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質問 1：
The following statements are about a health plan's underwriting of small groups. Select the answer choice containing the correct statement.
A. Generally, a health plan's underwriters require small employers to contribute at least 80% of the cost of the healthcare coverage.
B. Almost all states prohibit health plan s from rejecting a small group because of the nature of the business in which the small business is engaged.
C. Most states prohibit health plans from setting participation levels as a requirement for coverage, even when coverage is otherwise guaranteed issue.
D. In underwriting small groups, a health plan's underwriters typically consider both the characteristics of the group members and of the employer.
正解：D
質問 2：
The physicians who work for the Sunrise Health Plan, a staff model HMO, are paid a salary that is not augmented with another type of incentive plan. Compared to the use of a traditional reimbursement method, Sunrise's use of a salary reimbursement method is more likely to
A. Encourage Sunrise's physicians to perform services that are not medically necessary
B. Decrease Sunrise's liability for any negligent acts of the physicians in the plan's network of providers
C. Completely eliminate service risk for Sunrise's physicians
D. Help stabilize expenses for Sunrise
正解：D
質問 3：
With regard to a health plan's underwriting of groups, it can correctly be stated that, generally, a
A. Health plan's underwriters will not examine the age spread of the entire group being underwritten
B. Health plan will require that contributory healthcare plans have a participation level of between 50% and 70%
C. Health plan would expect a group with a large proportion of young females to have lower healthcare costs than does a similar group with a large proportion of young males
D. Health plan will decline to cover a group that has been formed for the sole purpose of obtaining healthcare coverage
正解：D
質問 4：
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Julio Benini is eligible to receive healthcare coverage through a health plan that is under contract to his employer. Mr. Benini is seeking coverage for the following individuals:
Elena Benini, his wife Maria Benini, his 18-year-old unmarried daughter Johann Benini, his 80-year-old father who relies on Julio for support and maintenance
The health plan most likely would consider that the definition of a dependent, for purposes of healthcare coverage, applies to:
A. Maria only
B. Elena only
C. Elena, Maria, and Johann
D. Elena and Maria only
正解：D
質問 5：
The provider contract that Dr. Zachery Cogan, an internist, has with the Neptune Health Plan calls for Neptune to reimburse him under a typical PCP capitation arrangement. Dr. Cogan serves as the PCP for Evelyn Pfeiffer, a Neptune plan member. After hospitalizing Ms. Pfeiffer and ordering several expensive diagnostic tests to determine her condition, Dr. Cogan referred her to a specialist for further treatment. In this situation, the compensation that Dr. Cogan receives under the PCP capitation arrangement most likely includes Neptune's payment for
A. His visits to Ms. Pfeiffer while she was hospitalized
B. All of the above
C. The cost of the services that the specialist performed for Ms. Pfeiffer
D. All of the diagnostic tests that he ordered on Ms. Pfeiffer
正解：A
質問 6：
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The accounting department of the Enterprise health plan adheres to the following policies:
Policy A-Report gains only after they actually occur
Policy B-Report losses immediately
Policy C-Record expenses only when they are certain
Policy D-Record revenues only when they are certain
Of these Enterprise policies, the ones that are consistent with the accounting principle of conservatism are Policies
A. A, B, C, and D
B. A, B, and D only
C. A and B only
D. C and D only
正解：B
質問 7：
An investor deposited $1,000 in an interest-bearing account today. That sum will accumulate to $1,200 two years from now. One true statement about this transaction is that:
A. $1,200 is the present value of the $1,000 deposit
B. The $200 difference between the original deposit and the accumulated value of the deposit is known as the deposit's discount
C. The $200 increase in the deposit's value is its incremental cash flow
D. The process by which the original $1,000 deposit grows to $1,200 is known as compounding
正解：D
質問 8：
The following statement(s) can correctly be made about a health plan's underwriting of small groups:
A. A only
B. B only
C. Both A and B
D. In the absence of laws mandating otherwise, a health plan's underwriting standards grow stricter as group size gets smaller.
E. Neither A nor B
F. Typically, a health plan medically underwrites both the employees of a small group and their dependents, even though small group reform laws prohibit health plans from singling out individuals for rejection or substandard rate-ups.
正解：F
解説: (Pass4Test メンバーにのみ表示されます)
質問 9：
The Puma health plan uses return on investment (ROI) and residual income (RI) to measure the performance of its investment centers. Two of these investment centers are identified as X and Y.
Investment Center X earns $10,000,000 in operating income on controllable investments of $50,000,000, and it has total revenues of $60,000,000. Investment Center Y earns $2,000,000 in operating income on controllable investments of $8,000,000, and it has total revenues of $10,000,000. Both centers have a minimum required rate of return of 15%.
One difference between the RI method and the ROI method is that
A. Only RI is useful to Puma for comparing investment centers of different sizes
B. Only RI can lead to decisions that improve Puma's short-term profits at the expense of its long-term objectives
C. The RI method favors Puma's small investment centers more than does the ROI method
D. The RI method demands greater goal congruence from Puma's managers than does the ROI method
正解：D
The following statements are about a health plan's underwriting of small groups. Select the answer choice containing the correct statement.
A. Generally, a health plan's underwriters require small employers to contribute at least 80% of the cost of the healthcare coverage.
B. Almost all states prohibit health plan s from rejecting a small group because of the nature of the business in which the small business is engaged.
C. Most states prohibit health plans from setting participation levels as a requirement for coverage, even when coverage is otherwise guaranteed issue.
D. In underwriting small groups, a health plan's underwriters typically consider both the characteristics of the group members and of the employer.
正解：D
質問 2：
The physicians who work for the Sunrise Health Plan, a staff model HMO, are paid a salary that is not augmented with another type of incentive plan. Compared to the use of a traditional reimbursement method, Sunrise's use of a salary reimbursement method is more likely to
A. Encourage Sunrise's physicians to perform services that are not medically necessary
B. Decrease Sunrise's liability for any negligent acts of the physicians in the plan's network of providers
C. Completely eliminate service risk for Sunrise's physicians
D. Help stabilize expenses for Sunrise
正解：D
質問 3：
With regard to a health plan's underwriting of groups, it can correctly be stated that, generally, a
A. Health plan's underwriters will not examine the age spread of the entire group being underwritten
B. Health plan will require that contributory healthcare plans have a participation level of between 50% and 70%
C. Health plan would expect a group with a large proportion of young females to have lower healthcare costs than does a similar group with a large proportion of young males
D. Health plan will decline to cover a group that has been formed for the sole purpose of obtaining healthcare coverage
正解：D
質問 4：
---
Julio Benini is eligible to receive healthcare coverage through a health plan that is under contract to his employer. Mr. Benini is seeking coverage for the following individuals:
Elena Benini, his wife Maria Benini, his 18-year-old unmarried daughter Johann Benini, his 80-year-old father who relies on Julio for support and maintenance
The health plan most likely would consider that the definition of a dependent, for purposes of healthcare coverage, applies to:
A. Maria only
B. Elena only
C. Elena, Maria, and Johann
D. Elena and Maria only
正解：D
質問 5：
The provider contract that Dr. Zachery Cogan, an internist, has with the Neptune Health Plan calls for Neptune to reimburse him under a typical PCP capitation arrangement. Dr. Cogan serves as the PCP for Evelyn Pfeiffer, a Neptune plan member. After hospitalizing Ms. Pfeiffer and ordering several expensive diagnostic tests to determine her condition, Dr. Cogan referred her to a specialist for further treatment. In this situation, the compensation that Dr. Cogan receives under the PCP capitation arrangement most likely includes Neptune's payment for
A. His visits to Ms. Pfeiffer while she was hospitalized
B. All of the above
C. The cost of the services that the specialist performed for Ms. Pfeiffer
D. All of the diagnostic tests that he ordered on Ms. Pfeiffer
正解：A
質問 6：
----
The accounting department of the Enterprise health plan adheres to the following policies:
Policy A-Report gains only after they actually occur
Policy B-Report losses immediately
Policy C-Record expenses only when they are certain
Policy D-Record revenues only when they are certain
Of these Enterprise policies, the ones that are consistent with the accounting principle of conservatism are Policies
A. A, B, C, and D
B. A, B, and D only
C. A and B only
D. C and D only
正解：B
質問 7：
An investor deposited $1,000 in an interest-bearing account today. That sum will accumulate to $1,200 two years from now. One true statement about this transaction is that:
A. $1,200 is the present value of the $1,000 deposit
B. The $200 difference between the original deposit and the accumulated value of the deposit is known as the deposit's discount
C. The $200 increase in the deposit's value is its incremental cash flow
D. The process by which the original $1,000 deposit grows to $1,200 is known as compounding
正解：D
質問 8：
The following statement(s) can correctly be made about a health plan's underwriting of small groups:
A. A only
B. B only
C. Both A and B
D. In the absence of laws mandating otherwise, a health plan's underwriting standards grow stricter as group size gets smaller.
E. Neither A nor B
F. Typically, a health plan medically underwrites both the employees of a small group and their dependents, even though small group reform laws prohibit health plans from singling out individuals for rejection or substandard rate-ups.
正解：F
解説: (Pass4Test メンバーにのみ表示されます)
質問 9：
The Puma health plan uses return on investment (ROI) and residual income (RI) to measure the performance of its investment centers. Two of these investment centers are identified as X and Y.
Investment Center X earns $10,000,000 in operating income on controllable investments of $50,000,000, and it has total revenues of $60,000,000. Investment Center Y earns $2,000,000 in operating income on controllable investments of $8,000,000, and it has total revenues of $10,000,000. Both centers have a minimum required rate of return of 15%.
One difference between the RI method and the ROI method is that
A. Only RI is useful to Puma for comparing investment centers of different sizes
B. Only RI can lead to decisions that improve Puma's short-term profits at the expense of its long-term objectives
C. The RI method favors Puma's small investment centers more than does the ROI method
D. The RI method demands greater goal congruence from Puma's managers than does the ROI method
正解：D
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