Question

The market segments for an MCO as defined by ACA are:

Group and individual.

Individual, employer group and private purchase.

Individual, small employer group and large employer group.

None of the above.

Estimating current medical claim liabilities and future medical expenses are the most important task of actuaries.

True

False

Private insurance exchanges are the same as under the ACA.

True

False

Under the ACA, no group or individual can be denied coverage as long as they enroll during open enrollment period or based on a "life event" as long as they have paid previous premiums and not committed fraud.

True

False

An underwriter considers all of the following factors in calculating a premium EXCEPT:

actuarial projections

risk level assessment

type of product (HMO, PPO, etc.)

None of the above. All of the above are considered in a premium calculations.

Answer 1

Question 1. The answer is option C. Individual, small employer group and large employer group

Question 2. The answer is TRUE, estimating mediclaim liabilities and future medical expenses are the most important tasks of actuaries

Question 3. The answer is TRUE. Private exchanges are the same as exchanges under the ACA.

Question 4. The answer is TRUE. Under the ACA, no group or individual can be denied coverage as long as they enroll during open enrollment period or based on a "life event" as long as they have paid previous premiums and not committed fraud is definitely true, as they have complete rights because they paid the premiums previously

Question 5. The answer is option D. None of the above. All of the above are considered in a premium calculations. As risk level assessment, actuarial projections etc all will be considered for premium calculations