AHIP AHM-520 問題集

質問 1：
The Challenger Group is a type of management services organization (MSO) that purchases the assets of physician practices, provides practice management andadministrative support servicesto participating providers, and offers physicians a long-term contract and an equity position in Challenger. This information indicates that Challenger is a type of health plan
A. Aprovider-sponsored organization (PSO)
B. Amedical foundation
C. An integrated delivery system (IDS)
D. Known as
E. Aphysician practice management (PPM) company
正解：A

質問 2：
The Longview Hospital contracted with the Carlyle Health Plan to provide inpatient services to Carlyle's enrolled members. Carlyle provides Longview with a type of stop-loss coverage that protects, on a claims incurred and paid basis, against losses arising from significantly higher than anticipated utilization rates among Carlyle's covered population. The stop-loss coverage specifies an attachment point of 130% of Longview's projected $2,000,000 costs of treating Carlyle plan members and requires Longview to pay 15% of any costs above the attachment point. In a given plan year, Longview incurred covered costs totaling $3,000,000.
For the year in which Longview's incurred covered costs were $3,000,000, the amount for which Longview will be responsible is:
A. $3,900,000
B. $2,660,000
C. $2,000,000
D. $2,600,000
正解：B

質問 3：
Geena Falk is eligible for both Medicare and Medicaid coverage. If Ms. Falk incurs a covered expense, then:
A. Medicare will be Ms. Falk's primary insurer
B. Either Medicare or Medicaid will be Ms. Falk's primary insurer depending on her election
C. Medicaid will be Ms. Falk's primary insurer
D. Medicare and Medicaid will each be responsible for one-half of Ms. Falk's covered expense
正解：A

質問 4：
One true statement about a health plan's underwriting margin is that
A. a larger assumed underwriting margin will reduce the price of the health plan's product and will make the plan more competitive
B. the only way that the health plan can effectively reduce its exposure to underwriting risk, and therefore adjust its underwriting margin, is to control anti selection
C. both the level of underwriting risk that the health plan assumes in providing benefits and the market competition it encounters most likely directly affect the size of its assumed
underwriting margin
D. the health plan's purchase of stop-loss insurance has no effect on its underwriting margin because stop-loss insurance can help the health plan control its expenses but not its underwriting risk
正解：C

質問 5：
The Coral Health Plan, a for-profit health plan, has two sources of capital:
Debt and equity. With regard to these sources of capital, it can correctly be stated that
A. The interest that Coral pays on its debt most likely is not tax deductible to Coral
B. Coral's debt holders have no legal claim to Coral's assets
C. Coral's equity holders have an ownership interest in the health plan
D. Equity is a more risky source of capital, from Coral's perspective, than is debt
正解：C

質問 6：
The Titanium health plan's product has a unit price of $120 PMPM and a unit variable cost of $80 PMPM. Titanium has $100,000 in fixed costs per month. This information indicates that, for its product, Titanium's
A. Unit contribution margin is $200
B. Break-even point is 500 members
C. Break-even point is 2,500 members
D. Unit contribution margin is $80
正解：C