed care plans are typically designed to include hospice benefits, which provide support for terminally ill patients and their families.
Pre-Hospitalization Authorization
- Pre-hospitalization authorization is a requirement from insurers:
- It serves as approval before an insured individual can be admitted to a hospital.
- This process is a tool for insurers to control and manage healthcare costs effectively.
Studying That Suits You
Use AI to generate personalized quizzes and flashcards to suit your learning preferences.
