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

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Health Plan Finance and Risk Management Questions and Answers

Question 1

One true statement about a type of capitation known as a percent-of-premium arrangement is that this arrangement

Options:

A.

Is the most common type of capitation

B.

Is less attractive to providers when the arrangement sets provisions to limit risk

C.

Sets provider reimbursement at a specific dollar amount per plan member

D.

Transfers some of the risk associated with underwriting and rating from a health plan to a provider

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Question 2

An actuary for the Noble Health Plan observed that the plan's actual morbidity was lower than its assumed morbidity and that the plan's actual administrative expenses were higher than its assumed administrative expenses. In this situation, Noble's actual underwriting margin was

Options:

A.

larger than its assumed underwriting margin, and the plan's actual expense margin was higher than its assumed expense margin

B.

larger than its assumed underwriting margin, but the plan's actual expense margin was lower than its assumed expense margin

C.

smaller than its assumed underwriting margin, but the plan's actual expense margin was higher than its assumed expense margin

D.

smaller than its assumed underwriting margin, and the plan's actual expense margin was lower than its assumed expense margin

Question 3

The Savanna health plan used a risk analysis technique which defines the key assumptions of Savanna's strategic financial plan in terms of mathematical formulas that can be correlated to each other or analyzed independently. This technique allowed Savanna to simulate probable future events on a computer and produce a distribution of possible outcomes. This risk analysis technique, which can be used to predict Savanna's distribution of expected claims, is known as

Options:

A.

A hurdle rate simulation

B.

Optimistic, most likely, pessimistic scenario modeling

C.

A Monte Carlo simulation

D.

Debt covenant modeling