AHIP AHIP Certifications AHM-250 Questions & Answers

• Question 81:

  Which of the following statements about the Title VII of the Civil Rights Act is WRONG?

  A. Employers with more than 15 employees engaged in interstate commerce need to comply

  B. Pregnancy Discrimination Act (an amendment to this act) requires health plans to provide coverage during childbirth and related medical conditions on the same basis as they provide coverage for other medical conditions

  C. Allows HMOs to set different policies for people from different races, religions, sex or national origin to safeguard their interests.

  D. Protects all employees

  Correct Answer: C

• Question 82:

  The following statements are about information management in health plans. Three of the statements are true and one statement is false. Select the answer choice containing the FALSE statement:

  A. Health plans find EDI useful for transmitting data among different health plan locations.

  B. EDI is different from eCommerce in the EDI is the transfer of data, typically in batches, while ecommerce is a back-and-forth exchange of information concerning individual transactions.

  C. The majority of health plan eCommerce occurs via proprietary computer networks.

  D. Benefits that health plans can receive from using electronic data interchange.

  Correct Answer: C

• Question 83:

  To set up and contribute to an HSA, an individual must:

  A. Be covered by a high-deductible health plan that meets federal requirements.

  B. Not have other health insurance.

  C. Not be enrolled in Medicare.

  D. All of the above.

  Correct Answer: D

• Question 84:

  When determining the premium rates it will charge a particular group, the Blue Jay Health Plan used a rating method known as community rating by class (CRC). Under this rating method, Blue Jay

  A. was allowed to use no more than four rating classes when determining how much to charge the group for health coverage

  B. was required to make the average premium in each class no more than 105% of the average premium for any other class

  C. divided its members into rating classes based on demographic factors, experience, or industry characteristics, and then charged each member in a rating class the same premium

  D. charged all employers or other group sponsors the same dollar amount for a given level of medical benefits, without adjustments for age, gender, industry, or experience

  Correct Answer: C

• Question 85:

  Which of the following statements is FALSE?

  A. The license that HMOs get in each state is called `Certificate of Authority'

  B. The HMO contracts directly with the individual physicians who provide the medical services to the HMO members in a variation of the IPA model called direct contract model HMO.

  C. All medicare/mediclaim beneficiaries should comply with utilization management requirements set forth by HCFA

  D. HMO's usually impose high coinsurance or deductible requirements

  Correct Answer: D

• Question 86:

  The following statements describe individuals who are applying for individual health insurance coverage:

  Six months ago, Wilbur Lee lost his health insurance coverage due to a reduction in work hours and has exhausted his coverage under COBRA. Mr. Lee has

  A. both Mr. Lee and Mr. Beeker

  B. Mr. Lee only

  C. Mr. Beeker only

  D. neither Mr. Lee nor Mr. Beeker

  Correct Answer: A

• Question 87:

  Exclusive provider organizations (EPO) is similar and operates like a PPO in administration, structure but however in an EPO an out-of-network care is

  A. Partially Covered

  B. Covered with more out of pocket

  C. Not covered

  Correct Answer: C

• Question 88:

  In order to be more effective, changes to structure and processes must be carefully

  A. Planned

  B. Implemented

  C. Documented

  D. Evaluated

  E. All the above

  Correct Answer: E

• Question 89:

  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

  Correct Answer: B

• Question 90:

  Disease management is typically set up as a voluntary outreach and support program for plan members with certain _________ diseases

  A. Acute

  B. Chronic

  C. None of the above

  Correct Answer: B