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Free AHM-520 Exam Braindumps (page: 18)

Page 17 of 55
PDF with 215 Questions

Most organizations that obtain group healthcare coverage can be classified as one of three types of groups: employer-employee groups, multiple employer groups, and professional associations. One true statement about these types of groups is that

  1. Anti selection risk is higher for both multiple-employer groups and professional associations than it is for an employer-employee group
  2. Private employers typically present a higher underwriting risk to health plans than do public employers
  3. Individual members of a multiple-employer group or a professional association typically are required to obtain healthcare coverage through the group or association
  4. I health plan is prohibited, when evaluating the risks represented by a professional association, from considering the industry experience of the agent or broker that sells a group plan to the association

Answer(s): A



Because a health plan cannot decline coverage for individuals who are eligible for conversion of group health coverage to individual health coverage, the bulk of the health plan's underwriting for conversion policies is accomplished through health plan design.

  1. True
  2. False

Answer(s): A



The Cardinal health plan complies with all of the provisions of HIPAA.

Cardinal has received requests for healthcare coverage from the following companies that meet the statutory definition of a small group:
The Xavier Company has excellent claims experience
The Youngblood Company has not previously offered group healthcare coverage to its employees

The Zebulon Company has poor claims experience

According to HIPAA's provisions, Cardinal must issue a healthcare contract to

  1. Xavier, Youngblood, and Zebulon
  2. Xavier and Youngblood only
  3. Xavier only
  4. None of these companies

Answer(s): A



Over time, health plans and their underwriters have gathered increasingly reliable information about the morbidity experience of small groups.

Generally, in comparison to large groups, small groups tend to

  1. Have more frequent and larger claims fluctuations
  2. Generate lower administrative expenses as a percentage of the total premium amount the group pays
  3. More closely follow actuarial predictions regarding morbidity rates
  4. All of the above

Answer(s): A






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