QUESTION: 33 Exam Topic: 1, Volume A

The Newfeld Hospital has contracted with the Azalea Health Plan to provide inpatient services to Azalea's enrolled members. The contract calls for Azalea to provide specific stop-loss coverage to Newfeld once Newfeld's treatment costs reach $20,000 per case and for Newfeld to pay 20% of the next $50,000 of expenses for this case. After Newfeld's treatment costs on a case reach $70,000, Azalea reimburses the hospital for all subsequent treatment costs.

One true statement about this specific stop-loss coverage is that

The carrier is Newfeld
The attachment point is $20,000
The shared-risk corridor is between $0 and $70,000
This coverage can also be activated when the total covered medical expenses generated by the hospitalizations of Azalea plan members reach a specified level

Answer(s): B

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QUESTION: 34 Exam Topic: 1, Volume A

The Newfeld Hospital has contracted with the Azalea Health Plan to provide inpatient services to Azalea's enrolled members. The contract calls for Azalea to provide specific stop-loss coverage to Newfeld once Newfeld's treatment costs reach $20,000 per case and for Newfeld to pay 20% of the next $50,000 of expenses for this case. After Newfeld's treatment costs on a case reach $70,000, Azalea reimburses the hospital for all subsequent treatment costs.

The maximum amount for which Newfeld is at risk for any one Azalea plan member's treatment costs is

$10,000
$14,000
$30,000
$34,000

Answer(s): C

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QUESTION: 35 Exam Topic: 1, Volume A

The Sanford Group, a provider group, entered into a risk contract with a health plan. Sanford has purchased aggregate stop-loss coverage with an attachment point of 115% of the group's predicted healthcare costs of $2,000,000 for the year. Sanford has a copayment of 10% for any costs above the attachment point. If Sanford's actual costs for the year are $2,800,000, then, according to the terms of the aggregate stop-loss agreement, the amount that Sanford is responsible for is

$2,080,000
$2,300,000
$2,350,000
$2,380,000

Answer(s): C

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QUESTION: 36 Exam Topic: 1, Volume A

A stop-loss contract may provide that claims are settled using a paid claims method or an incurred claims method. The Concord Company provides health coverage to its employees through a self- funded health plan. On March 17, a Concord employee who is enrolled in this plan underwent surgery, and the surgery was sufficiently expensive to trigger Concord's specific stop-loss coverage. On April 10, Concord paid the medical expenses associated with the surgery. The term of the stop- loss contract ended on April 1. This information indicates that the stop-loss carrier is responsible for paying a portion of the cost of the surgery under

both the paid claims method and the incurred claims method
the paid claims method but not the incurred claims method
the incurred claims method but not the paid claims method
neither the paid claims method nor the incurred claims method

Answer(s): C

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QUESTION: 33 Exam Topic: 1, Volume A

QUESTION: 34 Exam Topic: 1, Volume A

QUESTION: 35 Exam Topic: 1, Volume A

QUESTION: 36 Exam Topic: 1, Volume A