AHM-520 AHIP Health Plan Finance and Risk Management exact Exam Questions

Health Plan Finance and Risk Management

Last Update 4 hours ago Total Questions : 215

The Health Plan Finance and Risk Management content is now fully updated, with all current exam questions added 4 hours ago. Deciding to include AHM-520 practice exam questions in your study plan goes far beyond basic test preparation.

You'll find that our AHM-520 exam questions frequently feature detailed scenarios and practical problem-solving exercises that directly mirror industry challenges. Engaging with these AHM-520 sample sets allows you to effectively manage your time and pace yourself, giving you the ability to finish any Health Plan Finance and Risk Management practice test comfortably within the allotted time.

Question # 61

The Chamber Health Plan reimburses primary care physicians on a monthly basis by using a simple capitation method. Chamber assumes an annual utilization rate of three visits per year. The FFS rate per office visit is $75, and all plan members are required to make a $10 copayment for each office visit. This information indicates that the capitation rate that Chamber calculates per member per month (PMPM) is equal to:

$6.25

$16.25

$18.75

$21.25

Question # 62

Contingency risks, or C-risks, are general categories of risk that have a direct bearing on both the cash flow and solvency of a health plan. One of these C-risks, pricing risk (C-2 risk), is typically the most important risk a health plan faces. Pricing risk is crucial to a health plan’s solvency because:

A sizable portion of any health plan’s assets are held in long-term investments and any shift in interest rates can significantly impact a health plan’s ability to pay medical benefits

A health plan relies heavily on the sound judgment of its management, and poor management decisions can result in financial losses for the health plan

A situation in which actual expenses exceed the amounts budgeted for those expenses may result in the health plan failing to retain assets sufficient to cover current obligations

A sizable portion of the total expenses and liabilities faced by a health plan come from contractual obligations to pay future medical costs, and the exact amounts of those costs are not known at the time a product’s premium is established

Question # 63

The Sesame health plan uses a method of accumulating cost data that enables the health plan to satisfy financial reporting requirements for compiling financial statements and corporate tax returns. Although this method assists Sesame's managers in studying which types of costs are rising and falling over time, it does not explain which areas of Sesame incur each cost. This method, which is the most basic level of cost accumulation, is known as accumulating costs by

Cost center

Type of cost

Lines of business

Function

Question # 64

The following statements are about the option for health plan funding known as a self-funded plan. Select the answer choice containing the correct response:

In a self-funded plan, an employer is relieved of all risk associated with paying for the healthcare costs of its employees.

Self-funded plans are subject to the same state laws and regulations that apply to health insurance policies.

Employers electing to self-fund a health plan are required to pay claims from a separate trust established for that purpose.

An employer electing to self-fund a health plan has the option of purchasing stop-loss insurance to transfer part of the financial risk to an insurer.