AHIP AHIP Certification AHM-250 Questions & Answers

• Question 361:

  Dr. Julia Phram is a cardiologist under contract to Holcomb HMO, Inc., a typical closed- panel plan. The following statements are about this situation. Select the answer choice containing the correct statement.

  A. All members of Holcomb HMO must select Dr. Phram as their primary care physician (PCP).

  B. Any physician who meets Holcomb's standards of care is eligible to contract with Holcomb HMO as a provider.

  C. Dr. Phram is either an employee of Holcomb HMO or belongs to a group of physicians that has contracted with Holcomb HMO

  D. Holcomb HMO plan members may self-refer to Dr. Phram at full benefits without first obtaining a referral from their PCPs.

  Correct Answer: A

• Question 362:

  From the following answer choices, choose the description of the ethical principle that best corresponds to the term Beneficence

  A. Health plans and their providers are obligated not to harm their members

  B. Health plans and their providers should treat each member in a manner that respects the member's goals and values, and they also have a duty to promote the good of the members as a group

  C. Health plans and their providers should allocate resources in a way that fairly distributes benefits and burdens among the members

  D. Health plans and their providers have a duty to respect the right of their members to make decisions about the course of their lives

  Correct Answer: B

• Question 363:

  Before the Hill Health Maintenance Organization (HMO) received a certificate of authority (COA) to operate in State X, it had to meet the state's licensing requirements and financial standards which were established by legislation that is identical to the

  A. Hill had to have an initial net worth of at least $1.5 million in order to obtain a COA.

  B. The COA most likely exempts Hill from any of State X's enabling statutes.

  C. Hill had to be organized as a partnership in order to obtain a COA

  D. The COA in no way indicates that Hill has demonstrated that it is fiscally sound.

  Correct Answer: A

• Question 364:

  From the following answer choices, choose the description of the ethical principle that best corresponds to the term Beneficence

  A. Health plans and their providers are obligated not to harm their members

  B. Health plans and their providers should treat each member in a manner that respects the member's goals and values, and they also have a duty to promote the good of the members as a group

  C. Health plans and their providers should allocate resources in a way that fairly distributes benefits and burdens among the members

  D. Health plans and their providers have a duty to respect the right of their members to make decisions about the course of their lives

  Correct Answer: B

• Question 365:

  Brokers are one type of distribution channel that health plans use to market their health plans. One true statement about brokers for health plan products is that, typically, brokers

  A. Are not required to be licensed by the states in which they market health plans

  B. Are compensated on a salary basis

  C. Represent only one health plan or insurer

  D. Are considered to be an agent of the buyer rather than an agent of the health plan or Insurer

  Correct Answer: D

• Question 366:

  ______________ HMOs can't medically underwrite any group ?incl small groups.

  A. State

  B. Not-for-profit

  C. For-profit

  D. Federally qualified

  Correct Answer: B

• Question 367:

  In order to cover some of the gap between FFS Medicare coverage and the actual cost of services, beneficiaries often rely on Medicare supplements. Which of the following statements about Medicare supplements is correct?

  A. The initial ten (A-J) Medigap policies offer a basic benefit package that includes coverage for Medicare Part A and Medicare Part B coinsurance.

  B. Each insurance company selling Medigap must sell all the different Medigap policies.

  C. Medicare SELECT is a Medicare supplement that uses a preferred provider organization (PPO) to supplement Medicare Part A coverage.

  D. Medigap benefits vary by plan type (A through L), and are not uniform nationally.

  Correct Answer: A