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AHM-510 Exam Dumps : Governance and Regulation

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Governance and Regulation Questions and Answers

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Question 1

The Wentworth Corporation uses a self-funded plan to provide its employees with healthcare benefits. One consequence of Wentworth's approach to providing healthcare benefits is that self-funding

Options:

A.

Requires that Wentworth self-administer its healthcare benefit plan

B.

Requires that Wentworth pay higher state premium taxes than do insurers and health plans

C.

Eliminates the need for Wentworth to pay a risk charge to an insurer or health plan

D.

Increases the number of benefit and rating mandates that apply to Wentworth's plan

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Question 2

TRICARE, a military healthcare program, offers eligible beneficiaries three options for healthcare services: TRICARE Prime, TRICARE Extra, and TRICARE Standard. With respect to plan features, both an annual deductible and claims filing requirements must be met, regardless of whether care is delivered by network providers, under

Options:

A.

TRICARE Prime and TRICARE Extra only

B.

TRICARE Extra and TRICARE Standard only

C.

TRICARE Standard only

D.

None of these healthcare options

Question 3

Certificate of need (CON) laws apply to health plans in a variety of ways, depending upon the state. By definition, CON laws are laws that are designed to

Options:

A.

Regulate the construction, renovation, and acquisition of healthcare facilities as well as the purchase of major medical equipment in a geographical area

B.

Protect commerce from unlawful restraint of trade, price discrimination, price fixing, reduced competition, and monopolies

C.

Determine benefit payments when a person is covered by more than one plan, such as two group health plans

D.

License and regulate health plans that wish to establish and operate an HMO

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