A Health Plans Coverage Policies Are Linked to Its Purchaser

question 23

Multiple Choice

A health plans coverage policies are linked to its purchaser contracts. The following statement(s) can correctly be made about the purchaser contract and coverage decisions: 1.In case of conflict between the purchaser contract and a health plans medical policy or benefits administration policy, the contract takes precedence 2.Purchaser contracts commonly exclude custodial care from their coverage of services and supplies 3.All of the criteria for coverage decisions must be included in the purchaser contract

• A) All of the above
• B) 1 and 2 only
• C) 2 only
• D) 3 only

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Definitions:

Units

A standard measure or quantity used in statistics, mathematics, or physics.

Perfect Competition

A market structure characterized by a large number of small firms competing against each other, where no single firm has the market power to influence the price of the product it sells.

Economic Profit

The difference between total revenue and total costs, including both explicit and implicit costs, indicating the efficiency of resource utilization beyond just financial gain.

Marginal Costs

The cost of producing a subsequent unit of a product or service.