AHM-250 Exam AI-Powered | Exam-Dumps.net (Page: 7)

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 the

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
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
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
receive compensation based on a fee schedule, whereas the specialists receive compensation based on per diem charges

Answer(s): C

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QUESTION: 32

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

increased stress on individuals and families
increased availability of behavioral healthcare services
greater awareness and acceptance of behavioral healthcare issues
all of the above

Answer(s): D

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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 dr

CCC, AAA, BBB
BBB, CCC, AAA
BBB, AAA, CCC
CCC, BBB, AAA

Answer(s): A

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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

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

Answer(s): D

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QUESTION: 35

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

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

Answer(s): C

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AHIP AHM-250 (page: 7)

QUESTION: 31

QUESTION: 32

QUESTION: 33

QUESTION: 34

QUESTION: 35