QUESTION: 5

A health plan's ability to establish an effective provider network depends on the characteristics of the proposed service area and the needs of proposed plan members. It is generally correct to say that

health plans have more contracting options if providers are affiliated with single entities than if providers are affiliated with multiple entities
urban areas offer more flexibility in provider contracting than do rural areas
consumers and purchasers in markets with little health plan activity are likely to be more receptive to HMOs than to loosely managed plans such as PPOs
large employers tend to adopt health plans more slowly than do small companies

Answer(s): B

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QUESTION: 6

A health savings account must be coupled with an HDHP that meets federal requirements for minimum deductible and maximum out-of-pocket expenses. Dollar amounts are indexed annually for inflation. For 2006, the annual deductible for self-only coverage must

$525
$1,050
$2,100
$5,250

Answer(s): B

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QUESTION: 7

A medical foundation is a not-for-profit entity that purchases and manages physician practices. In order to retain its not-for-profit status, a medical foundation must

Provide significant benefit to the community
Employ, rather than contract with, participating physicians
Achieve economies of scale through facility consolidation and practice management
Refrain from the corporate practice of medicine

Answer(s): A

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QUESTION: 8

A particular health plan offers a higher level of benefits for services provided in-network than for out-of-network services. This health plan requires preauthorization for certain medical services. With regard to the steps that the health plan's claims e

should assume that all services requiring preauthorization have been preauthorized
should investigate any conflicts between diagnostic codes and treatment codes before approving the claim to ensure that the appropriate payment is made for the claim
need not verify that the provider is part of the health plan's network before approving the claim at the in-network level of benefits
need not determine whether the member is covered by another health plan that allows for coordination of benefits

Answer(s): B

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QUESTION: 5

QUESTION: 6

QUESTION: 7

QUESTION: 8

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