AHIP AHM-520 問題集

質問 1：
The Newfeld Hospital has contracted with the Azalea Health Plan to provide inpatient services to Azalea's enrolled members. The contract calls for Azalea to provide specific stop-loss coverage to Newfeld once Newfeld's treatment costs reach $20,000 per case and for Newfeld to pay 20% of the next $50,000 of expenses for this case. After Newfeld's treatment costs on a case reach $70,000, Azalea reimburses the hospital for all subsequent treatment costs.
The maximum amount for which Newfeld is at risk for any one Azalea plan member's treatment costs is
A. $14,000
B. $34,000
C. $10,000
D. $30,000
正解：D

質問 2：
The following statement(s) can correctly be made about a health plan's cash receipts and cash disbursements budgets:
A. A health plan uses a cash disbursements budget in order to establish the amount, but not the timing, of all of its cash disbursements.
B. A only
C. B only
D. To predict both the timing and the amount of its cash receipts, a health plan constructs the cash receipts budget using data from its sales forecast and investment forecasts.
E. Both A and B
F. Neither A nor B
正解：A

質問 3：
Mandated benefit laws are state or federal laws that require health plans to arrange for the financing and delivery of particular benefits. Within a market, the implementation of mandated benefit laws is likely to cause __________.
A. A reduction in the number of self-funded healthcare plans
B. A reduction in the uniformity among the healthcare plans of competing health plans
C. A reduction in the size of the provider panels of health plans
D. An increase in the cost to the health plans
正解：D

質問 4：
State A, which requires guaranteed issue of at least two mandated healthcare plans, has established a typical health coverage reinsurance program for small employer groups. One true statement about this reinsurance program is that it most likely
A. has, for the coverage on a plan, a base premium, which is multiplied by a factor of 2 in the case of reinsurance on entire groups or a factor of 3 for reinsurance on individuals
B. allows a small employer carrier operating in State A to reinsure either an entire small group or specific individuals within the group
C. prohibits a small employer carrier operating in State A from placing individuals enrolled in small groups in a reinsurance pool
D. is administered by a commercial reinsurance company that operates in State A
正解：B

質問 5：
A health plan can use a SWOT (strengths, weaknesses, opportunities, and threats) analysis to analyze its relationships with the major providers in each market in which it conducts business.
A. False
B. True
正解：B

質問 6：
The Fairway health plan is a for-profit health plan that issues stock. The following data was taken from Fairway's financial statements:
Current assets.....$5,000,000
Total assets.....6,000,000
Current liabilities.....2,500,000
Total liabilities.....3,600,000
Stockholders' equity.....2,400,000
Fairway's total revenues for the previous financial period were $7,200,000, and its net income for that period was $180,000.
Assume that the healthcare industry average for the debt-to-equity ratio is 0.90. The following statement(s) can correctly be made about Fairway's debt to equity ratio:
A. A only
B. B only
C. Fairway's debt-to-equity ratio is 1.50
D. Fairway relies less than most other healthcare organizations on borrowed funds to cover future and current benefit payments, to pay for ongoing business operations, and to finance growth
E. Both A and B
F. Neither A nor B
正解：D