AHM-250 Free Practice Test

- (Topic 3)
To set up and contribute to an HSA, an individual must:

1. A. Be covered by a high-deductible health plan that meets federal requirements.
2. B. Not have other health insurance.
3. C. Not be enrolled in Medicare.
4. D. All of the above.

Correct Answer: D

- (Topic 3)
Which of the following statements is FALSE?

1. A. The license that HMOs get in each state is called ‘Certificate of Authority’
2. B. The HMO contracts directly with the individual physicians who provide the medical services to the HMO members in a variation of the IPA model called direct contract model HMO.
3. C. All medicare/mediclaim beneficiaries should comply with utilization management requirements set forth by HCFA
4. D. HMO’s usually impose high coinsurance or deductible requirements

Correct Answer: D

- (Topic 2)
One device that PBM plans use to manage both the cost and use of pharmaceuticals is a formulary. A formulary is defined as

1. A. a listing of drugs classified by therapeutic category or disease class that are considered preferred therapy for a given managed population and that are to be used by a health plan's providers in prescribing medications
2. B. a reduction in the price of a particular pharmaceutical obtained by the PBM from the pharmaceutical manufacturer
3. C. drugs ordered and delivered through the mail to the PBM's plan members at a reduced cost
4. D. an identification card issued by the PBM to its plan members

Correct Answer: A

- (Topic 1)
In the following sections, we will describe some of the measures health plans use to evaluate the quality of the services and healthcare they offer their members.
Which of the following is the best description of what a 'Process measure' evaluates?

1. A. The nature, quantity, and quality of the resources that a health plan has available for member service and patient care.
2. B. The methods and procedures a health plan and its providers use to furnish service and care.
3. C. The extent to which services succeed in improving or maintaining satisfaction and patient health.
4. D. None of the above

Correct Answer: B

- (Topic 1)
If a state commissioner of insurance places an HMO under administrative supervision, then the purpose of this action most likely is to:

1. A. Transfer all of the HMO's business to other carriers.
2. B. Allow the state commissioner, acting for a state court, to take control of and administer the HMO's assets and liabilities.
3. C. Sell the HMO's assets in order to satisfy the HMO's obligations.
4. D. Place the HMO's operations under the direction and control of the state commissioner or a person appointed by the commissioner.

Correct Answer: D