AHM-250 AHIP Exam Questions and Free Practice Test

Question 7

- (Topic 2)
One typical characteristic of preferred provider organization (PPO) benefit plans is that PPOs:

A. Assume full financial risk for arranging medical services for their members.

B. Require plan members to obtain a referral before getting medical services from specialists.

C. Use a capitation arrangement, instead of a fee schedule, to reimburse physicians.

D. Offer some coverage, although at a higher cost, for plan members who choose to use the services of non-network providers.

Correct Answer:D

Question 8

- (Topic 3)
When the Knoll Company purchased group health coverage from the Castle Health Maintenance Organization (HMO), the agreement between the two parties specified that the plan would be a typical fully funded plan. Because Knoll had been covered under a previous

A. 230

B. 270

C. 220

D. 180

Correct Answer:C

Question 9

- (Topic 3)
The following statement(s) can correctly be made about the Joint Commission on Accreditation of Healthcare Organizations (JCAHO):

A. JCAHO's accreditation process for MCOs and healthcare networks consists of complete on-site surveys conducted every three

B. A only

C. Neither A nor B

D. Both A and B

E. B only

Correct Answer:A

Question 10

- (Topic 3)
An HMO’s quality assurance program must include

A. A statement of the HMO’s goals and objectives for evaluating and improving enrollees’ health status

B. Documentation of all quality assurance activities

C. System for periodically reporting program results to the HMO’s board of directors, its providers, and regulators

D. All the above

Correct Answer:D

Question 11

- (Topic 2)
PBM plans operate under several types of contractual arrangements. Under one contractual arrangement, the PBM plan and the employer agree on a target cost per employee per month. If the actual cost per employee per month is greater than the target cost, t

A. fee-for-service arrangement

B. risk sharing contract

C. capitation contract

D. rebate contract

Correct Answer:B

Question 12

- (Topic 3)
The following statements apply to enrollment statistics for HSAs. Select the answer choice that contains the CORRECT statement.

A. HSAs have helped expand health care coverage to consumers who were previously uninsured.

B. The vast majority of enrollees in HSA health plans are wealthy.

C. Most people receiving coverage through HSA health plans are individuals rather than families.

D. HSAs appeal primarily to young consumers.

Correct Answer:A

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