AHM-520 試験問題を無料オンラインアクセス

Under the alternative funding method used by the Flair Company, Flair assumes financial responsibility for paying claims up to a specified level and deposits the funds necessary to pay these claims into a bank account that belongs to Flair. However, an insurer, which acts as an agent of Flair, makes the actual payment of claims from this account. When claims exceed the specified level, the insurer pays the balance from its own funds. No state premium tax is levied on the amounts that Flair deposits into this bank account.
From the following answer choices, choose the name of the alternative funding method described.

• A.Minimum-premium plan
• B.Reserve-reduction arrangement
• C.Retrospective-rating arrangement
• D.Premium-delay arrangement

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The Fairway health plan is a for-profit health plan that issues stock. The following data was taken from Fairway's financial statements:
Current assets.....$5,000,000
Total assets.....6,000,000
Current liabilities.....2,500,000
Total liabilities.....3,600,000
Stockholders' equity.....2,400,000
Fairway's total revenues for the previous financial period were $7,200,000, and its net income for that period was $180,000.
For the previous financial period, Fairway's net profit margin was

• A.7.50%
• B.2.50%
• C.3.60%
• D.3.00%

With regard to capitation arrangements for hospitals, it can correctly be Back to Top stated that

• A.Many hospitals have formed physician hospital organizations (PHOs), hospital systems, or integrated delivery systems (IDSs) that can accept global capitation payments from health plans
• B.The most common reimbursement method for hospitals is professional services capitation
• C.Ahealth plan typically can capitate a hospital for outpatient laboratory and X-ray services only if the health plan also capitates the hospital for inpatient care
• D.Most jurisdictions prohibit hospitals and physicians from joining together to receive global capitations that cover institutional services provided by the hospitals

One true statement about the rate ratios used by a health plan is that the

• A.End result of a typical family rate ratio is that the health plan's family rate is subsidized by its single premium rate
• B.rate ratios used by the health plan most likely have been established by government regulations
• C.health plan cannot arbitrarily increase or decrease its rate ratio for a rate category
• D.health plan should determine its rate ratios by considering family size alone rather than competitive factors such as the ratios that competitors are using

The following examples describe situations that expose an individual or a health plan to
either pure risk or speculative risk:
Example 1 - A health plan invested in 1,000 shares of stock issued by a technology
company.
Example 2 - An individual could contract a terminal illness.
Example 3 - A health plan purchased a new information system.
Example 4 - A health plan could be held liable for the negligent acts of an employee.
The examples that describe pure risk are

• A.Examples 2 and 3
• B.Examples 1 and 2
• C.Examples 1 and 4
• D.Examples 2 and 4