AHIP AHM-520 - Health Plan Finance and Risk Management Exam
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Total 215 questions
Question #6 (Topic: Topic 1)
Mandated benefit laws are state or federal laws that require health plans to arrange for the
financing and delivery of particular benefits. Within a market, the implementation of
mandated benefit laws is likely to cause __________.
financing and delivery of particular benefits. Within a market, the implementation of
mandated benefit laws is likely to cause __________.
A. A reduction in the number of self-funded healthcare plans
B. An increase in the cost to the health plans
C. A reduction in the size of the provider panels of health plans
D. A reduction in the uniformity among the healthcare plans of competing health plans
Answer: B
Question #7 (Topic: Topic 1)
Kevin Olin applied for individual healthcare coverage from the Mercury health plan. Before
issuing the policy, Mercury's underwriters attached a rider that excludes from coverage any
loss that results from Mr. Olin's chronic knee problem. This information indicates that Mr.
Olin's policy includes
issuing the policy, Mercury's underwriters attached a rider that excludes from coverage any
loss that results from Mr. Olin's chronic knee problem. This information indicates that Mr.
Olin's policy includes
A. a moral hazard rider
B. an essential plan rider
C. an impairment rider
D. an insurable interest rider
Answer: C
Question #8 (Topic: Topic 1)
The physicians who work for the Sunrise Health Plan, a staff model HMO, are paid a salary
that is not augmented with another type of incentive plan. Compared to the use of a
traditional reimbursement method, Sunrise's use of a salary reimbursement method is
more likely to
that is not augmented with another type of incentive plan. Compared to the use of a
traditional reimbursement method, Sunrise's use of a salary reimbursement method is
more likely to
A. Encourage Sunrise's physicians to perform services that are not medically necessary
B. Completely eliminate service risk for Sunrise's physicians
C. Decrease Sunrise's liability for any negligent acts of the physicians in the plan's network of providers
D. Help stabilize expenses for Sunrise
Answer: D
Question #9 (Topic: Topic 1)
The following statement(s) can correctly be made about a health plan's underwriting of
small groups:
small groups:
A. Typically, a health plan medically underwrites both the employees of a small group and their dependents, even though small group reform laws prohibit health plans from singling out individuals for rejection or substandard rate-ups.
B. In the absence of laws mandating otherwise, a health plan's underwriting standards grow stricter as group size gets smaller.
C. Both A and B
D. A only
E. B only
F. Neither A nor B
Answer: A
Question #10 (Topic: Topic 1)
The Eagle health plan wants to limit the possibility that it will be held vicariously liable for
the negligent acts of providers. Dr. Michael Chan is a member of an independent practice
association (IPA) that has contracted with Eagle. One step that Eagle could take in order to
limit its exposure under the theory of vicarious liability is to
the negligent acts of providers. Dr. Michael Chan is a member of an independent practice
association (IPA) that has contracted with Eagle. One step that Eagle could take in order to
limit its exposure under the theory of vicarious liability is to
A. Supply Dr. Chan with office space
B. Employ nurses, laboratory technicians, and therapists to support Dr.Chan
C. Be responsible for keeping Dr. Chan's medical records updated
D. Ensure that documents provided to Dr. Chan's patients describe him as an independent practitioner
Answer: D
