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  • Exam Name: Governance and Regulation
  • Last Update: Apr 24, 2024
  • Questions and Answers: 76
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AHM-510 Practice Exam Questions with Answers Governance and Regulation Certification

Question # 6

One typical difference between a for-profit health plan's board of directors and a not-for-profit health plan's board of directors is that the directors in a for-profit health plan

A.

Can serve on the board for a period of no more than ten years, whereas the terms of service for a not-for-profit board's directors are usually unlimited by the director's age or by a preset maximum number of years of service

B.

Must participate in raising capital for the health plan, whereas a not-for-profit board's directors are prohibited from participating directly in raising capital for the health plan

C.

Are directly accountable to shareholders, whereas a not-for-profit board's directors are accountable to plan members and the community

D.

Are not compensated for board participation, whereas a not-for-profit board's directors are compensated for board participation

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Question # 7

Directors on a health plan's board must demonstrate their compliance with three duties in all their decisions. Directors who exercise their duties in good faith and with the same degree of diligence and skill that an ordinary, reasonable person would be expected to display in the same situation are meeting the duty known as the

A.

Duty of loyalty

B.

Duty to supervise

C.

Duty of care

D.

Trustee duty

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Question # 8

One example of health plan's influence on the practice of medicine is that, during the past decade, the focus of healthcare has moved toward _________________, which is designed to reduce the overall need for healthcare services by providing patients with decision-making information.

A.

Demand management

B.

Managed competition

C.

Comprehensive coverage

D.

Private inurement

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Question # 9

The government uses various tools within the realm of two broad categories of public policy-allocative policies and regulatory policies. In the context of public policy, laws that fall into the category of allocative policy include

A.

The Balanced Budget Act (BBA) of 1997

B.

The Health Insurance Portability and Accountability Act (HIPAA) of 1996

C.

Laws affecting health plan quality oversight

D.

Laws specifying procedures for health plan handling of consumer appeals and grievances

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Question # 10

TRICARE, a military healthcare program, offers eligible beneficiaries three options for healthcare services: TRICARE Prime, TRICARE Extra, and TRICARE Standard. With respect to plan features, both an annual deductible and claims filing requirements must be met, regardless of whether care is delivered by network providers, under

A.

TRICARE Prime and TRICARE Extra only

B.

TRICARE Extra and TRICARE Standard only

C.

TRICARE Standard only

D.

None of these healthcare options

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Question # 11

The Tidewater Life and Health Insurance Company is owned by its policy owners, who are entitled to certain rights as owners of the company, and it issues both participating and nonparticipating insurance policies. Tidewater is considering converting to the type of company that is owned by individuals who purchase shares of the company's stock. Tidewater is incorporated under the laws of Illinois, but it conducts business in the Canadian provinces of Ontario and Manitoba.

Tidewater established the Diversified Corporation, which then acquired various subsidiary firms that produce unrelated products and services. Tidewater remains an independent corporation and continues to own Diversified and the subsidiaries. In order to create and maintain a common vision and goals among the subsidiaries, the management of Diversified makes decisions about strategic planning and budgeting for each of the businesses.

In creating Diversified, Tidewater formed the type of company known as

A.

A mutual holding company

B.

A spin-off company

C.

An upstream holding company

D.

A downstream holding company

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