Free AHIP AHM-540 Exam Questions

Medicare beneficiaries can obtain healthcare benefits through fee-for-service (FFS) Medicare programs, Medicare medical savings account (MSA) plans, Medigap insurance, or coordinated care plans (CCPs). Unlike other coverage options, CCPs  

Helena Ray, a member of the Harbrace Health Plan, suffers from migraine headaches. To treatMs. Ray’s condition, her physician has prescribed Upzil, a medication that has Food and DrugAdministration (FDA) approval only for the treatment of depression. Upzil has not been tested forsafety or effectiveness in the treatment of migraine headache. Although Harbrace’s medical policyfor migraine headache does not include coverage of Upzil, Harbrace has agreed to provide extracontractualcoverage of Upzil for Ms. Ray.In this situation, the prescribing of Upzil for Ms. Ray’s headaches is an example of 

Health plans arrange for the delivery of various levels of healthcare, including1. Emergency care2. Urgent care3. Primary care delivered in a provider’s officeIn a ranking of these levels of care according to cost, beginning with the least expensive level ofcare and ending with the most expensive level of care, the correct order would be 

Michelle Durden, who is enrolled in a dental health maintenance organizations (DHMO) offered by her employer, is due for a routine dental examination. If the plan is typical of most DHMOs, then Ms. Durden

A health plan’s coverage policies are linked to its purchaser contracts. The following statement(s) can correctly be made about the purchaser contract and coverage decisions: 1. In case of conflict between the purchaser contract and a health plan’s medical policy or benefits administration policy, the contract takes precedence 2. Purchaser contracts commonly exclude custodial care from their coverage of services and supplies 3. All of the criteria for coverage decisions must be included in the purchaser contract