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質問 1：
The traditional financial ratios that analysts use to study a health plan's GAAP-based financial statements include liquidity ratios, activity ratios, leverage ratios, and profitability ratios. Of these categories of ratios, analysts are most likely to use
A. Liquidity ratios to measure a health plan's ability to meet its current liabilities
B. Activity ratios relate the returns of a health plan to its sales, total revenues, assets, stockholders' equity, capital, surplus, or stock share price
C. Leverage ratios to measure how quickly a health plan converts specified financial statement items into premium income or cash
D. Profitability ratios to measure the effect that fixed costs have on magnifying a health plan's risk and return
正解：A
質問 2：
The process of converting the present value of a specified amount of money to its future value is known as
A. Capital budgeting
B. Discounting
C. Compounding
D. Capital rationing
正解：C
質問 3：
The Fiesta Health Plan prices its products in such a way that the rates for its products are reasonable, adequate, equitable, and competitive. Fiesta is using blended rating to calculate a premium rate for the Murdock Company, a large employer. Fiesta has assigned a credibility factor of 0.6 to Murdock. Fiesta has also determined that Murdock's manual rate is $200 PMPM and that Murdock's experience rate is $180 PMPM.
According to regulations, Fiesta's premium rates are reasonable if they
A. are high enough to ensure that Fiesta has enough money on hand to pay operating expenses as they come due
B. vary only on the factors that affect Fiesta's costs
C. do not exceed what Fiesta needs to cover its costs and provide the plan with a fair profit
D. are at a level that balances Fiesta's need to generate a profit against its need to obtain or retain a specified share of the market in which it conducts business
正解：C
質問 4：
The provider contract that Dr. Zachery Cogan, an internist, has with the Neptune Health Plan calls for Neptune to reimburse him under a typical PCP capitation arrangement. Dr. Cogan serves as the PCP for Evelyn Pfeiffer, a Neptune plan member. After hospitalizing Ms. Pfeiffer and ordering several expensive diagnostic tests to determine her condition, Dr. Cogan referred her to a specialist for further treatment. In this situation, the compensation that Dr. Cogan receives under the PCP capitation arrangement most likely includes Neptune's payment for
A. His visits to Ms. Pfeiffer while she was hospitalized
B. All of the above
C. The cost of the services that the specialist performed for Ms. Pfeiffer
D. All of the diagnostic tests that he ordered on Ms. Pfeiffer
正解：A
質問 5：
The Lindberg Company has decided to terminate its group healthcare coverage with the Benson Health Plan. Lindberg has several former employees who previously experienced qualifying events that caused them to lose their group coverage. One federal law allows these former employees to continue their group healthcare coverage. From the answer choices below, select the response that correctly identifies the federal law that grants these individuals with the right to continue group healthcare coverage, as well as the entity which is responsible for continuing this coverage:
A. Federal law: Employee Retirement Income Security Act (ERISA) Entity: Lindberg
B. Federal law: Consolidated Omnibus Budget Reconciliation Act (COBRA) Entity: Lindberg
C. Federal law: Consolidated Omnibus Budget Reconciliation Act (COBRA) Entity: Benson
D. Federal law: Employee Retirement Income Security Act (ERISA) Entity: Benson
正解：B
質問 6：
As part of the first step in its strategic planning process, the Trout health plan developed the following statements:
- Statement A-Trout will deliver quality healthcare to our customers at a reasonable cost. - Statement B-Within five years, Trout will be recognized as the industry leader in all of our markets.
Statement A can best be described as a
A. Mission statement, and Statement B also can best be described as a mission statement
B. Vision statement, whereas Statement B can best be described as a mission statement
C. Vision statement, and Statement B also can best be described as a vision statement
D. Mission statement, whereas Statement B can best be described as a vision statement
正解：D
質問 7：
The Longview Hospital contracted with the Carlyle Health Plan to provide inpatient services to Carlyle's enrolled members. Carlyle provides Longview with a type of stop-loss coverage that protects, on a claims incurred and paid basis, against losses arising from significantly higher than anticipated utilization rates among Carlyle's covered population. The stop-loss coverage specifies an attachment point of 130% of Longview's projected $2,000,000 costs of treating Carlyle plan members and requires Longview to pay 15% of any costs above the attachment point. In a given plan year, Longview incurred covered costs totaling $3,000,000.
With regard to the type of stop-loss coverage provided to Longview by Carlyle and to whether this coverage is classified as insurance or reinsurance, the risk transfer approach
used in this situation can be described as:
A. specific stop-loss reinsurance
B. specific stop-loss insurance
C. aggregate stop-loss reinsurance
D. aggregate stop-loss insurance
正解：A
質問 8：
Three general strategies that health plans use for controlling types of risk are risk avoidance, risk transfer, and risk acceptance. The following statements are about these strategies. Three of these statements are true, and one statement is false. Select the answer choice containing the FALSE statement.
A. If a risk is a pure risk from the point of view of a health plan, then the health plan most likely will attempt to avoid the risk.
B. Generally, the smaller the likely benefits of accepting a risk, and the lower the costs of avoiding that risk, the greater the likelihood that a health plan will elect to avoid the risk.
C. A health plan is seldom able to transfer any of the risk that utilization rates will be higher than expected and that its cost of providing healthcare will exceed the revenues it receives.
D. A health plan would most likely transfer some or all of its utilization risk if it pays a provider a rate that is based on the number of plan enrollees that choose the provider as their primary care provider (PCP).
正解：C
質問 9：
One true statement about the rate ratios used by a health plan is that the
A. health plan should determine its rate ratios by considering family size alone rather than competitive factors such as the ratios that competitors are using
B. End result of a typical family rate ratio is that the health plan's family rate is subsidized by its single premium rate
C. health plan cannot arbitrarily increase or decrease its rate ratio for a rate category
D. rate ratios used by the health plan most likely have been established by government regulations
正解：B
The traditional financial ratios that analysts use to study a health plan's GAAP-based financial statements include liquidity ratios, activity ratios, leverage ratios, and profitability ratios. Of these categories of ratios, analysts are most likely to use
A. Liquidity ratios to measure a health plan's ability to meet its current liabilities
B. Activity ratios relate the returns of a health plan to its sales, total revenues, assets, stockholders' equity, capital, surplus, or stock share price
C. Leverage ratios to measure how quickly a health plan converts specified financial statement items into premium income or cash
D. Profitability ratios to measure the effect that fixed costs have on magnifying a health plan's risk and return
正解：A
質問 2：
The process of converting the present value of a specified amount of money to its future value is known as
A. Capital budgeting
B. Discounting
C. Compounding
D. Capital rationing
正解：C
質問 3：
The Fiesta Health Plan prices its products in such a way that the rates for its products are reasonable, adequate, equitable, and competitive. Fiesta is using blended rating to calculate a premium rate for the Murdock Company, a large employer. Fiesta has assigned a credibility factor of 0.6 to Murdock. Fiesta has also determined that Murdock's manual rate is $200 PMPM and that Murdock's experience rate is $180 PMPM.
According to regulations, Fiesta's premium rates are reasonable if they
A. are high enough to ensure that Fiesta has enough money on hand to pay operating expenses as they come due
B. vary only on the factors that affect Fiesta's costs
C. do not exceed what Fiesta needs to cover its costs and provide the plan with a fair profit
D. are at a level that balances Fiesta's need to generate a profit against its need to obtain or retain a specified share of the market in which it conducts business
正解：C
質問 4：
The provider contract that Dr. Zachery Cogan, an internist, has with the Neptune Health Plan calls for Neptune to reimburse him under a typical PCP capitation arrangement. Dr. Cogan serves as the PCP for Evelyn Pfeiffer, a Neptune plan member. After hospitalizing Ms. Pfeiffer and ordering several expensive diagnostic tests to determine her condition, Dr. Cogan referred her to a specialist for further treatment. In this situation, the compensation that Dr. Cogan receives under the PCP capitation arrangement most likely includes Neptune's payment for
A. His visits to Ms. Pfeiffer while she was hospitalized
B. All of the above
C. The cost of the services that the specialist performed for Ms. Pfeiffer
D. All of the diagnostic tests that he ordered on Ms. Pfeiffer
正解：A
質問 5：
The Lindberg Company has decided to terminate its group healthcare coverage with the Benson Health Plan. Lindberg has several former employees who previously experienced qualifying events that caused them to lose their group coverage. One federal law allows these former employees to continue their group healthcare coverage. From the answer choices below, select the response that correctly identifies the federal law that grants these individuals with the right to continue group healthcare coverage, as well as the entity which is responsible for continuing this coverage:
A. Federal law: Employee Retirement Income Security Act (ERISA) Entity: Lindberg
B. Federal law: Consolidated Omnibus Budget Reconciliation Act (COBRA) Entity: Lindberg
C. Federal law: Consolidated Omnibus Budget Reconciliation Act (COBRA) Entity: Benson
D. Federal law: Employee Retirement Income Security Act (ERISA) Entity: Benson
正解：B
質問 6：
As part of the first step in its strategic planning process, the Trout health plan developed the following statements:
- Statement A-Trout will deliver quality healthcare to our customers at a reasonable cost. - Statement B-Within five years, Trout will be recognized as the industry leader in all of our markets.
Statement A can best be described as a
A. Mission statement, and Statement B also can best be described as a mission statement
B. Vision statement, whereas Statement B can best be described as a mission statement
C. Vision statement, and Statement B also can best be described as a vision statement
D. Mission statement, whereas Statement B can best be described as a vision statement
正解：D
質問 7：
The Longview Hospital contracted with the Carlyle Health Plan to provide inpatient services to Carlyle's enrolled members. Carlyle provides Longview with a type of stop-loss coverage that protects, on a claims incurred and paid basis, against losses arising from significantly higher than anticipated utilization rates among Carlyle's covered population. The stop-loss coverage specifies an attachment point of 130% of Longview's projected $2,000,000 costs of treating Carlyle plan members and requires Longview to pay 15% of any costs above the attachment point. In a given plan year, Longview incurred covered costs totaling $3,000,000.
With regard to the type of stop-loss coverage provided to Longview by Carlyle and to whether this coverage is classified as insurance or reinsurance, the risk transfer approach
used in this situation can be described as:
A. specific stop-loss reinsurance
B. specific stop-loss insurance
C. aggregate stop-loss reinsurance
D. aggregate stop-loss insurance
正解：A
質問 8：
Three general strategies that health plans use for controlling types of risk are risk avoidance, risk transfer, and risk acceptance. The following statements are about these strategies. Three of these statements are true, and one statement is false. Select the answer choice containing the FALSE statement.
A. If a risk is a pure risk from the point of view of a health plan, then the health plan most likely will attempt to avoid the risk.
B. Generally, the smaller the likely benefits of accepting a risk, and the lower the costs of avoiding that risk, the greater the likelihood that a health plan will elect to avoid the risk.
C. A health plan is seldom able to transfer any of the risk that utilization rates will be higher than expected and that its cost of providing healthcare will exceed the revenues it receives.
D. A health plan would most likely transfer some or all of its utilization risk if it pays a provider a rate that is based on the number of plan enrollees that choose the provider as their primary care provider (PCP).
正解：C
質問 9：
One true statement about the rate ratios used by a health plan is that the
A. health plan should determine its rate ratios by considering family size alone rather than competitive factors such as the ratios that competitors are using
B. End result of a typical family rate ratio is that the health plan's family rate is subsidized by its single premium rate
C. health plan cannot arbitrarily increase or decrease its rate ratio for a rate category
D. rate ratios used by the health plan most likely have been established by government regulations
正解：B
浅仓** -
もちろん合格することが目標ではあるが、AHM-520知識としてこれだけの情報を持っていれば、仕事にも必ず役に立つ。