최신AHIP Health Plan Finance and Risk Management - AHM-520무료샘플문제
문제1
The Essential Health Plan markets a product for which it assumed total expenses to equal 92% of premiums. Actual data relating to this product indicate that expenses equal 89% of premiums. This information indicates that the expense margin for this product has:
The Essential Health Plan markets a product for which it assumed total expenses to equal 92% of premiums. Actual data relating to this product indicate that expenses equal 89% of premiums. This information indicates that the expense margin for this product has:
정답: C
문제2
With regard to alternative funding arrangements, the part of a health plan premium that is intended to contribute to the claims reserve that a health plan maintains to pay for unusually high utilization is known as the:
With regard to alternative funding arrangements, the part of a health plan premium that is intended to contribute to the claims reserve that a health plan maintains to pay for unusually high utilization is known as the:
정답: D
문제3
The Jamal Health Plan operates in a state that mandates that a health plan either allow providers to become part of its network or reimburse those providers at the health plan's negotiated-contract rate, so long as the non-contract provider is willing to perform the services at the contract rate. This type of law is known as:
The Jamal Health Plan operates in a state that mandates that a health plan either allow providers to become part of its network or reimburse those providers at the health plan's negotiated-contract rate, so long as the non-contract provider is willing to perform the services at the contract rate. This type of law is known as:
정답: A
문제4
Correct statements about the financial risks associated with benefits that health plans provide to the Medicare and Medicaid markets include:
Correct statements about the financial risks associated with benefits that health plans provide to the Medicare and Medicaid markets include:
정답: C
문제5
The Fiesta Health Plan prices its products in such a way that the rates for its products are reasonable, adequate, equitable, and competitive. Fiesta is using blended rating to calculate a premium rate for the Murdock Company, a large employer. Fiesta has assigned a credibility factor of 0.6 to Murdock. Fiesta has also determined that Murdock's manual rate is $200 PMPM and that Murdock's experience rate is $180 PMPM.
According to regulations, Fiesta's premium rates are reasonable if they
The Fiesta Health Plan prices its products in such a way that the rates for its products are reasonable, adequate, equitable, and competitive. Fiesta is using blended rating to calculate a premium rate for the Murdock Company, a large employer. Fiesta has assigned a credibility factor of 0.6 to Murdock. Fiesta has also determined that Murdock's manual rate is $200 PMPM and that Murdock's experience rate is $180 PMPM.
According to regulations, Fiesta's premium rates are reasonable if they
정답: C
문제6
If Grace Wilson is eligible for benefits under both the Medicare and Medicaid programs, then
If Grace Wilson is eligible for benefits under both the Medicare and Medicaid programs, then
정답: C
문제7
Doctors' Care is an individual practice association (IPA) under contract to the Jasper Health Plan to provide primary and secondary care to Jasper's members. Jasper's capitation payments compensate Doctors' Care for all physician services and associated diagnostic tests and laboratory work. The physicians at Doctors' Care, as a group, determine how individual physicians in the group will be remunerated. The type of capitation used by Jasper to compensate Doctors' Care is known as:
Doctors' Care is an individual practice association (IPA) under contract to the Jasper Health Plan to provide primary and secondary care to Jasper's members. Jasper's capitation payments compensate Doctors' Care for all physician services and associated diagnostic tests and laboratory work. The physicians at Doctors' Care, as a group, determine how individual physicians in the group will be remunerated. The type of capitation used by Jasper to compensate Doctors' Care is known as:
정답: C
문제8
Experience rating methods can be either prospective or retrospective. With regard to these types of experience rating methods, it can correctly be stated that
Experience rating methods can be either prospective or retrospective. With regard to these types of experience rating methods, it can correctly be stated that
정답: A
문제9
Experience rating and manual rating are two rating methods that the Cheshire health plan uses to determine its premium rates. One difference between these two methods is that, under experience rating, Cheshire
Experience rating and manual rating are two rating methods that the Cheshire health plan uses to determine its premium rates. One difference between these two methods is that, under experience rating, Cheshire
정답: D
문제10
The methods of alternative funding for health coverage can be divided into the following general categories:
- Category A-Those methods that primarily modify traditional fully insured group insurance contracts - Category B-Those methods that have either partial or total self funding
Typically, small employers are able to use some of the alternative funding methods in
The methods of alternative funding for health coverage can be divided into the following general categories:
- Category A-Those methods that primarily modify traditional fully insured group insurance contracts - Category B-Those methods that have either partial or total self funding
Typically, small employers are able to use some of the alternative funding methods in
정답: C