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Free AHM-250 Exam Braindumps
Healthcare Management: An Introduction Questions 146–150 (page: 31)

Updated On: 10-Feb-2026
Page 31 of 74
PDF with 367 Questions

One way in which a health plan can support an ethical environment is by

  1. requiring organizations with which it contracts to adopt the plan's formal ethical policy
  2. developing and maintaining a culture where ethical considerations are integrated into decision making at the top organizational level only
  3. establishing a formal method of managing ethical conflicts, such as using an ethics task force or bioethics consultant
  4. maintaining control of policy development by removing providers and members from the process of developing and implementing policies and procedures that provide guidance to providers and members confronted with ethical issues

Answer(s): C



One way in which health plans differ from traditional indemnity plans is that health plans typically

  1. provide less extensive benefits than those provided under traditional indemnity plans
  2. place a greater emphasis on preventive care than do traditional indemnity plans
  3. require members to pay a percentage of the cost of medical services rendered after a claim is filed, rather than a fixed copayment at the time of service as required by indemnity plans
  4. contain cost-sharing requirements that result in more out-of-pocket spending by members than do the cost-sharing requirements in traditional indemnity plans

Answer(s): B



One way that MCOs involve providers in risk sharing is by retaining a percentage of the providers' payment during a plan year. At the end of the plan year, the MCO may use the amount retained to offset or pay for any cost overruns for referral or hospital

  1. withholds
  2. usual, customary, and reasonable (UCR) fees
  3. risk pools
  4. per diems

Answer(s): A



Parable Healthcare Providers, a health plan, recently segmented the market for a new healthcare service. Parable began the process by dividing the healthcare market into two broad categories: non- group and group. Next, Parable further segmented the non-gr

  1. channel segmentation
  2. geographic segmentation
  3. demographic segmentation
  4. product segmentation

Answer(s): C



Parul Gupta has been covered by a group health plan for eighteen months. For the past four months, she has been undergoing treatment for diabetes. Last week, Ms. Gupta began a new job and immediately enrolled in her new company's group health plan, which

  1. can exclude coverage for treatment of Ms. Gupta's diabetes for one year, because she did not have at least two years of creditable coverage under her previous health plan
  2. cannot exclude Ms. Gupta's diabetes as a pre-existing condition, because the one-year preexisting condition provision is offset by at least one year of continuous coverage under her previous health plan
  3. can exclude coverage for treatment of Ms. Gupta's diabetes for one year, because HIPAA does not impact a group health plan's pre-existing condition provision
  4. can exclude coverage for treatment of Ms. Gupta's diabetes for four months, because that is the length of time she received treatment for this medical condition prior to her enrollment in the new health plan

Answer(s): B



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