AHIP AHM-520 Exam - Topic 5 Question 85 Discussion

Actual exam question for AHIP's AHM-520 exam

Question #: 85
Topic #: 5

The Poplar Company and a Blue Cross/Blue Shield organization have contracted to provide a typical fully funded health plan for Poplar's employees. One true statement about this health plan for Poplar's employees is that

APoplar bears the entire financial risk if, during a given period, the dollar amount of services rendered to Poplar plan members exceeds the dollar amount of premiums collected for this health plan

BPoplar and the Blue Cross/Blue Shield organization share the financial risk of paying for claims under Poplar's health plan

CThe Blue Cross/Blue Shield organization, upon acceptance of a premium, becomes the group plan sponsor for Poplar's health plan

DThe Blue Cross/Blue Shield organization, upon acceptance of a premium, bears the entire financial risk of paying for the administrative expenses associated with health plan operations

Show Suggested Answer

Suggested Answer: B

by Willard at Apr 23, 2024, 03:06 AM

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Alonzo

5 months ago

Just to clarify, fully funded means Poplar pays premiums, right?

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Margot

5 months ago

D sounds surprising, are they really covering all admin costs?

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Annamae

6 months ago

C seems off, Blue Cross isn't the sponsor.

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Kerrie

6 months ago

I think B is more accurate, they share the risk.

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Patti

6 months ago

A is definitely true, Poplar takes all the risk!

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Ivan

6 months ago

I don't think the insurer becomes the sponsor just by accepting premiums, so option C seems off to me. I might go with A or D instead.

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Kip

7 months ago

I recall a practice question that mentioned shared risk in some plans, but I thought fully funded meant the employer takes all the risk, so I'm confused about option B.

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Carry

7 months ago

I'm not entirely sure, but I feel like we discussed how the insurer typically takes on the risk in these arrangements, which makes me lean towards option D.

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Justine

7 months ago

I think I remember that in a fully funded plan, the employer usually bears the financial risk, so option A might be correct?

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Leota

7 months ago

I've seen similar questions before, so I have a general idea of how to approach this. Time to put my knowledge to the test.

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Micah

7 months ago

The wording of the options is tricky, I'll have to read them closely to determine the correct answer.

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Crista

7 months ago

Okay, I need to focus on the key details about the contract between Poplar and Blue Cross/Blue Shield.

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France

7 months ago

Hmm, I'm a bit unsure about the financial risk aspect here. Let me think this through carefully.

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Jackie

7 months ago

This question seems straightforward, I think I can handle it.

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Deeann

7 months ago

Okay, I've got this. Tier 2 providers typically have a public transit relationship with Tier 1 providers, so I'm going to go with option A.

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Lettie

7 months ago

Okay, let's see here. I think it has something to do with how the system handles creating vulnerability groups, but I'm not entirely sure which property controls that.

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Tresa

7 months ago

I remember we talked about needing a data file in CSV format for BAT. I think that might be one of the steps.

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Rolf

12 months ago

Option B seems like the most logical choice to me. I mean, if Poplar was bearing all the risk, why would they need to contract with Blue Cross/Blue Shield in the first place?

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Eva

12 months ago

Haha, this question is a real brain-teaser! I bet the test writers are just trying to trip us up. But I think I've got it - the answer is B.

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Tamesha

12 months ago

Hmm, I'm not sure. I was leaning towards option A, but now I'm second-guessing myself. I guess I'll have to review the material again.

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Nickie

11 months ago

I'm not sure either. Let's review the material together to figure out the correct answer.

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Han

11 months ago

I believe option B is the right choice. Poplar and Blue Cross/Blue Shield share the financial risk.

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Sheron

11 months ago

I think option A is correct. Poplar bears the entire financial risk if services exceed premiums.

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Ludivina

1 year ago

I think the correct answer is B. Poplar and the Blue Cross/Blue Shield organization share the financial risk of paying for claims under Poplar's health plan. This makes sense since it's a fully funded plan.

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