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Free AHM-250 Exam Braindumps (page: 39)

Page 38 of 92
PDF with 367 Questions

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



Patrick Flaherty's employer has contracted to receive healthcare for its employees from the Abundant Healthcare System. Mr. Flaherty visits his primary care physician (PCP), who sends him to have some blood tests. The PCP then refers Mr. Flaherty to a special

  1. an integrated delivery system (IDS)
  2. a Management Services Organization (MSO)
  3. a Physician Practice Management (PPM) company
  4. a physician-hospital organization (PHO)

Answer(s): A



Paul Gilbert has been covered by a group health plan for two years. He has been undergoing treatment for angina for the past three months. Last week, Mr. Gilbert began a new job and immediately enrolled in his new company's group health plan, which has a

  1. Can exclude coverage for treatment of Mr. Gilbert's angina for one year, because HIPAA does not impact a group health plan's pre-existing condition provision.
  2. Can exclude coverage for treatment of Mr. Gilbert's angina for one year, because Mr. Gilbert did not have at least 36 months of creditable coverage under his previous health plan.
  3. Can exclude coverage for treatment of Mr. Gilbert's angina for three months, because that is the length of time he received treatment for this medical condition prior to his enrollment in the new health plan.
  4. Cannot exclude his angina as a pre-existing condition, because the one-year pre-existing condition provision is offset by at least one year of continuous coverage under his previous health plan.

Answer(s): D






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