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AHIP AHM-250 - Questions & Answers

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Question 1
Single choice

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.

Question 2
Single choice

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

Question 3
Single choice

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

A.

State

B.

Not-for-profit

C.

For-profit

D.

Federally qualified

Question 4
Single choice

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

Question 5
Single choice

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.

Question 6
Single choice

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

Question 7
Single choice

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.

Question 8
Single choice

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

Question 9
Single choice

As part of its quality management program, the Lyric Health Plan regularly compares its practices and services with those of its most successful competitor. When Lyric concludes that its competitor's practices or services are better than its own, Lyric im

A.

Benchmarking.

B.

Standard of care.

C.

An adverse event.

D.

Case-mix adjustment.

Question 10
Single choice

In response to the demand for a method of assessing outcomes, accrediting organizations and other government and commercial groups have developed quantitative measures of quality that consumers, purchasers, regulators, and others can use to compare health

A.

quality standards

B.

accreditation decisions

C.

standards of care

D.

performance measures

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