AHM-250 AHIP Exam Questions and Free Practice Test

Question 67

- (Topic 2)
One feature of the Employee Retirement Income Security Act (ERISA) is that it:

A. Requires self-funded employee benefit plans to pay premium taxes at the state level.

B. Contains a pre-emption provision, which typically makes the terms of ERISA take precedence over any state laws that regulate employee welfare benefit plans.

C. Contains strict reporting and disclosure requirements for all employee benefit plans except health plans.

D. Requires that state insurance laws apply to all employee benefit plans except insured plans.

Correct Answer:B

Question 68

- (Topic 3)
The National Association of Insurance Commissioners (NAIC) developed the Small Group Model Act to enable small groups to obtain accessible, yet affordable, group health benefits. The model law limits the rate spread, which is the difference between the highest and lowest rates that a health plan charges small groups, to a particular ratio.
According to the Model Act, for example, if the lowest rate an HMO charges a small group for a given set of medical benefits is $40, then the maximum rate the HMO can charge for the same set of benefits is

A. $60

B. $80

C. $120

D. $160

Correct Answer:B

Question 69

- (Topic 2)
Provider integration has two components: operational integration and structural integration. An example of operational integration in health plans is the:

A. Acquisition of the Leopard Health Plan by the Hickory Health Plan.

B. Joint venture entered into by the Eclipse Health Plan and a local hospital system to create a new health plan in which Eclipse and the hospital system share ownership.

C. Formation of an organization by a group of providers to carry out billing, collections, and contracting with health plans for the entire group of providers.

D. Consolidation of the Carver Health Plan and the Limestone Health Plan.

Correct Answer:C

Question 70

- (Topic 1)
Health plans require utilization review for all services administered by its participating physicians.

A. True

B. False

Correct Answer:B

Question 71

- (Topic 2)
Medicaid is a jointly funded federal and state program that provides hospital and medical expense coverage to low-income individuals and certain aged and disabled individuals. One characteristic of Medicaid is that

A. providers who care for Medicaid recipients must accept Medicaid payment as payment in full for services rendered

B. Medicaid requires recipients to pay deductibles, copayments, and coinsurance amounts for all services

C. Medicaid is always the primary payer of benefits

D. benefits offered by Medicaid programs are federally mandated and do not vary by state

Correct Answer:A

Question 72

- (Topic 1)
Arthur Moyer is covered under his employer's group health plan, which must comply with the Consolidated Omnibus Budget Reconciliation Act (COBRA). Mr. Moyer is terminating his employment. He has elected to continue his coverage under his employer's group

A. 18 months, but his coverage under COBRA will cease if he obtains group health coverage through another employer.

B. 18 months, even if he obtains group health coverage through another employer.

C. 36 months, but his coverage under COBRA will cease if he obtains group health coverage through another employer.

D. 36 months, even if he obtains group health coverage through another employer.

Correct Answer:A

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