AHM-520問題集、AHIP実際の試験問題

質問 1

The following statements are about state health coverage reinsurance programs.

A. The purpose of these programs is to reinsure MCOs and other carriers who offer guaranteed healthcare plans to small employers.

B. The reinsurance offered through these programs is administered on a for-profit basis by the federal government.

C. Any shortfalls in the pool established by these programs are funded by the state government.

D. These programs must reinsure only an entire small group, not specific individuals within a group.

正解: A

質問 2

As part of the first step in its strategic planning process, the Trout health plan developed the following statements:
- Statement A-Trout will deliver quality healthcare to our customers at a reasonable cost. - Statement B-Within five years, Trout will be recognized as the industry leader in all of our markets.
Statement A can best be described as a

A. Mission statement, whereas Statement B can best be described as a vision statement

B. Vision statement, and Statement B also can best be described as a vision statement

C. Mission statement, and Statement B also can best be described as a mission statement

D. Vision statement, whereas Statement B can best be described as a mission statement

正解: A

質問 3

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

A. can use group demographics to help determine the rate for a block of business, whereas, under manual rating, Cheshire cannot use group demographics when determining the rate for a block of business

B. Uses a purchaser's actual experience to estimate the group's expected experience, whereas, under manual rating, Cheshire uses its own average experience-and sometimes the experience of other plans-to estimate the group's expected experience

C. charges each group in the same class the same premium whereas, under manual rating, Cheshire charges lower premiums to groups that have experienced lower utilization rates

D. can establish rates for groups that have no previous plan experience, whereas, under manual rating, Cheshire cannot establish rates for groups with no previous plan experience

正解: B

質問 4

One true statement about a type of capitation known as a percent-of-premium arrangement is that this arrangement

A. Sets provider reimbursement at a specific dollar amount per plan member

B. Is less attractive to providers when the arrangement sets provisions to limit risk

C. Is the most common type of capitation

D. Transfers some of the risk associated with underwriting and rating from a health plan to a provider

正解: D

質問 5

The Lighthouse health plan operates in a state that allows the health plan to use an underwriting method of determining a group's premium in which underwriters treat several small groups as one large group for risk assessment purposes. This method, which helps Lighthouse more accurately estimate a small group's probable claims costs, is known as

A. Case stripping

B. The low-option rating method

C. Pooling

D. The rate spread method

正解: C

質問 6

The Sesame health plan uses a method of accumulating cost data that enables the health plan to satisfy financial reporting requirements for compiling financial statements and corporate tax returns. Although this method assists Sesame's managers in studying which types of costs are rising and falling over time, it does not explain which areas of Sesame incur each cost. This method, which is the most basic level of cost accumulation, is known as accumulating costs by

A. Lines of business

B. Function

C. Cost center

D. Type of cost

正解: D

質問 7

A health plan may experience negative working capital whenever healthcare expenses generated by plan members exceed the premium income the health plan receives.
Ways in which a health plan can manage the volatility in claims payments, and therefore reduce the risk of negative working capital, include:
1.Accurately estimating incurred but not reported (IBNR) claims
2.Using capitation contracts for provider reimbursement

A. Neither 1 nor 2

B. Both 1 and 2

C. 2 only

D. 1 only

正解: B

質問 8

The Swann Health Plan excludes mental health coverage from its basic health benefit plan. Coverage for mental health is provided by a specialty health plan called a managed behavioral health organization (MBHO). This arrangement recognizes the fact that distinct administrative and clinical expertise is required to effectively manage mental health services. This information indicates that Swann manages mental health services through the use of a:

A. Risk pod

B. Formulary

C. Case rate

D. Carve-out

正解: D

質問 9

The following statements are about a health plan's underwriting of small groups. Select the answer choice containing the correct statement.

A. In underwriting small groups, a health plan's underwriters typically consider both the characteristics of the group members and of the employer.

B. Most states prohibit health plans from setting participation levels as a requirement for coverage, even when coverage is otherwise guaranteed issue.

C. Generally, a health plan's underwriters require small employers to contribute at least 80% of the cost of the healthcare coverage.

D. Almost all states prohibit health plan s from rejecting a small group because of the nature of the business in which the small business is engaged.

正解: A

AHIP Health Plan Finance and Risk Management - AHM-520 模擬練習