QUESTION: 205

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

Anti selection refers to the fact that individuals who believe that they have a less-than-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
Federally qualified HMOs are required to medically underwrite all groups applying for coverage.
Typically, a health plan guarantees the premium rate for a group health contract for a period of five years.
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.

Answer(s): D

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QUESTION: 206

The following statements are about federal laws that affect healthcare organizations. Select the answer choice containing the correct response.

The Women's Health and Cancer Rights Act (WHCRA) of 1998 requires health plans to offer mastectomy benefits.
The Health Care Quality Improvement Act (HCQIA) requires hospitals, group practices, and HMOs to comply with all standard antitrust legislation, even if these entities adhere to due process standards that are outlined in HCQIA.
The Newborns' and Mothers' Health Protection Act (NMHPA) of 1996 mandates that coverage for hospital stays for childbirth must generally be a minimum of 24 hours for normal deliveries and 48 hours for cesarean births.
Although the Mental Health Parity Act (MHPA) does not require health plans to offer mental health coverage, it imposes requirements on those plans that do offer mental health benefits.

Answer(s): D

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QUESTION: 207

The following statements are about health information networks (HINs). Three of the statements are true and one statement is false. Select the answer choice containing the FALSE statement.

Most HINs are built on proprietary computer networks rather than being Internet based.
While a HIN is for the exclusive use of one organization, a community health information network (CHIN) is shared by several organizations.
A health plan can use a secured extranet design or a distributed database approach for its HIN.
HINs have the potential to increase the quality of medical care because they make a patient's medical history readily available to each provider at the point of service.

Answer(s): A

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QUESTION: 208

The following statements are about information management in health plans. Three of the statements are true and one statement is false. Select the answer choice containing the FALSE statement:

Health plans find EDI useful for transmitting data among different health plan locations.
EDI is different from eCommerce in the EDI is the transfer of data, typically in batches, while ecommerce is a back-and-forth exchange of information concerning individual transactions.
The majority of health plan eCommerce occurs via proprietary computer networks.
Benefits that health plans can receive from using electronic data interchange.

Answer(s): C

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