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AHIP AHM-520 Exam - Topic 5 Question 30 Discussion

The Longview Hospital contracted with the Carlyle Health Plan to provide inpatient services to Carlyle's enrolled members. Carlyle provides Longview with a type of stop-loss coverage that protects, on a claims incurred and paid basis, against losses arising from significantly higher than anticipated utilization rates among Carlyle's covered population. The stop-loss coverage specifies an attachment point of 130% of Longview's projected $2,000,000 costs of treating Carlyle plan members and requires Longview to pay 15% of any costs above the attachment point. In a given plan year, Longview incurred covered costs totaling $3,000,000.For the year in which Longview's incurred covered costs were $3,000,000, the amount for which Longview will be responsible is:
C) $2,660,000
A) $2,000,000
B) $2,600,000
D) $3,900,000

AHIP AHM-520 Exam - Topic 5 Question 30 Discussion

Actual exam question for AHIP's AHM-520 exam
Question #: 30
Topic #: 5
[All AHM-520 Questions]

The Longview Hospital contracted with the Carlyle Health Plan to provide inpatient services to Carlyle's enrolled members. Carlyle provides Longview with a type of stop-loss coverage that protects, on a claims incurred and paid basis, against losses arising from significantly higher than anticipated utilization rates among Carlyle's covered population. The stop-loss coverage specifies an attachment point of 130% of Longview's projected $2,000,000 costs of treating Carlyle plan members and requires Longview to pay 15% of any costs above the attachment point. In a given plan year, Longview incurred covered costs totaling $3,000,000.

For the year in which Longview's incurred covered costs were $3,000,000, the amount for which Longview will be responsible is:

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Suggested Answer: C

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Lucina
8 months ago
Are we sure about that? Looks like it could be more.
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Dean
8 months ago
Totally agree, it’s definitely $2.66M!
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Rosann
8 months ago
Wait, how does the 15% work out? Seems complicated!
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Roosevelt
8 months ago
They’ll be responsible for $2.66M after the stop-loss kicks in.
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Cristal
8 months ago
Longview's costs were $3M, so they exceed the $2M projection.
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Luz
9 months ago
This is a tricky one. I'm thinking Workspace ONE UEM and either the Unified Access Gateway or Hub Services would be needed, but I'm not 100% sure. I'll need to review the details of each component to make sure I'm choosing the right ones.
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Kate
9 months ago
I'm pretty confident I know the answer to this. It's got to be a technical measure, like some kind of automated system to check contract dates.
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Linwood
9 months ago
The rotate tool doesn't seem like it would be used to locate grids on a ceiling, so I'm going to go with that as the answer.
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