- (Topic 2)
Ronald Canton is a member of the Omega MCO. He receives his nonemergency medical care from Dr. Kristen High, an internist. When Mr. Canton needed to visit a cardiologist about his irregular heartbeat, he first had to obtain a referral from Dr. High to see

1. A. D
2. B. High serves as the coordinator of care for the medical services that M
3. C. Canton receives.
4. D. Omega's network of providers includes D
5. E. High, but not D
6. F. Miller.
7. G. Omega's system allows its members open access to all of Omega's participating providers.
8. H. Omega used a financing arrangement known as a relative value scale (RVS) to compensate D
9. I. Miller.

Correct Answer: A

- (Topic 3)
The HMO Act of 1973 was significant in that the Act

1. A. mandated certain requirements that all HMOs had to meet in order to conduct business
2. B. required that all HMOs be licensed as insurance companies
3. C. offered HMOs federal financial assistance through grants and loans, and provided access to the employer-based insurance market
4. D. encouraged the use of pre-existing condition exclusion provisions in all HMO contracts

Correct Answer: C

- (Topic 2)
Marlee Whitcomb was covered as a dependent under the group health plan provided by her father's employer. That health plan complied with the provisions of the Consolidated Omnibus Budget Reconciliation Act (COBRA) of 1986. When Ms. Whitcomb married, she c

1. A. can continue her group coverage for a period not to exceed 48 months
2. B. can continue her group coverage for a period not to exceed 36 months
3. C. cannot continue her group coverage, but has the right to convert the group coverage to an individual health plan
4. D. can continue her group coverage indefinitely

Correct Answer: B

- (Topic 3)
The following statements describe individuals who are applying for individual health insurance coverage:
Six months ago, Wilbur Lee lost his health insurance coverage due to a reduction in work hours and has exhausted his coverage under COBRA. Mr. Lee has

1. A. both M
2. B. Lee and M
3. C. Beeker
4. D. M
5. E. Lee only
6. F. M
7. G. Beeker only
8. H. neither M
9. I. Lee nor M
10. J. Beeker

Correct Answer: A

- (Topic 1)
A common physician-only integrated model is a group practice without walls (GPWW). One characteristic of a typical GPWW is that the

1. A. GPWW combines multiple independent physician practices under one umbrella organization
2. B. GPWW generally has a lesser degree of integration than does an IPA
3. C. member physicians cannot own the GPWW
4. D. GPWW's member physicians must perform their own business operations

Correct Answer: A