AHIP AHM-250 Online Practice Questions and Exam Preparation

AHIP AHM-250 Online Questions & Answers

• Question 121:

  Which of the following people would be considered part of the individual market segment?

  A. John is eligible for Medicare.
  B. Julie has coverage through an employer group.
  C. James works for an employer that does not offer health coverage.
  D. Jenny is eligible for Medicaid.
  C. James works for an employer that does not offer health coverage.

• Question 122:

  One among the following is a reason that limit access to health care for US people.

  A. Life Style of the people
  B. Concentration of physicians in highly populated areas.
  C. Advancement in information technology
  B. Concentration of physicians in highly populated areas.

• Question 123:

  The following statement(s) can correctly be made about the Joint Commission on Accreditation of Healthcare Organizations (JCAHO):

  A. JCAHO's accreditation process for MCOs and healthcare networks consists of complete on-site surveys conducted every three
  B. A only
  C. Neither A nor B
  D. Both A and B
  E. B only
  A. JCAHO's accreditation process for MCOs and healthcare networks consists of complete on-site surveys conducted every three

• Question 124:

  Janet Riva is covered by a traditional indemnity health insurance plan that specifies a $250 deductible and includes a 20% coinsurance provision. When Ms. Riva was hospitalized, she incurred $2,500 in medical expenses that were covered by her health plan.

  A. $1,750
  B. $1,800
  C. $2,000
  D. $2,250
  B. $1,800

• Question 125:

  The following statements are about concepts related to the underwriting function within a health plan. Select the answer choice containing the correct statement.

  A. Anti selection refers to the fact that individuals who believe that they have a less-than- average likelihood of loss tend to seek healthcare coverage to a greater extent than do individuals who believe that they have an average or greater-than-average like
  B. Federally qualified HMOs are required to medically underwrite all groups applying for coverage.
  C. Typically, a health plan guarantees the premium rate for a group health contract for a period of five years.
  D. When evaluating the risk for a group policy, underwriters typically focus on such factors as the size of the group, the stability of the group, and the activities of the group.
  D. When evaluating the risk for a group policy, underwriters typically focus on such factors as the size of the group, the stability of the group, and the activities of the group.

• Question 126:

  The Blaine Healthcare Corporation seeks to manage its quality by first identifying the best practices and best outcomes for a given procedure. Blaine can then determine areas in which it can emulate the best practices in order to equal or surpass the best

  A. provider profiling
  B. benchmarking
  C. peer review
  D. quality assessment
  B. benchmarking

• Question 127:

  By offering a comprehensive set of healthcare benefits to its members, an HMO ensures that its members obtain quality, cost-effective, and appropriate medical care. Ways that an HMO provides comprehensive care include

  A. coordinating care across a variety of benefits
  B. emphasizing preventive care by covering many preventive services either in full or with a small copayment
  C. offering its members access to wellness programs
  D. All of the above
  D. All of the above

• Question 128:

  The Houston Company, a United States company, offers its eligible employees health insurance coverage through a group health plan. Houston hired the Dallas Company to handle the plan's claim administration and membership services, but Houston is financial

  A. Houston is required to purchase stop-loss insurance to cover its losses under this group health plan
  B. Houston's plan is a self-funded plan
  C. Dallas is the plan's sponsor
  D. Houston's plan is not exempt from any state insurance regulations under ERISA
  B. Houston's plan is a self-funded plan

• Question 129:

  Medicare Advantage product options include:

  A. Coordinated care plans, medical savings accounts and national PPOs.
  B. Private Fee for Service plans, health care prepayment plans and medical savings accounts
  C. Coordinated care plans, regional PPOs and private fee for service plans
  D. Cost contracts, coordinated care programs and medical savings accounts.
  C. Coordinated care plans, regional PPOs and private fee for service plans

• Question 130:

  If most of the physicians, or many of the physicians in a particular specialty, are affiliated with a single entity, then a health plan building a network in the service area _____________.

  A. Has many contracting options available.
  B. Should not contract with that entity
  C. Most likely needs to contract with that entity
  D. Should attempt to disband the existing affiliations
  C. Most likely needs to contract with that entity