AHM-520 Certification Exam Questions with AI Explanations

QUESTION: 36 Exam Topic: 1, Volume A

A stop-loss contract may provide that claims are settled using a paid claims method or an incurred claims method. The Concord Company provides health coverage to its employees through a self- funded health plan. On March 17, a Concord employee who is enrolled in this plan underwent surgery, and the surgery was sufficiently expensive to trigger Concord's specific stop-loss coverage. On April 10, Concord paid the medical expenses associated with the surgery. The term of the stop- loss contract ended on April 1. This information indicates that the stop-loss carrier is responsible for paying a portion of the cost of the surgery under

both the paid claims method and the incurred claims method
the paid claims method but not the incurred claims method
the incurred claims method but not the paid claims method
neither the paid claims method nor the incurred claims method

Answer(s): C

Reveal Solution Next Question

QUESTION: 37 Exam Topic: 1, Volume A

A health plan that capitates a provider group typically provides or offers to provide stop-loss coverage to that provider group.

True
False

Answer(s): A

Reveal Solution Next Question

QUESTION: 38 Exam Topic: 1, Volume A

The sentence below contains two pairs of words enclosed in parentheses. Determine which word in each pair correctly completes the statement. Then select the answer choice containing the two words that you have chosen. Purchasing stop-loss coverage most likely (increases / reduces) a health plan's underwriting risk and (increases / reduces) the health plan's affiliate risk.

increases / increases
increases / reduces
reduces / increases
reduces / reduces

Answer(s): C

Reveal Solution Next Question

QUESTION: 39 Exam Topic: 1, Volume A

The Poplar Company and a Blue Cross/Blue Shield organization have contracted to provide a typical fully funded health plan for Poplar's employees. One true statement about this health plan for Poplar's employees is that

Poplar bears the entire financial risk if, during a given period, the dollar amount of services rendered to Poplar plan members exceeds the dollar amount of premiums collected for this health plan
Poplar and the Blue Cross/Blue Shield organization share the financial risk of paying for claims under Poplar's health plan
The Blue Cross/Blue Shield organization, upon acceptance of a premium, becomes the group plan sponsor for Poplar's health plan
The Blue Cross/Blue Shield organization, upon acceptance of a premium, bears the entire financial risk of paying for the administrative expenses associated with health plan operations

Answer(s): D

Reveal Solution Next Question

QUESTION: 40 Exam Topic: 1, Volume A

The Kayak Company self funds the health plan for its employees. This plan is an example of a type of self-funded plan known as a general asset plan. The fact that this is a completely self-funded plan indicates that

The plan has no funding vehicle
Kayak passes to its employees the financial risk of providing healthcare coverage
The plan most likely is exempt from ERISA requirements concerning the limits on benefit discrimination for classes of employees
The plan is exempt from the state laws and regulations that apply to health insurance policies

Answer(s): D

Reveal Solution Next Question

AHIP Health Plan Finance and Risk Management AHM-520 Dumps in PDF

Free AHIP AHM-520 Real Questions (page: 36)

QUESTION: 36 Exam Topic: 1, Volume A

QUESTION: 37 Exam Topic: 1, Volume A

QUESTION: 38 Exam Topic: 1, Volume A

QUESTION: 39 Exam Topic: 1, Volume A

QUESTION: 40 Exam Topic: 1, Volume A