- (Topic 1)
Allgood Medical, Inc., a health plan, has contracted with Mercy Memorial Hospital to provide inpatient medical services to Allgood's plan members. The terms of the contract specify that Allgood will reimburse Mercy Memorial on the basis of a negotiated ch

1. A. per diem agreement
2. B. fee-for-service agreement
3. C. withhold agreement
4. D. diagnostic related group (DRG) agreement

Correct Answer: A

- (Topic 3)
Prescription drug benefits in Medicare can be obtained through:

1. A. Stand alone prescription drug pl (PDPs)
2. B. Traditional fee for service (FFS) Medicare
3. C. Medicare Advantage pl
4. D. Both A & C

Correct Answer: A

- (Topic 3)
Flexible Spending Accounts (FSAs) can be established by

1. A. The employer alone
2. B. The employee alone
3. C. By both the employer & the employee
4. D. Self - employed individuals

Correct Answer: A

- (Topic 3)
The Links Company, which offers its employees a self-funded health plan, signed a contract with a third party administrator (TPA) to administer the plan. The TPA handles the group's membership services and claims administration. The contract between Links

1. A. a manual rating contract
2. B. a funding vehicle contract
3. C. an administrative services only (ASO) contract
4. D. a pooling contract

Correct Answer: C

- (Topic 2)
The Employee Retirement Income Security Act (ERISA) requires health plan members who receive healthcare benefits through employee benefit plans to file legal challenges involving coverage decisions or plan administration at the federal level. Under the te

1. A. contract damages, which cover the cost of denied treatment
2. B. compensatory damages, which compensate the injured party for his or her injuries
3. C. punitive damages, which are designed to punish or make an example of the wrongdoer
4. D. all of the above

Correct Answer: A