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Free PHIAS — Professional, Health Insurance Advanced Studies Exam Questions and Answers
Last updated: March 29, 2025
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PHIAS — Professional, Health Insurance Advanced Studies
#Question
170. Which of the following is a common challenge faced in managing high-risk populations?
A.
Balancing treatment costs
B.
All of the above
C.
Keeping patients informed
D.
Ensuring compliance
Correct Answer:
B
Managing high-risk populations involves balancing treatment costs, ensuring patient compliance, and keeping patients informed about their healthcare options.
#Question
169. What does "medical necessity" imply?
A.
Providers can deny access
B.
None of the above
C.
Coverage is never guaranteed
D.
Treatment is essential for health
Correct Answer:
D
Medical necessity signifies that specific medical services are essential for diagnosing or treating a health condition, affecting coverage decisions.
#Question
168. Under what conditions can insurance companies limit benefits?
A.
Poor financial performance
B.
All of the above
C.
Insurance fraud
D.
Excessive treatment
Correct Answer:
B
Insurers can limit benefits based on various factors, including excessive treatment, claims made for fraudulent reasons, and fiscal performance metrics.
#Question
167. How do discounts on premium rates for non-smokers work?
A.
None of the above
B.
Non-smokers receive low rates
C.
Discounts are mandatory
D.
All smokers pay the same
Correct Answer:
B
Many health plans offer premium discounts for non-smokers, rewarding healthier lifestyle choices and reducing associated risks.
#Question
166. Why do health plans typically perform audits?
A.
To ensure regulatory compliance
B.
None of the above
C.
To lower operational expenses
D.
To increase administrative costs
Correct Answer:
A
Health plans perform audits to ensure compliance with regulatory standards and verify the accuracy of claims and reports.
#Question
165. What is the significance of the term "adjusted community rating"?
A.
Rating based on prior claims
B.
Rates are determined by group average
C.
None of the above
D.
Sets rates based on individuals
Correct Answer:
B
Adjusted community rating means premiums are based on the average risk of the group rather than individual health status or claims history.
#Question
164. Which type of insurance model is designed to compensate for catastrophic incidents?
A.
Limited benefit plans
B.
Major medical insurance
C.
Basic health insurance
D.
None of the above
Correct Answer:
B
Major medical insurance is specifically designed to provide coverage against significant health incidents or catastrophic events.
PHIAS — Professional, Health Insurance Advanced Studies
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