AHIP AHM-250 Online Practice Questions and Exam Preparation

AHIP AHM-250 Online Questions & Answers

• Question 271:

  In assessing the potential degree of risk represented by a proposed insured, a health underwriter considers the factor of anti selection. Anti selection can correctly be defined as the

  A. inability of a proposed insured to share with the insurer the financial risks of healthcare coverage
  B. possibility that a proposed insured will profit from an illness by receiving benefits that exceed the total amount of his or her eligible medical expenses
  C. inability of a proposed insured to provide sufficient evidence that proves he or she is an insurable risk
  D. tendency of people who have a greater-than-average likelihood of loss to apply for or continue insurance protection to a greater extent than people who have an average or less than average likelihood of the same loss
  D. tendency of people who have a greater-than-average likelihood of loss to apply for or continue insurance protection to a greater extent than people who have an average or less than average likelihood of the same loss

• Question 272:

  The nature of the claims function within health plans varies by type of plan and by the compensation arrangement that the plan has made with its providers. For example, it is generally correct to say that, in a Preferred provider organization (PPO)

  A. Both A and B
  B. A only
  C. B only
  D. Neither A nor B
  A. Both A and B

• Question 273:

  The Hill Health Plan designed a set of benefits that it packaged in the form of a PPO product. Hill then established a pricing structure that allowed its product to compete in the small group market, and it developed advertising designed to inform potential

  A. An indemnity wraparound plan
  B. A self-funded plan
  C. An aggregate stop-loss plan
  D. A fully funded plan
  D. A fully funded plan

• Question 274:

  The Conquest Corporation contracts with the Apex health plan to provide basic medical and surgical services to Conquest employees. Conquest entered into a separate contract with the Bright Dental Group to provide and manage a dental care program for employee

  A. a negotiated rebate agreement
  B. a carve-out arrangement
  C. an indemnity plan
  D. PBM
  B. a carve-out arrangement

• Question 275:

  In the United States, the Department of Defense offers ongoing healthcare coverage to military personnel and their families through the TRICARE health plan. One true statement about TRICARE is that:

  A. Active duty military personnel are automatically considered enrolled in TRICARE Prime
  B. TRICARE covers inpatient and outpatient services, physician and hospital charges, and medical supplies, but not mental health services.
  C. TRICARE enrollees are not entitled to appeal authorization or coverage decisions
  D. Hospitals participating in the TRICARE program are exempt from JCAHO accreditation and Medicare certification.
  A. Active duty military personnel are automatically considered enrolled in TRICARE Prime

• Question 276:

  The HMO Act of 1973 was significant in that the Act

  A. mandated certain requirements that all HMOs had to meet in order to conduct business
  B. required that all HMOs be licensed as insurance companies
  C. offered HMOs federal financial assistance through grants and loans, and provided access to the employer-based insurance market
  D. encouraged the use of pre-existing condition exclusion provisions in all HMO contracts
  C. offered HMOs federal financial assistance through grants and loans, and provided access to the employer-based insurance market

• Question 277:

  The Titanium Health Plan and a third-party administrator (TPA) have entered into a TPA agreement with regard to the administration of a particular health plan. This agreement complies with all of the provisions of the NAIC TPA Model Law. One of the TPA's

  A. Hold all funds it receives on behalf of Titanium in trust.
  B. Assume full responsibility for ensuring that the health plan is administered properly
  C. Obtain from the federal government a certificate of authority designating the organization as a TPA.
  D. Assume full responsibility for determining the claim payment procedures for the plan
  A. Hold all funds it receives on behalf of Titanium in trust.

• Question 278:

  The National Association of Insurance Commissioners' (NAIC's) Unfair Claims Settlement Practices Act specifies standards for the investigation and handling of claims. The Act defines unfair claims practices and notes that such practices are improper if the

  A. Both A and B
  B. A only
  C. B only
  D. Neither A nor B
  A. Both A and B

• Question 279:

  The agreement by two or more independent competitors on the prices or fees that they will charge for services is known as:

  A. Tying arrangements
  B. Price fixing
  C. Horizontal group boycott
  D. Horizontal division of markets
  B. Price fixing

• Question 280:

  In the paragraph below, two statements each contain a pair of terms enclosed in parentheses. Determine which term correctly completes each statement. Then select the answer choice containing the two terms that you have chosen. For providers, (operational /

  A. operational / an acquisition
  B. operational / a consolidation
  C. structural / an acquisition
  D. structural / a consolidation
  D. structural / a consolidation