AHIP AHM-250 問題集

質問 1：
The following statements are about issues associated with marketing healthcare plans to small groups and large groups. Select the answer choice that contains the correct statement.
A. health plans typically treat an employer purchasing coalition as a small group for marketing purposes.
B. Because providing healthcare coverage for employees is often a burden for small businesses, price is typically the most critical consideration for small businesses in selecting a healthcare plan.
C. In the large group market, large group accounts that have employees in more than one geographic area who are covered through a single national contract for healthcare coverage are known as large local groups.
D. Large groups rarely use self-funding to finance their healthcare plans.
正解：B

質問 2：
When the Knoll Company purchased group health coverage from the Castle Health Maintenance Organization (HMO), the agreement between the two parties specified that the plan would be a typical fully funded plan. Because Knoll had been covered under a previo
A. Knoll makes no premium payments to Castle
B. Knoll is solely responsible for guaranteeing claim payments
C. Castle is responsible for paying for all incurred covered benefits
D. Castle has no responsibilities for administering the health plan
正解：C

質問 3：
The Koster Company plans to purchase a health plan for its employees from Intuitive HMO. Intuitive will administer the plan and will bear the responsibility of guaranteeing claim payments by paying all incurred covered benefits. Koster will pay for the he
A. stop-loss plan
B. fully funded plan
C. self-funded plan
D. self-pay plan
正解：B

質問 4：
Phillip Tsai is insured by both a indemnity health insurance plan, which is his primary plan, and a health plan, which is his secondary plan. Both plans have typical coordination of benefits (COB) provisions, but neither has a nonduplication of benefits p
A. $900
B. $300
C. $400
D. $0
正解：C

質問 5：
From the answer choices below, select the response that correctly identifies the rating method that Mr. Sybex used and the premium rate PMPM that Mr. Sybex calculated for the Koster group.
A. Rating Method blended rating Premium Rate PMPM $138
B. Rating Method blended rating Premium Rate PMPM $132
C. Rating Method book rating Premium Rate PMPM $138
D. Rating Method book rating Premium Rate PMPM $132
正解：B

質問 6：
Two MCOs in a single service area divided purchasers into two groups and agreed to each market their products to only one purchaser group. This information indicates that these two MCOs violated antitrust requirements because they engaged in an activity k
A. price fixing
B. horizontal division of markets
C. a tying arrangement
D. horizontal group boycott
正解：B

質問 7：
One non-group market segment to which health plans market health plan products is the senior market, which is comprised mostly of persons over age 65 who are eligible for Medicare benefits. One factor that affects a health plan's efforts to market to the
A. managed Medicare plans can refuse to cover persons with certain health problems
B. managed Medicare plans typically require Medicare beneficiaries to purchase Medigap insurance to supplement gaps in coverage
C. The Centers for Medicare and Medicaid Services (CMS) must approve all marketing materials used by health plans to market health plan products to the Medicare population
D. the CMS prohibits health plans from using telemarketing to market health plan products to the Medicare population
正解：B