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Free AHIP AHM-520 Exam Questions (page: 21)

Page 11 of 55
PDF with 215 Questions

A health plan that capitates a provider group typically provides or offers to provide stop-loss coverage to that provider group.

  1. True
  2. False

Answer(s): A



The sentence below contains two pairs of words enclosed in parentheses. Determine which word in each pair correctly completes the statement. Then select the answer choice containing the two words that you have chosen. Purchasing stop-loss coverage most likely (increases / reduces) a health plan's underwriting risk and (increases / reduces) the health plan's affiliate risk.

  1. increases / increases
  2. increases / reduces
  3. reduces / increases
  4. reduces / reduces

Answer(s): C



The Poplar Company and a Blue Cross/Blue Shield organization have contracted to provide a typical fully funded health plan for Poplar's employees. One true statement about this health plan for Poplar's employees is that

  1. Poplar bears the entire financial risk if, during a given period, the dollar amount of services rendered to Poplar plan members exceeds the dollar amount of premiums collected for this health plan
  2. Poplar and the Blue Cross/Blue Shield organization share the financial risk of paying for claims under Poplar's health plan
  3. The Blue Cross/Blue Shield organization, upon acceptance of a premium, becomes the group plan sponsor for Poplar's health plan
  4. The Blue Cross/Blue Shield organization, upon acceptance of a premium, bears the entire financial risk of paying for the administrative expenses associated with health plan operations

Answer(s): D



The Kayak Company self funds the health plan for its employees. This plan is an example of a type of self-funded plan known as a general asset plan. The fact that this is a completely self-funded plan indicates that

  1. The plan has no funding vehicle
  2. Kayak passes to its employees the financial risk of providing healthcare coverage
  3. The plan most likely is exempt from ERISA requirements concerning the limits on benefit discrimination for classes of employees
  4. The plan is exempt from the state laws and regulations that apply to health insurance policies

Answer(s): D



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