AHM-250 Free Practice Test

- (Topic 3)
The following statements are about the various Health Plan Accountability Models adopted by the NAIC.

1. A. Under the terms of the Health Plan Network Adequacy Model Act, all health plans would be required to hold covered persons harmless against provider collections and provide continued coverage for uncompleted treatment in the event of plan insolvency
2. B. The Health Carrier Grievance Procedure Model Act requires all health carriers to maintain a first-level grievance review, but it does not require any second-level review
3. C. According to the Health Care Professional Credentialing Verification Model Act, a health plan must select all providers who meet the plan's credentialing criteria
4. D. The Quality Assessment and Improvement Model Act exempts closed plans from
5. E. implementing a quality improvement program.

Correct Answer: A

- (Topic 1)
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

1. A. CCC, AAA, BBB
2. B. BBB, CCC, AAA
3. C. BBB, AAA, CCC
4. D. CCC, BBB, AAA

Correct Answer: A

- (Topic 3)
The process of identifying and classifying the risk represented by an individual or group is called

1. A. Rating
2. B. Anti selection
3. C. Underwriting
4. D. None of the above

Correct Answer: C

- (Topic 2)
Lansdale Healthcare, a health plan, offers comprehensive healthcare coverage to its members through a network of physicians, hospitals, and other service providers. Plan members who use in-network services pay a copayment for these services. The copayment

1. A. specified dollar amount charge that a plan member must pay out-of-pocket for a specified medical service at the time the service is rendered
2. B. percentage of the fees for medical services that a plan member must pay after Magellan has paid its share of the costs of those services
3. C. flat amount that a plan member must pay each year before Magellan will make any
4. D. benefit payments on behalf of the plan member
5. E. specified payment for services that was negotiated between the provider and Magellan

Correct Answer: A

- (Topic 2)
One true statement regarding ethics and laws is that the values of a community are reflected in

1. A. both ethics and laws, and both ethics and laws are enforceable in the court system
2. B. both ethics and laws, but only laws are enforceable in the court system
3. C. ethics only, but only laws are enforceable in the court system
4. D. laws only, but both ethics and laws are enforceable in the court system

Correct Answer: B