QUESTION: 73

HMOs typically employ several techniques to manage provider utilization and member utilization of medical services. One technique that an HMO uses to manage member utilization is

the use of physician practice guidelines
the requirement of copayments for office visits
capitation
risk pools

Answer(s): B

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Ian Vladmir wants to have a routine physical examination to ascertain that he is in good health. Mr.

Vladmir is a member of a health plan that will allow him to select the physician of his choice, either from within his plan's network or from outside of h

a traditional HMO plan
a managed indemnity plan
a point of service (POS) option
an exclusive provider organization (EPO)

Answer(s): C

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QUESTION: 75

Identify the CORRECT statement(s):
(A) Smaller the group, the more likely it is that the group will experience losses similar to the average rate of loss that was predicted.
(B) Gender of the group's participants has no effect on the likelihood of loss.

All of the listed options
B & C
None of the listed options
A & C

Answer(s): C

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QUESTION: 76

If a state commissioner of insurance places an HMO under administrative supervision, then the purpose of this action most likely is to:

Transfer all of the HMO's business to other carriers.
Allow the state commissioner, acting for a state court, to take control of and administer the HMO's assets and liabilities.
Sell the HMO's assets in order to satisfy the HMO's obligations.
Place the HMO's operations under the direction and control of the state commissioner or a person appointed by the commissioner.

Answer(s): D

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QUESTION: 73

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QUESTION: 75

QUESTION: 76

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