AHM-530 AHIP Exam Questions and Free Practice Test

Question 31

- (Topic 1)
The sizes of the businesses in a market affect the types of health programs that are likely to be purchased. Compared to smaller employers (those with fewer than 100 employees), larger employers (those with more than 1,000 employees) are

A. more likely to contract with indemnity health plans

B. more likely to offer their employees a choice in health plans

C. less likely to contract with health plans

D. less likely to require a wide variety of benefits

Correct Answer:B

Question 32

- (Topic 2)
Grant Pelham is covered by both a workers’ compensation program and a group health plan provided by his employer. The Shipwright Health Plan administers both programs. Mr. Grant was injured while on the job and applied for benefits.
Mr. Pelham’s group health insurance plan and workers’ compensation both provide benefits to cover expenses incurred as a result of illness or injury. However, unlike traditional group insurance coverage, workers’ compensation

A. Provides reimbursement for lost wages

B. Requires employees who suffer a work-related illness or injury to obtain care from specified network providers

C. Covers all injuries and illnesses, regardless of their cause

D. Requires employees to share the cost of treatment through deductible, coinsurance, and benefit limits

Correct Answer:A

Question 33

- (Topic 1)
The following statement(s) can correctly be made about the TRICARE managed healthcare program of the U.S. Department of Defense.
* 1. Active-duty military personnel are automatically enrolled in TRICARE’s HMO option (TRICARE Prime).
* 2. Eligible family members and dependents can enroll in TRICARE Prime, the PPO plan (TRICARE Extra), or an indemnity plan (TRICARE Standard).

A. Both 1 and 2

B. 1 only

C. 2 only

D. Neither 1 nor 2

Correct Answer:A

Question 34

- (Topic 1)
The following paragraph contains an incomplete statement. Select the answer choice containing the term that correctly completes the statement.
One important activity within the scope of network management is ensuring the quality of the health plan’s provider networks. A primary purpose of ________ is to review the clinical competence of a provider in order to determine whether the provider meets the health plan’s preestablished criteria for participation in the network.

A. authorization

B. provider relations

C. credentialing

D. utilization management

Correct Answer:C

Question 35

- (Topic 2)
In most states, workers’ compensation is first-dollar and last-dollar coverage, which means thatworkers’ compensation programs

A. Can place limits on the benefits they will pay for a given claim

B. Can deny coverage for work-related illness or injury if the employer is not at fault

C. Must pay 100% of work-related medical and disability expenses

D. Can hold employers liable for additional amounts that result from court decisions

Correct Answer:C

Question 36

- (Topic 2)
As an authorized Medicare+Choice plan, the Brightwell HMO must satisfy CMS requirements regulating access to covered services. In order to ensure that its network provides adequate access, Brightwell must

A. Allow enrollees to determine whether they will receive primary care from a physician, nurse practitioner, or other qualified network provider

B. Base a provider’s participation in the network, reimbursement, and indemnification levels on the provider’s license or certification

C. Define its service area according to community patterns of care

D. Require enrollees to obtain prior authorization for all emergency or urgently needed services

Correct Answer:C

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