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

Is the most common type of capitation

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

Sets provider reimbursement at a specific dollar amount per plan member

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

The net effect of using provider reimbursement contracts to transfer risk is that the health plan’s net worth requirement increases.

Once the health plan has transferred utilization risk to its providers, it is relieved of the legal obligation to provide medical services to plan members in the event of the provider’s insolvency.

The greater the amount of risk the health plan transfers to providers, the larger the credit-risk factor becomes in the health plan’s RBC formula.

By decreasing its utilization risk, the health plan increases its underwriting risk.

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

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

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

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