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Governance and Regulation

Last Update Dec 22, 2024
Total Questions : 76

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Governance and Regulation Questions and Answers

Questions 1

In the course of doing business, health plans conduct basic corporate transactions. For example, when a health plan engages in the corporate transaction known as aggressive sourcing, the health plan

Options:

A.

Chooses to contract with vendors who provide specific functions that would otherwise be performed in-house, such as paying claims

B.

Seeks to obtain the best deals from various vendors for equipment, supplies, and services such as telephones, overnight mail, computer hardware and software, and copy machines

C.

Merges with one or more companies to form an entirely new company

D.

Joins with one or more companies, but retains its autonomy and relies on the other companies to perform specific functions

Questions 2

The National Association of Insurance Commissioners (NAIC) adopted the Health Maintenance Organization Model Act (HMO Model Act) to regulate the development and operations of HMOs. One true statement regarding the HMO Model Act is that the act

Options:

A.

includes mental health services in its definition of basic healthcare services

B.

authorizes only one state agency-the department of insurance-to regulate HMOs

C.

requires HMOs to place a deposit in trust with the state insurance commissioner for the purpose of protecting the interests of enrollees should an HMO become financially impaired

D.

requires HMOs that wish to offer a point-of-service (POS) product to contract with a licensed insurance company to provide POS options to plan members

Questions 3

Indigo Health Plan advertised a specific individual health insurance policy through a direct mail advertisement that provided detailed information about the product. In order to comply with the NAIC Model Rules Governing Advertisements of Accident and Sickness Insurance, Indigo must disclose whether the advertised policy contains any exceptions, reductions, or limitations. Thus, Indigo disclosed in the advertisement that one policy provision limits coverage for dental exams to $50 per exam and to one exam per calendar year. This information indicates that, with respect to the definitions in the NAIC Model Rules, Indigo's advertisement is an example of an

Options:

A.

Invitation to contract, and it discloses a policy provision known as an exception

B.

Invitation to contract, and it discloses a policy provision known as a reduction

C.

Invitation to inquire, and it discloses a policy provision known as an exception

D.

Invitation to inquire, and it discloses a policy provision known as a reduction

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