HOM 5307 Final Practice Questions Answered 100%
T/F: Health plans are increasingly looking at "retail" concepts of sales and marketing.
T
The rate formula typically adjusts the base rate for all of the following factors except:
A. Demographics
B. Geographical area
C. Eating habits
D. All of the above
C
_ is a key driver of the recent investment in improving health plan marketing.
A. Increasing cost
B. Growth of consumer-directed products
C. Emerging Medicare products
D. B & C
D
Each of the following are characteristic of high performing direct markets sales, except
,A. High touch
B. Door-to-door selling
C. Marketing automation
D. A & B
D
Traditional health plan customer segments include:
A. Individual
B. Small group
C. Mid-market
D. Medicare and Medicaid
E. All of the above
E
T/F: Benefit determination is the process of automatically determining eligibility and
correctly applying benefits and payment terms for each claim using pre-determined rules
without any human intervention.
F
T/F: The most common reason cited by physicians for limiting their practice to Medicaid
consumers was low reimbursement rates
T
T/F: State mandated benefits laws apply to self-funded employee benefits plans.
F
T/F: The most common form of claims submission is electronic
T
, Typical health plan marketing functions include:
A. Brand management
B. Market research
C. Closing the sale
D.A&B
D
T/F: ERISA applies only to self-funded health plans.
F
The first step in developing a quality management program is to:
A. Identify process criteria
B. Develop measures to screen diseases
C. Understand consumer need
D. All of the above
C
T/F: Coordination of benefits allows insurers to keep premiums lower.
T
T/F: Practice guidelines that can be repeated over and over again with the same result
are always considered to be valid.
F
T/F: Health plans growing via acquisition are expected to have a return that is typically higher
than health plans achieving organic growth.
F
T/F: Health plans are increasingly looking at "retail" concepts of sales and marketing.
T
The rate formula typically adjusts the base rate for all of the following factors except:
A. Demographics
B. Geographical area
C. Eating habits
D. All of the above
C
_ is a key driver of the recent investment in improving health plan marketing.
A. Increasing cost
B. Growth of consumer-directed products
C. Emerging Medicare products
D. B & C
D
Each of the following are characteristic of high performing direct markets sales, except
,A. High touch
B. Door-to-door selling
C. Marketing automation
D. A & B
D
Traditional health plan customer segments include:
A. Individual
B. Small group
C. Mid-market
D. Medicare and Medicaid
E. All of the above
E
T/F: Benefit determination is the process of automatically determining eligibility and
correctly applying benefits and payment terms for each claim using pre-determined rules
without any human intervention.
F
T/F: The most common reason cited by physicians for limiting their practice to Medicaid
consumers was low reimbursement rates
T
T/F: State mandated benefits laws apply to self-funded employee benefits plans.
F
T/F: The most common form of claims submission is electronic
T
, Typical health plan marketing functions include:
A. Brand management
B. Market research
C. Closing the sale
D.A&B
D
T/F: ERISA applies only to self-funded health plans.
F
The first step in developing a quality management program is to:
A. Identify process criteria
B. Develop measures to screen diseases
C. Understand consumer need
D. All of the above
C
T/F: Coordination of benefits allows insurers to keep premiums lower.
T
T/F: Practice guidelines that can be repeated over and over again with the same result
are always considered to be valid.
F
T/F: Health plans growing via acquisition are expected to have a return that is typically higher
than health plans achieving organic growth.
F
