AHIP AHM-520 問題集

質問 1：
The following statements are about state health coverage reinsurance programs.
A. The reinsurance offered through these programs is administered on a for-profit basis by the federal government.
B. These programs must reinsure only an entire small group, not specific individuals within a group.
C. Any shortfalls in the pool established by these programs are funded by the state government.
D. The purpose of these programs is to reinsure MCOs and other carriers who offer guaranteed healthcare plans to small employers.
正解：D

質問 2：
With regard to the major risk factors associated with group underwriting, it can correctly be stated that, typically,
A. The age and gender of group plan members are not predictors of utilization of health services by group members
B. A health plan should track demographic factors of groups only if the plan specifically adjusts for demographic factors on a group basis
C. A health plan's product design or delivery system has an impact on member selection of the health plan, unless the members are in an environment in which employees have at least two benefit options or health plans from which to choose
D. A large group is more likely to exhibit a consistent claims pattern, level of healthcare cost, or utilization of services than is a small group
正解：D

質問 3：
A product is often described as having a thin margin or a wide margin. With regard to the factors that help determine the size of the margin of a health plan's product, it can correctly be stated that the
A. longer the premium rates are guaranteed to a group, the wider the health plan's margin should be
B. greater the risk a health plan assumes in a health plan, the thinner the product margin should be
C. more that competition acts to force prices down, the wider the product margins tend to become
D. greater the demand for the product, the thinner the margin for this product tends to become
正解：A

質問 4：
The following statements illustrate common forms of capitation:
1.The Antler Health Plan pays the Epsilon Group, an integrated delivery system (IDS), a capitated amount to provide substantially all of the inpatient and outpatient services that Antler offers. Under this arrangement, Epsilon accepts much of the risk that utilization rates will behigher than expected. Antler retains responsibility for the plan's marketing, enrollment, premium billing, actuarial, underwriting, and member services functions.
2.The Bengal Health Plan pays an independent physician association (IPA) a capitated amount to provide both primary and specialty care to Bengal's plan members. The payments cover all physician services and associated diagnostic tests and laboratory work. The physicians in the IPA determine as a group how the individual physicians will be paid for their services.
From the following answer choices, select the response that best indicates the form of capitation used by Antler and Bengal.
A. Antler = global capitation Bengal = full professional capitation
B. Antler = subcapitation Bengal = full-risk capitation
C. Antler = global capitation Bengal = subcapitation
D. Antler = subcapitation Bengal = full professional capitation
正解：A

質問 5：
For this question, select the answer choice containing the terms that correctly complete blanks A and B in the paragraph below. The FASB mandates that accounting information must exhibit certain qualitative characteristics. One of these characteristics is ________A________, which means that a company's financial statements use the same accounting policies and procedures from one accounting period to the next, unless there is a sound reason for changing a policy or procedure. Another characteristic is _________B________, which requires a company to disclose in its financial statements all significant financial information about the company.
A. A = consistency B = comparability
B. A = reliability B = materiality
C. A = consistency B = materiality
D. A = reliability B = comparability
正解：C

質問 6：
The goal of the investment department at the Wayfarer Health Plan is to maximize investment return. The investment department executes investments on time and at a low cost. However, these transactions often result in low returns or risks that are deemed too high for Wayfarer. With regard to effectiveness and efficiency, it is correct to say that Wayfarer's investment department is:
A. neither effective nor efficient
B. efficient, but not effective
C. effective, but not efficient
D. both effective and efficient
正解：B