Free AHM-250 Exam Braindumps

- (Topic 3)
The NAIC adopted the HMO Model Act in order to provide a system of ongoing regulatory monitoring of HMOs. All of the following statements are correct about the HMO Model Act EXCEPT that it:

1. A. Regulates HMO operations in two critical areas: financial responsibility and healthcare delivery.
2. B. Requires each HMO to send state regulators an annual report describing the HMO's finances and operations.
3. C. Focuses on three key aspects of healthcare delivery: network adequacy, quality assurance, and grievance procedures.
4. D. Requires state insurance departments to conduct annual examinations of an HMO's operations, quality assurance programs, and provider networks.

Correct Answer: D

- (Topic 2)
Specialty services with certain characteristics tend to make good candidates for health plan approaches. One characteristic used to identify a specialty service that may be a good candidate for a health plan approach is that the service should have

1. A. a defined patient population
2. B. a complex benefit structure
3. C. low, stable costs
4. D. appropriate utilization rates

Correct Answer: A

- (Topic 3)
The following statements are about the non-group market for managed care products in the United States. Select the answer choice containing the correct statement.

1. A. In order to promote a product to the individual market, MCOs typically rely on personal selling by captive agents rather than on promotional tools such as direct mail, telemarketing, and advertising.
2. B. Managed Medicare plans typically are allowed to reject a Medicare applicant on the basis of the results of medical underwriting of the applicant.
3. C. HCFA (now known as the Centers for Medicare and Medicaid Services) must approve all membership and enrollment materials used by MCOs to market managed care products to the Medicare population.
4. D. Managed care plans are not allowed to health screen individual market customers who are under age 65, even if the health screen could help prevent anti selection.

Correct Answer: C

- (Topic 2)
The administrative simplification standards described under Title II of HIPAA include
privacy standards to control the use and disclosure of health information. In general, these privacy standards prohibit

1. A. all health plans, healthcare providers, and healthcare clearinghouses from using any protected health information for purposes of treatment, payment, or healthcare operations without an individual's written consent
2. B. patients from requesting that restrictions be placed on the accessibility and use of protected health information
3. C. transmission of individually identifiable health information for purposes other than treatment, payment, or healthcare operations without the individual's written authorization
4. D. patients from accessing their medical records and requesting the amendment of incorrect or incomplete information

Correct Answer: D

- (Topic 1)
From the answer choices below, select the response that correctly identifies the rating method that Mr. Sybex used and the premium rate PMPM that Mr. Sybex calculated for the Koster group.

1. A. Rating Method book rating Premium Rate PMPM $132
2. B. Rating Method book rating Premium Rate PMPM $138
3. C. Rating Method blended rating Premium Rate PMPM $132
4. D. Rating Method blended rating Premium Rate PMPM $138

Correct Answer: C