AHM-250

AHM-250 practice questions, page 7 of 15, with answer review and explanations.

Question 31

Before the Leo Health Maintenance Organization (HMO) received a certificate of authority (COA) to operate in State X, it had to meet the state's licensing requirements and financial standards which were established by legislation that is identical to

  1. receive compensation based on the volume and variety for medical services they perform for Leo plan members, whereas the specialists receive compensation based solely on the number of plan members who are covered for specific services
  2. have no financial incentive to practice preventive care or to focus on improving the health of their plan members, whereas the specialists have a positive incentive to help their plan members stay healthy
  3. receive from the IPA the same monthly compensation for each Leo plan member under the PCP's care, whereas the specialists receive compensation based on a percentage discount from their normal fees
  4. receive compensation based on a fee schedule, whereas the specialists receive compensation based on per diem charges

Question 32

Beginning in the early 1980s, several factors contributed to increased demand for behavioral healthcare services. These factors included:

  1. increased stress on individuals and families
  2. increased availability of behavioral healthcare services
  3. greater awareness and acceptance of behavioral healthcare issues
  4. all of the above

Question 33

Bill Clinton is a member of Lewinsky's PBM plan which has a three-tier copayment structure. Bill fell ill and his doctor prescribed him AAA, a brand-name drug which was included in the Lewinsky's formulary; BBB, a non-formulary drug; and CCC, a generic drug. In which order, from most preferred to least, is the preferred drug of choice for this coverage?

  1. CCC, AAA, BBB
  2. BBB, CCC, AAA
  3. BBB, AAA, CCC
  4. CCC, BBB, AAA

Question 34

Brokers are one type of distribution channel that health plans use to market their health plans. One true statement about brokers for health plan products is that, typically, brokers:

  1. Are not required to be licensed by the states in which they market health plans
  2. Are compensated on a salary basis
  3. Represent only one health plan or insurer
  4. Are considered to be an agent of the buyer rather than an agent of the health plan or Insurer

Question 35

By definition, a health plan's network refers to the:

  1. organizations and individuals involved in the consumption of healthcare provided by the plan
  2. relative accessibility of the plan's providers to the plan's participants
  3. group of physicians, hospitals, and other medical care providers with whom the plan has contracted to deliver medical services to its members
  4. integration of the plan's participants with the plan's providers