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Health Plan Finance and Risk Management (AHM-520) - AHIP Exam Questions

Last updated on June 20, 2026

97% Exam Compliance
215 Total Questions
1
Question
The core of a health plan's strategic financial plan is the development of its pro forma financial statements. The following statements are about these pro forma financial statements. Select the
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2
Question
With regard to alternative funding arrangements, the part of a health plan premium that is intended to contribute to the claims reserve that a health plan maintains to pay for unusually high utilization is known as the:
Options
A Retention charge
B Risk charge
C Interest charge
D Surplus
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3
Question
The amount of risk for health plan products is dependent on the degree of influence and the relationships that the health plan maintains with its providers. Consider the following types of managed care structures: Preferred provider organization (PPO) Group model HMO Staff model health maintenance organization (HMO) Traditional health insurance Of these health plan products, the one that would most likely expose a health plan to the highest risk is the:
Options
A staff model health maintenance organization (HMO)
B group model HMO
C preferred provider organization (PPO)
D traditional health insurance
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4
Question
The following information relates to the Hardcastle Health Plan for the month of June:
Incurred claims (paid and IBNR) equal $100,000
Earned premiums equal $120,000
Paid claims, excluding IBNR, equal $80,000
Total health plan expenses equal $300,000
This information indicates that Hardcastle’s medical loss ratio (MLR) for the month of June was approximately equal to:
Options
A 83%
B 67%
C 40%
D 120%
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5
Question
The following examples describe situations that expose an individual or a health plan to either pure risk or speculative risk:
Example 1 — A health plan invested in 1,000 shares of stock issued by a technology company.
Example 2 — An individual could contract a terminal illness. Example 3 — A health plan purchased a new information system. Example 4 — A health plan could be held liable for the negligent acts of an employee. The examples that describe pure risk are
Options
A Examples 2 and 4
B Examples 1 and 4
C Examples 1 and 2
D Examples 2 and 3
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