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

Provider reimbursement methods that transfer some utilization risk from a health plan to providers affect the health plan's RBC formula. A health plan's use of these reimbursement methods is likely to result in

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:

The following information relates to the Hardcastle Health Plan for the month of June:

• Incurred claims (paid and IBNR) equal $100,000
• Earned premiums equal $120,000
• Paid claims, excluding IBNR, equal $80,000
• Total health plan expenses equal $300,000

This information indicates that Hardcastle’s medical loss ratio (MLR) for the month of June was approximately equal to: