AHIP AHM-510 問題集

質問 1：
The National Association of Insurance Commissioners (NAIC) adopted the Health Maintenance Organization Model Act (HMO Model Act) to regulate the development and operations of HMOs. One true statement regarding the HMO Model Act is that the act
A. includes mental health services in its definition of basic healthcare services
B. requires HMOs that wish to offer a point-of-service (POS) product to contract with a licensed insurance company to provide POS options to plan members
C. requires HMOs to place a deposit in trust with the state insurance commissioner for the purpose of protecting the interests of enrollees should an HMO become financially impaired
D. authorizes only one state agency-the department of insurance-to regulate HMOs
正解：C

質問 2：
Regulatory and legislative bodies are among the important environmental forces in the health plan industry. The following statements are about such regulation and legislation. Select the answer choice that contains the correct statement.
A. In recent years, the number of health plan bills in the state and the federal legislatures has decreased.
B. As stakeholders in the health plan industry, federal and state governments exert tremendous influence over a health plan's formation and operations.
C. Administrative rules and regulations do not carry the force of law.
D. Federal guidelines exist to direct health plans on compliance issues when a health plan encounters conflicting state laws in a given service area.
正解：B

質問 3：
The Wentworth Corporation uses a self-funded plan to provide its employees with healthcare benefits. One consequence of Wentworth's approach to providing healthcare benefits is that self-funding
A. Increases the number of benefit and rating mandates that apply to Wentworth's plan
B. Requires that Wentworth self-administer its healthcare benefit plan
C. Eliminates the need for Wentworth to pay a risk charge to an insurer or health plan
D. Requires that Wentworth pay higher state premium taxes than do insurers and health plans
正解：C

質問 4：
While traditional workers' compensation laws have restricted the use of managed care
techniques, many states now allow managed workers' compensation. One common characteristic of managed workers' compensation plans is that they
A. Cover an employee's medical costs, but they do not provide coverage for lost wages
B. Discourage injured employees from returning to work until they are able to assume all the duties of their jobs
C. Use low copayments to encourage employees to choose preferred providers
D. Rely on total disability management to control indemnity benefits
正解：D

質問 5：
The Balanced Budget Act (BBA) of 1997 created the Medicare+Choice plan. One provision of the BBA under Medicare+Choice is that the BBA
A. Narrows the geographic variations in payments to Medicare health plans by lowering the growth rate of payments in high-payment counties and raising the rates in low-payment counties
B. Increases Graduate Medical Education (GME) payments to hospitals for the training and cost of educating and training residents
C. Requires health plans to qualify as either a competitive medical plan (CMP) or a federally qualified HMO in order to participate in the Medicare program
D. Eliminates funding for demonstration projects such as the Medicare Enrollment Demonstration Project
正解：A

質問 6：
States may impose nominal deductibles, coinsurance, or copayments on some Medicaid recipients for certain services. Services for which states can require copayments from Medicaid recipients include:
A. Emergency services
B. A only
C. B only
D. Both A and B
E. Neither A nor B
F. Family planning services
正解：B