AHM-520試験無料問題集（215題）「AHIP Health Plan Finance and Risk Management 認定」

出題：1

A key factor that distinguishes the various types of health plans is the type and amount of risk that a health plan assumes with respect to the delivery and financing of healthcare benefits. An example of a type of health plan that typically assumes the financial risk of delivering and financing healthcare benefits is a

A. Third party administrator (TPA)

B. Utilization review organization (URO)

C. Pharmacy benefit management (PBM) plan

D. Preferred provider organization (PPO)

正解：D 解答を投票する

出題：2

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

A. Poplar and the Blue Cross/Blue Shield organization share the financial risk of paying for claims under Poplar's health plan

B. The Blue Cross/Blue Shield organization, upon acceptance of a premium, becomes the group plan sponsor for Poplar's health plan

C. 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

D. 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

正解：C 解答を投票する

出題：3

The Nuevo health plan's capital structure consists of 30% debt and 70% equity. Nuevo's average after-tax cost of debt is 6% and its cost of equity is 12%. The following statement(s) can correctly be made about Nuevo's weighted average cost of capital (WACC):

A. Nuevo has a WACC of 10.2%

B. B only

C. A only

D. Both A and B

E. If Nuevo establishes its WACC as the handle rate for capital investments, then it can expect an investment to add value to the health plan only if the investment is expected to earn a return of less than Nuevo's WACC

F. Neither A nor B

正解：E 解答を投票する

出題：4

The methods of alternative funding for health coverage can be divided into the following general categories:
- Category A-Those methods that primarily modify traditional fully insured group insurance contracts - Category B-Those methods that have either partial or total self funding
Typically, small employers are able to use some of the alternative funding methods in

A. Neither Category A nor Category B

B. Category B only

C. Category A only

D. Both Category A and Category B

正解：B 解答を投票する

出題：5

A health plan may experience negative working capital whenever healthcare expenses generated by plan members exceed the premium income the health plan receives.
Ways in which a health plan can manage the volatility in claims payments, and therefore reduce the risk of negative working capital, include:
1.Accurately estimating incurred but not reported (IBNR) claims
2.Using capitation contracts for provider reimbursement

A. Neither 1 nor 2

B. Both 1 and 2

C. 1 only

D. 2 only

正解：B 解答を投票する

出題：6

A product is often described as having a thin margin or a wide margin. With regard to the factors that help determine the size of the margin of a health plan's product, it can correctly be stated that the

A. greater the risk a health plan assumes in a health plan, the thinner the product margin should be

B. more that competition acts to force prices down, the wider the product margins tend to become

C. longer the premium rates are guaranteed to a group, the wider the health plan's margin should be

D. greater the demand for the product, the thinner the margin for this product tends to become

正解：C 解答を投票する

出題：7

Kevin Olin applied for individual healthcare coverage from the Mercury health plan. Before issuing the policy, Mercury's underwriters attached a rider that excludes from coverage any loss that results from Mr. Olin's chronic knee problem. This information indicates that Mr. Olin's policy includes

A. an impairment rider

B. a moral hazard rider

C. an essential plan rider

D. an insurable interest rider

正解：A 解答を投票する

出題：8

The Sesame health plan uses a method of accumulating cost data that enables the health plan to satisfy financial reporting requirements for compiling financial statements and corporate tax returns. Although this method assists Sesame's managers in studying which types of costs are rising and falling over time, it does not explain which areas of Sesame incur each cost. This method, which is the most basic level of cost accumulation, is known as accumulating costs by

A. Lines of business

B. Type of cost

C. Cost center

D. Function

正解：B 解答を投票する

出題：9

The medical loss ratio (MLR) for the Peacock health plan is 80%. Peacock's expense ratio is 16%.
Peacock's MLR and its expense ratio indicate that Peacock

A. Has a combined ratio of 64%

B. Has a 4% potential profit margin

C. Must increase its premium income in order to remain in business

D. Must rely on investment income in order to avoid financial losses

正解：B 解答を投票する

AHM-520試験無料問題集「AHIP Health Plan Finance and Risk Management 認定」