AHIP AHM-510 Quiz 1 Topic 2 Questions 1-5

Question: 1

The National Association of Insurance Commissioners (NAIC) adopted the Health Maintenance Organization Model Act (HMO Model Act) to regulate the development and operations of HMOs. One true statement regarding the HMO Model Act is that the act

Aincludes mental health services in its definition of basic healthcare services

Bauthorizes only one state agency-the department of insurance-to regulate HMOs

Crequires HMOs to place a deposit in trust with the state insurance commissioner for the purpose of protecting the interests of enrollees should an HMO become financially impaired

Drequires HMOs that wish to offer a point-of-service (POS) product to contract with a licensed insurance company to provide POS options to plan members

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Question: 2

The Balanced Budget Act (BBA) of 1997 created the Medicare+Choice plan. One provision of the BBA under Medicare+Choice is that the BBA

ARequires health plans to qualify as either a competitive medical plan (CMP) or a federally qualified HMO in order to participate in the Medicare program

BEliminates funding for demonstration projects such as the Medicare Enrollment Demonstration Project

CNarrows the geographic variations in payments to Medicare health plans by lowering the growth rate of payments in high-payment counties and raising the rates in low-payment counties

DIncreases Graduate Medical Education (GME) payments to hospitals for the training and cost of educating and training residents

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Question: 3

Health plans typically divide their costs into medical and administrative expenses. Examples of medical expenses are.

AEquipment costs

BSalaries and benefits for executives and for all functional areas

CSales and marketing costs

DPayments to providers for the delivery of healthcare

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Question: 4

The following statements are about market conduct examinations of health plans. Select the answer choice that contains the correct statement.

AMultistate examinations are not appropriate for financial examinations, because regulatory requirements concerning a health plan's financial condition tend to vary from state to state.

BMarket conduct examinations of a health plan's advertising and sales materials include comparing the advertising materials to the policies they advertise.

COnce an examination report is provided to the state insurance department, a health plan is not given an opportunity to present a formal objection to the report.

DIn imposing sanctions on health plans, state insurance departments are required to follow federal sentencing guidelines.

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Question: 5

The Surrey Medical Supply Company was formed as a limited partnership. In this partnership, Victoria Lewin is one of the limited partners and Oscar Gould is a general partner. This information indicates that, with respect to the typical characteristics of limited partnerships,

AMs. Lewin has more freedom to opt out of the partnership than does Mr. Gould

BMs. Lewin has more liability for the debts of Surrey than does Mr. Gould

Cboth Ms. Lewin and Mr. Gould participate in the day-to-day management of Surrey

Dthe partnership will continue upon the death of Mr. Gould, whereas it will end with the death of Ms. Lewin

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AHIP AHM-510 Quiz:1 Topic:2 Questions:1-5