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AHM-520 – Health Plan Finance and Risk Management

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Showing 4–6 of 15 questions

Question 4 (Volume A)

The following statement(s) can correctly be made about a health plan's underwriting of small groups:

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    Typically, a health plan medically underwrites both the employees of a small group and their dependents, even though small group reform laws prohibit health plans from singling out individuals for rejection or substandard rate-ups.

    Both A and B
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    In the absence of laws mandating otherwise, a health plan's underwriting standards grow stricter as group size gets smaller.


    A only
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    B only
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    Neither A nor B
Question 5 (Volume A)

Providing services under Medicare or Medicaid can impose on health plans financial risks and costs that are greater than those related to providing services to the commercial population. Reasons that an health plan's financial risks and costs for providing services to Medicare and Medicaid enrollees tend to be higher include

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    Most Medicare and Medicaid enrollees can disenroll from a health plan on a monthly basis
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    The high incidences of chronic illness in both the Medicare and Medicaid populations results in higher costs related to coordinating care and case management
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    Medicare and Medicaid enrollees tend to have a high level of costs in the first few months of enrollment as the health plan educates them about the health plan system and performs initial health screening to evaluate their health

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    all of the above
Question 6 (Volume B)

One way that a health plan can protect itself against case stripping is by requiring:

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    Employees covered by a small group plan to contribute 100% of the cost of the healthcare coverage
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    The small group to have no more than 10 members
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    A minimum level of participation in order for a small group to be eligible for healthcare coverage
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    Its underwriters to consider the characteristics of the employer, but not of the group members, when underwriting the group