AHM-250 AHIP Exam Questions and Free Practice Test

Question 19

- (Topic 3)
Which of the following people would be considered part of the individual market segment?

A. John is eligible for Medicare.

B. Julie has coverage through an employer group.

C. James works for an employer that does not offer health coverage.

D. Jenny is eligible for Medicaid.

Correct Answer:C

Question 20

- (Topic 2)
Janet Riva is covered by a traditional indemnity health insurance plan that specifies a $250 deductible and includes a 20% coinsurance provision. When Ms. Riva was hospitalized, she incurred $2,500 in medical expenses that were covered by her health plan.

A. $1,750

B. $1,800

C. $2,000

D. $2,250

Correct Answer:B

Question 21

- (Topic 3)
The following statements are about the various Health Plan Accountability Models adopted by the NAIC.

A. Under the terms of the Health Plan Network Adequacy Model Act, all health plans would be required to hold covered persons harmless against provider collections and provide continued coverage for uncompleted treatment in the event of plan insolvency

B. The Health Carrier Grievance Procedure Model Act requires all health carriers to maintain a first-level grievance review, but it does not require any second-level review

C. According to the Health Care Professional Credentialing Verification Model Act, a health plan must select all providers who meet the plan's credentialing criteria

D. The Quality Assessment and Improvement Model Act exempts closed plans from

E. implementing a quality improvement program.

Correct Answer:A

Question 22

- (Topic 3)
The following statements are about concepts related to the underwriting function within a health plan. Select the answer choice containing the correct statement.

A. Anti selection refers to the fact that individuals who believe that they have a less-than-

B. average likelihood of loss tend to seek healthcare coverage to a greater extent than do individuals who believe that they have an average or greater-than-average like

C. Federally qualified HMOs are required to medically underwrite all groups applying for coverage.

D. Typically, a health plan guarantees the premium rate for a group health contract for a period of five years.

E. When evaluating the risk for a group policy, underwriters typically focus on such factors as the size of the group, the stability of the group, and the activities of the group.

Correct Answer:D

Question 23

- (Topic 3)
Salient features of a Health Savings Account include all of the following except

A. Funding by both employer & the employee

B. Employer account ownership

C. Account portability & roll over of funds from year to year

D. Investment opportunities

Correct Answer:B

Question 24

- (Topic 3)
Prescription drug benefits in Medicare can be obtained through:

A. Stand alone prescription drug pl (PDPs)

B. Traditional fee for service (FFS) Medicare

C. Medicare Advantage pl

D. Both A & C

Correct Answer:A

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