AHM-250 Exam Dumps : Healthcare Management: An Introduction

Assume full financial risk for arranging medical services for their members.

Require plan members to obtain a referral before getting medical services from specialists.

Use a capitation arrangement, instead of a fee schedule, to reimburse physicians.

Offer some coverage, although at a higher cost, for plan members who choose to use the services of non-network providers.

Can exclude coverage for treatment of Mr. Gilbert's angina for one year, because HIPAA does not impact a group health plan's pre-existing condition provision.

Can exclude coverage for treatment of Mr. Gilbert's angina for one year, because Mr. Gilbert did not have at least 36 months of creditable coverage under his previous health plan.

Can exclude coverage for treatment of Mr. Gilbert's angina for three months, because that is the length of time he received treatment for this medical condition prior to his enrollment in the new health plan.

Cannot exclude his angina as a pre-existing condition, because the one-year pre-existing condition provision is offset by at least one year of continuous coverage under his previous health plan.

ERISA

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