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Health Plan Finance and Risk Management

Last Update Dec 22, 2024
Total Questions : 215

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Health Plan Finance and Risk Management Questions and Answers

Questions 1

The following statements illustrate the use of different rating methods by health plans:

  • The Dover health plan established rates for small groups by using a rating method which requires that the average premium in each group cannot be more than 120% of the average premium for any other group. Under this method, all members of each group pay the same premium, which is based on the experience of the group.
  • Under the rating method used by the Rolling Hills health plan, the health plan calculates the ratio of a group's experience to the group's historical manual rate. Rolling Hills then multiplies this ratio by the group's future manual rate. Rolling Hills cannot consider the group's experience in determining premium rates.

From the following answer choices, select the response that correctly indicates the rating methods used by Dover and Rolling Hills.

Options:

A.

Dover = modified community rating

Rolling Hills = factored rating

B.

Dover = modified community rating

Rolling Hills = adjusted community rating (ACR)

C.

Dover = community rating by class (CRC)

Rolling Hills = factored rating

D.

Dover = community rating by class (CRC)

Rolling Hills = adjusted community rating (ACR)

Questions 2

Under GAAP, three approaches to expense recognition are generally allowed: associating cause and effect, systematic and rational allocation, and immediate recognition. A health plan most likely would use the approach of systematic and rational allocation in order to

Options:

A.

Report the payment of the health plan's utility bills

B.

Spread the payment of sales force commissions over the premium paying period of healthcare coverage

C.

Report the fees paid by the health plan to attorneys and consultants

D.

Depreciate the cost of a new computer system over the useful life of the system

Questions 3

The Lighthouse health plan operates in a state that allows the health plan to use an underwriting method of determining a group's premium in which underwriters treat several small groups as one large group for risk assessment purposes. This method, which helps Lighthouse more accurately estimate a small group's probable claims costs, is known as

Options:

A.

Case stripping

B.

The low-option rating method

C.

The rate spread method

D.

Pooling