AHM-520 Exam Dumps : Health Plan Finance and Risk Management

A health plan that capitates a provider group typically provides or offers to provide stop-loss coverage to that provider group.

Mandated benefit laws are state or federal laws that require health plans to arrange for the financing and delivery of particular benefits. Within a market, the implementation of mandated benefit laws is likely to cause __________.

The amount of risk for health plan products is dependent on the degree of influence and the relationships that the health plan maintains with its providers. Consider the following types of managed care structures:

• Preferred provider organization (PPO)
• Group model HMO
• Staff model health maintenance organization (HMO)
• Traditional health insurance

Of these health plan products, the one that would most likely expose a health plan to the highest risk is the: