Reference no: EM133240791

1. Define the term risk pool.

2. What is the relationship between covered conditions and covered services in health insurance plans?

3. List three synonyms for the policyholder.

4. Define deductible.

5. What is the purpose of the Summary of Benefits and Coverage(SBC)?

6. Describe at least three ways in which MCOs work toward their goals of quality patient care.

7. From where do evidence-based clinical guidelines originate?

8. Name the three steps in the utilization review.

9. Why is prescription management an important cost control?

10. Describe three mechanisms used by MCOs to ensure cost-effective care.