HOM 5307 FINAL EXAM 2025
QUESTIONS AND ANSWERS 100%
CORRECT.
T/F: State mandated laws apply to self-funded employee benefits plans - ANSWER
FALSE
T/F: ERISA applies only to self-funded health plans - ANSWER FALSE
T/F: ERISA requires expedited review for claims involving urgent care - ANSWER
TRUE
T/F: ERISA preempts all state laws - ANSWER FALSE
T/F: Given the low payment rates in Medicaid, there is no interest in developing
incentive or pay for performance programs - ANSWER FALSE
T/F: Consumers and small employers may shop for and purchase health insurance
through the exchange as a result of the Children's health insurance reauthorization act
of 2009. - ANSWER FALSE
What is a key supporting function of the member services center? - ANSWER -
Workforce management
- Quality monitoring
Dual eligible Special Needs Plans enroll individuals who are 'dual eligible'. Who are the
'dual eligible? - ANSWER Individuals who are eligible for both medicare and Medicaid
T/F: Health care fraud is or is not an issue for managed care organizations - ANSWER
FALSE
What does HIPAA regulate? - ANSWER - Electronic communication between payers
and providers
- Portability and access standards
- Guaranteed renewability of group coverage
What is the largest factor contributing to poor health outcomes? - ANSWER Poverty
What is the leading reason for member complaints? - ANSWER Claims Issues
The greatest volume of interaction between a health plan and its members will occur by
means of ? - ANSWER Telephone
QUESTIONS AND ANSWERS 100%
CORRECT.
T/F: State mandated laws apply to self-funded employee benefits plans - ANSWER
FALSE
T/F: ERISA applies only to self-funded health plans - ANSWER FALSE
T/F: ERISA requires expedited review for claims involving urgent care - ANSWER
TRUE
T/F: ERISA preempts all state laws - ANSWER FALSE
T/F: Given the low payment rates in Medicaid, there is no interest in developing
incentive or pay for performance programs - ANSWER FALSE
T/F: Consumers and small employers may shop for and purchase health insurance
through the exchange as a result of the Children's health insurance reauthorization act
of 2009. - ANSWER FALSE
What is a key supporting function of the member services center? - ANSWER -
Workforce management
- Quality monitoring
Dual eligible Special Needs Plans enroll individuals who are 'dual eligible'. Who are the
'dual eligible? - ANSWER Individuals who are eligible for both medicare and Medicaid
T/F: Health care fraud is or is not an issue for managed care organizations - ANSWER
FALSE
What does HIPAA regulate? - ANSWER - Electronic communication between payers
and providers
- Portability and access standards
- Guaranteed renewability of group coverage
What is the largest factor contributing to poor health outcomes? - ANSWER Poverty
What is the leading reason for member complaints? - ANSWER Claims Issues
The greatest volume of interaction between a health plan and its members will occur by
means of ? - ANSWER Telephone
