AHM-250

AHM-250 practice questions, page 10 of 15, with answer review and explanations.

Question 46

Ed Murray is a claims analyst for a managed care plan that provides a higher level of benefits for services received in-network than for services received out-of-network. Whenever Mr. Murray receives a health claim from a plan member, he reviews the claim

  1. A, B, C, and D
  2. A and C only
  3. A, B, and D only
  4. B, C, and D only

Question 47

Ed O'Brien has both Medicare Part A and Part B coverage. He also has coverage under a PBM plan that uses a closed formulary to manage the cost and use of pharmaceuticals. Recently, Mr. O'Brien was hospitalized for an aneurysm. Later, he was transferred by:

  1. Confinement in the extended-care facility after his hospitalization.
  2. Transportation by ambulance from the hospital to the extended-care facility.
  3. Physicians' professional services while he was hospitalized.
  4. physicians' professional services while he was at the extended-care facility.

Question 48

Eleanor Giambi is covered by a typical 24-hour managed care program. One characteristic of this program is that it:

  1. Provides Ms. Giambi with healthcare coverage for any illness or injury, but only if the cause of the illness or injury is work-related.
  2. Combines the group health plan and disability plan offered by Ms. Giambi's employer with workers' compensation coverage.
  3. Requires Ms. Giambi and her employer to each pay half of the cost of this coverage.
  4. Requires Ms. Giambi to pay specified deductibles and copayments before receiving benefits under this program for any illness or injury.

Question 49

Emily Brown works for Integral Health Plan and represents the company as a board member for the board of directors. Which best describes Emily's position?

  1. Community Representative
  2. Inside Director
  3. Outside Director
  4. None of these

Question 50

Employer-sponsored benefit plans that provide healthcare benefits must comply with the Employee Retirement Income Security Act (ERISA). One of the most significant features of ERISA is that it:

  1. contains a provision stating that the terms of ERISA generally take precedence over any state laws that regulate employee welfare benefit plans
  2. standardizes the conversion of group healthcare benefits to individual healthcare benefits
  3. mandates that self-funded healthcare plans must pay state premium taxes
  4. requires that all active employees, regardless of age, must be eligible for coverage under employer-sponsored benefit plans