AHIP AHM-520 問題集

質問 1：
The following statements are about rate ratios used by health plans. Select the answer choice containing the correct statement:
A. A rate ratio can only be increased if the health plan has obtained regulatory approval.
B. If the rate ratio for a couple rate category is 2.0, then the single premium is divided by
2.0 to derive the couple rate category premium.
C. While rate ratios consider family size, they are most often based on competitive factors, such as the ratios being used by competitors and the ratios that plan sponsors are requesting.
D. The effect of a typical family rate ratio is that a family rate is somewhat higher than it otherwise should be, and the single rate is somewhat lower that it otherwise should be.
正解：C

質問 2：
The Puma health plan uses return on investment (ROI) and residual income (RI) to measure the performance of its investment centers. Two of these investment centers are identified as X and Y.
Investment Center X earns $10,000,000 in operating income on controllable investments of $50,000,000, and it has total revenues of $60,000,000. Investment Center Y earns $2,000,000 in operating income on controllable investments of $8,000,000, and it has total revenues of $10,000,000. Both centers have a minimum required rate of return of 15%.
The following statements are about Puma's evaluation of these investment centers. Select the answer choice containing the correct statement.
A. The ROI for Investment Center X is 16.7%, and the ROI for Investment Center Y is 20.0%.
B. Because Investment Centers X and Y are different sizes, Puma should not use ROI to compare these investment centers.
C. According to the evaluation of ROI, Investment Center Y achieves a higher return on its available resources than does Investment Center X.
D. Investment Center Y's RI is greater than Investment Center X's RI.
正解：C

質問 3：
Under the alternative funding method used by the Trilogy Company, the insurer charges Trilogy an initial premium that is based on the assumption that claims will be 93% of the expected claims for the year. If claims exceed 93% of expected claims, then Trilogy must reimburse the insurer for any additional claims paid, up to 112% of expected claims. The insurer bears the responsibility for paying claims in excess of 112% of expected claims.
From the following answer choices, choose the name of the alternative funding method described.
A. Retrospective-rating arrangement
B. Reserve-reduction arrangement
C. Minimum-premium plan
D. Premium-delay arrangement
正解：A

質問 4：
In order to print all of its forms in-house, the Prism health plan isconsidering the purchase of 10 new printers at a total cost of $30,000. Prismestimates that the proposed printers have a useful life of 5 years. Under itscurrent system, Prism spends $10,000 a year to have forms printed by a localprinting company. Assume that Prism selects a 15% discount rate based onits weighted-average costs of capital. The cash inflows for each year,discounted to their present value, are shown in the following chart:

Prism will use both the payback method and the discounted payback methodto analyze the worthiness of this potential capital investment. Prism's decisionrule is to accept all proposed capital projects that have payback periods offour years or less.
Now assume that Prism decides to use the net present value (NPV) method toevaluate this potential investment's worthiness and that Prism will accept theproject if the project's NPV is greater than $4,000. Using the NPV method,Prism would correctly conclude that this project should be
A. Accepted because its NPV is $5,028
B. Rejected because its NPV is $3,520
C. Accepted because its NPV is $16,480
D. Accepted because its NPV is $23,520
正解：B

質問 5：
The following statements are about a health plan's pricing of a preferred provider organization (PPO) plan. Three of the statements are true, and one statement is false. Select the answer choice containing the FALSE statement.
A. After the health plan's actuaries use risk adjustment factors to adjust the existing claims costs for selection issues, the actuaries weight the in network and out-of-network costs to arrive at a composite claims cost for the PPO plan.
B. Typically, the first step in pricing a PPO is to develop a base indemnity claims cost, which results from adjusting the indemnity plan as though the entire eligible group of employees is enrolled in the indemnity plan.
C. One difficulty in pricing a PPO is that the health plan's actuaries have no method of estimating which employees would be likely to select which provider groups.
D. To develop the expected claims costs for the in-network PPO plan, the health plan's actuaries adjust the base indemnity claims costs to reflect pertinent characteristics of the plan, including the specific network plan design and provider discount arrangements.
正解：C

質問 6：
The Eclipse Health Plan is a not-for-profit health plan that qualifies under the Internal Revenue Code for tax-exempt status. This information indicates that Eclipse
A. Does not pay federal, state, or local taxes on its earnings
B. Has only one potential source of funding: borrowing money
C. Must distribute its earnings to its owners-investors for their personal gain
D. Is a privately held corporation
正解：A