Free AHM-250 Exam Dumps

Question 56

- (Topic 3)
The Gable MCO sometimes experience-rates small groups by underwriting a number of small groups as if they constituted one large group and then evaluating the experience of
the entire large group. This practice, which allows small groups to take advantage

A. prospective experience rating
B. pooling
C. retrospective experience rating
D. positioning

Correct Answer:B

Question 57

- (Topic 1)
In the paragraph below, a sentence contains two pairs of words enclosed in parentheses. Determine which word in each pair correctly completes the sentence. Then select the answer choice containing the two words that you have chosen. Many pharmacy benefit

A. Therapeutic / always
B. Generic / always
C. Generic / never
D. Therapeutic / never

Correct Answer:A

Question 58

- (Topic 3)
The owners of an MCO typically delegate authority for governing the operation of the MCO by electing the MCO's

A. quality management committee
B. medical director
C. board of directors
D. chief executive officer

Correct Answer:C

Question 59

- (Topic 3)
The NAIC designed a small group model law to enable small groups to obtain accessible, yet affordable, group health benefits. Specifically, the model law limits the rate spread. According to this model law, if the lowest rate that an HMO charges a small g

A. $80
B. $120
C. $160
D. $240

Correct Answer:C

Question 60

- (Topic 3)
The following statements are about accreditation in health plans. Select the answer choice that contains the correct statement.

A. Accreditation is typically performed by a panel of physicians and administrators employed by the health plan under evaluation.
B. All accrediting organizations use the same standards of accreditation.
C. Results of accreditation evaluations are provided only to state regulatory agencies and are not made available to the general public.
D. Accreditation demonstrates to an health plan's external customers that the plan meets established standards for quality care.

Correct Answer:D