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

The following statements are about the financial risks for health plans in Medicare and Medicaid markets. Three of these statements are true, and one statement is false. Select the answer choice containing the FALSE statement.

Kevin Olin applied for individual healthcare coverage from the Mercury health plan. Before issuing the policy, Mercury's underwriters attached a rider that excludes from coverage any loss that results from Mr. Olin's chronic knee problem. This information indicates that Mr. Olin's policy includes

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: