- (Topic 2)
Some states mandate that an independent enrollment broker or benefits counselor contractor selected by the state must manage enrollment of the eligible Medicaid population into managed care. In other states a health plan can engage independent brokers and

1. A. Many states have regulations that prohibit health plans from using door-to-door and/or telephone solicitation to market health plan products to the Medicaid population.
2. B. Health plans are never allowed to medically underwrite individual market customers who are under age 65.
3. C. To promote a health plan product to the individual market, health plans typically use captive agents who give sales presentations to potential customers, rather than using promotion tools such as direct mail, telemarketing, or advertising.
4. D. Health plans typically are allowed to medically underwrite all individual market customers who are covered by Medicare and can refuse to cover such customers.

Correct Answer: A

- (Topic 1)
Employer-sponsored benefit plans that provide healthcare benefits must comply with the Employee Retirement Income Security Act (ERISA). One of the most significant features of ERISA is that it

1. A. contains a provision stating that the terms of ERISA generally take precedence over any state laws that regulate employee welfare benefit plans
2. B. standardizes the conversion of group healthcare benefits to individual healthcare benefits
3. C. mandates that self-funded healthcare plans must pay state premium taxes
4. D. requires that all active employees, regardless of age, must be eligible for coverage under employer-sponsored benefit plans

Correct Answer: A

- (Topic 2)
One typical characteristic of an integrated delivery system (IDS) is that an IDS.

1. A. Is more highly integrated structurally than it is operationally.
2. B. Provides a full range of healthcare services, including physician services, hospital services, and ancillary services.
3. C. Cannot negotiate directly with health plans, plan sponsors, or other healthcare purchasers.
4. D. Performs a single business function, such as negotiating with health plans on behalf of all of the member providers.

Correct Answer: B

- (Topic 3)
Which of the following is WRONG?

1. A. Computer Based Patient Records Institute (CPRI) developed the standards for digital imaging of xrays.
2. B. HL7 developers focuses on interchange of Clinical Health Data
3. C. ANSI, a voluntary national standards organization, creates a consensus based process by which fair and equitable standards can be developed and serves as a legitmizer of standards.
4. D. American Health Information Management Association focuses on EDI standards for exchange of clinical data

Correct Answer: A

- (Topic 3)
Renewal underwriting involves a reevaluation of

1. A. The group’s experience
2. B. Level of participation in the health plan
3. C. Both A and B
4. D. None of the Above

Correct Answer: C