AHIP AHM-510 問題集

質問 1：
While traditional workers' compensation laws have restricted the use of managed care
techniques, many states now allow managed workers' compensation. One common characteristic of managed workers' compensation plans is that they
A. Cover an employee's medical costs, but they do not provide coverage for lost wages
B. Discourage injured employees from returning to work until they are able to assume all the duties of their jobs
C. Use low copayments to encourage employees to choose preferred providers
D. Rely on total disability management to control indemnity benefits
正解：D

質問 2：
The following statements are about the Federal Employees Health Benefits Program (FEHBP), which is administered by the Office of Personnel Management (OPM). Three of the statements are true and one statement is false. Select the answer choice that contains the FALSE statement.
A. Each spring, OPM sends all plan providers its call letter, a document that specifies the kinds of benefits that must be available to plan participants and cost goals and procedural changes that the plans need to adopt.
B. For every plan in the FEHBP, OPM annually determines the lowest premium that is actuarially sound and then negotiates with each plan to establish that premium rate.
C. Once a health plan has submitted its rate proposals for a contract year to the OPM, it cannot adjust its premium rate for any reason.
D. To cover its administrative costs, OPM sets aside 1% of all FEHBP premiums.
正解：B

質問 3：
Directors on a health plan's board must demonstrate their compliance with three duties in all their decisions. Directors who exercise their duties in good faith and with the same degree of diligence and skill that an ordinary, reasonable person would be expected to display in the same situation are meeting the duty known as the
A. Trustee duty
B. Duty to supervise
C. Duty of loyalty
D. Duty of care
正解：D

質問 4：
Indigo Health Plan advertised a specific individual health insurance policy through a direct mail advertisement that provided detailed information about the product. In order to comply with theNAIC Model Rules Governing Advertisements of Accident and Sickness Insurance, Indigo must disclose whether the advertised policy contains any exceptions, reductions, or
limitations. Thus, Indigo disclosed in the advertisement that one policy provision limits coverage for dental exams to $50 per exam and to one exam per calendar year. This information indicates that, with respect to the definitions in the NAIC Model Rules, Indigo's advertisement is an example of an
A. Invitation to contract, and it discloses a policy provision known as a reduction
B. Invitation to contract, and it discloses a policy provision known as an exception
C. Invitation to inquire, and it discloses a policy provision known as an exception
D. Invitation to inquire, and it discloses a policy provision known as a reduction
正解：A

質問 5：
SoundCare Health Services, a health plan, recently conducted a situation analysis. One step in this analysis required SoundCare to examine its current activities, its strengths and weaknesses, and its ability to respond to potential threats and opportunities in the environment. This activity provided SoundCare with a realistic appraisal of its capabilities. One weakness that SoundCare identified during this process was that it lacked an effective program for preventing and detectingviolations of law. SoundCare decided to remedy this weakness by using the 1991 Federal Sentencing Guidelines for Organizations as a model for its compliance program.
With respect to the Federal Sentencing Guidelines, actions that SoundCare should take in developing its compliance program include
A. Holding management accountable for the misconduct of their subordinates
B. Assigning a high-level member of management to the position of compliance coordinator or administrator
C. Creating a system through which employees and other agents can report suspected misconduct without fear of retribution
D. All of the above
正解：D

質問 6：
The Nonprofit Institutions Act allows the Neighbor Hospital, a not-for-profit hospital, to purchase at a discount drugs for its 'own use'. Consider whether the following sales of drugs were not for Neighbor's own use and therefore were subject to antitrust enforcement:
Elijah Jamison, a former patient of Neighbor, renewed a prescription that was originally dispensed when he was discharged from Neighbor.
Neighbor filled a prescription for Camille Raynaud, who has no connection to Neighbor other than that her prescribing physician is located in a nearby physician's office building.
Neighbor filled a prescription for Nigel Dixon, who is a friend of a Neighbor medical staff member.
With respect to the United States Supreme Court's definition of 'own use,' the drug sales
that were not for Neighbor's own use were the sales that Neighbor made to
A. Mr. Dixon only
B. Mr. Jamison, Ms. Raynaud, and Mr. Dixon
C. None of these individuals
D. Mr. Jamison and Ms. Raynaud only
正解：B