AHM-250 AHIP Exam Questions and Free Practice Test

Question 73

- (Topic 2)
In the United States, the Department of Defense offers ongoing healthcare coverage to military personnel and their families through the TRICARE health plan. One true statement about TRICARE is that

A. hospitals participating in TRICARE program are exempt from JCAHO accreditation and Medicare certification

B. TRICARE enrollees are not entitled to appeal authorization coverage decisions

C. active duty personnel are automatically considered enrolled in TRICARE Prime

D. TRICARE covers inpatient and outpatient services, physician and hospital charges, and medical supplies, but not mental health services

Correct Answer:C

Question 74

- (Topic 3)
Which of the following statements is true?

A. A declining economy can lead to lower healthcare costs as a result of an older population with greater healthcare needs.

B. A larger patient population increases pressure on the health plan to offer larger panels.

C. Provider networks are not affected by the federal and state laws that apply to health plans

D. Network management standards established by independent accrediting organizations have no influence on health plan network design.

Correct Answer:B

Question 75

- (Topic 1)
If most of the physicians, or many of the physicians in a particular specialty, are affiliated with a single entity, then a health plan building a network in the service area
.

A. Has many contracting options available.

B. Should not contract with that entity

C. Most likely needs to contract with that entity

D. Should attempt to disband the existing affiliations

Correct Answer:C

Question 76

- (Topic 2)
The following paragraph contains an incomplete statement. Select the answer choice containing the term that correctly completes the statement. In early efforts to manage healthcare costs, traditional indemnity health insurers included in their health pla

A. cost shifting

B. deductibles

C. underwriting

D. copy

Correct Answer:B

Question 77

- (Topic 3)
The Houston Company, a United States company, offers its eligible employees health insurance coverage through a group health plan. Houston hired the Dallas Company to handle the plan's claim administration and membership services, but Houston is financial

A. Houston is required to purchase stop-loss insurance to cover its losses under this group health plan

B. Houston's plan is a self-funded plan

C. Dallas is the plan's sponsor

D. Houston's plan is not exempt from any state insurance regulations under ERISA

Correct Answer:B

Question 78

- (Topic 1)
Health plans sometimes contract with independent organizations to provide specialty services, such as vision care or rehabilitation services, to plan members. Specialty services that have certain characteristics are generally good candidates for health pl

A. Low or stable costs.

B. Appropriate, rather than inappropriate, utilization rates.

C. A benefit that cannot be easily defined.

D. Defined patient population.

Correct Answer:D

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