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Health Plan Finance and Risk Management

Last Update Dec 27, 2024
Total Questions : 215

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Health Plan Finance and Risk Management Questions and Answers

Questions 1

The Lindberg Company has decided to terminate its group healthcare coverage with the Benson Health Plan. Lindberg has several former employees who previously experienced qualifying events that caused them to lose their group coverage. One federal law allows these former employees to continue their group healthcare coverage. From the answer choices below, select the response that correctly identifies the federal law that grants these individuals with the right to continue group healthcare coverage, as well as the entity which is responsible for continuing this coverage:

Options:

A.

Federal law: Consolidated Omnibus Budget Reconciliation Act (COBRA)

Entity: Lindberg

B.

Federal law: Consolidated Omnibus Budget Reconciliation Act (COBRA)

Entity: Benson

C.

Federal law: Employee Retirement Income Security Act (ERISA)

Entity: Lindberg

D.

Federal law: Employee Retirement Income Security Act (ERISA)

Entity: Benson

Questions 2

For a given healthcare product, the Magnolia Health Plan has a premium of $80 PMPM and a unit variable cost of $30 PMPM. Fixed costs for this product are $30,000 per month. Magnolia can correctly calculate the break-even point for this product to be:

Options:

A.

274 members

B.

375 members

C.

600 members

D.

1,000 members

Questions 3

The Swann Health Plan excludes mental health coverage from its basic health benefit plan. Coverage for mental health is provided by a specialty health plan called a managed behavioral health organization (MBHO). This arrangement recognizes the fact that distinct administrative and clinical expertise is required to effectively manage mental health services. This information indicates that Swann manages mental health services through the use of a:

Options:

A.

Formulary

B.

Risk pod

C.

Carve-out

D.

Case rate