The National Association of Insurance Commissioners (NAIC) developed the Small Group Model Act
to enable small groups to obtain accessible, yet affordable, group health benefits. The model law
limits the rate spread, which is the difference between the highest and lowest rates that a health
plan charges small groups, to a particular ratio.
According to the Model Act, for example, if the lowest rate an HMO charges a small group for a given
set of medical benefits is $40, then the maximum rate the HMO can charge for the same set of
The scandent Health Group contracted with the Empire Corporation to provide behavioral healthcare
Empire employees. As a condition of providing behavioral healthcare services, scandent required
Empire to contract with scandent for basic medical services scandent's actions constituted the type
of antitrust violation known as a
The following statements are about the various Health Plan Accountability Models adopted by the
Diabetic patients with high glucose levels requiring stabilization following treatment of an acute
attack would best be served in an ___________
Which facility would best meet the need of Jack who fell on road and sprained his ankle?
Utilization review offers health plans a means of managing costs by managing
Calculate the hospital bed days per 1000 members for the Month to date (MTD) on 25 April, with
plan membership of 25,000 and total gross hospital bed days in MTD is 300 for an XYZ Health plan?
Disease management is typically set up as a voluntary outreach and support program for plan
members with certain _________ diseases
Maternity management programs are commonly included in?
Integration of provider organizations is said to occur when