Câu 39: AHM-520: Health Plan Finance and Risk Management

The following statements illustrate the use of different rating methods by health plans: The Dover health plan established rates for small groups by using a rating method which requires that the average premium in each group cannot be more than 120% of the average premium for any other group. Under this method, all members of each group pay the same premium, which is based on the experience of the group. Under the rating method used by the Rolling Hills health plan, the health plan calculates the ratio of a group's experience to the group's historical manual rate. Rolling Hills then multiplies this ratio by the group's future manual rate. Rolling Hills cannot consider the group's experience in determining premium rates. From the following answer choices, select the response that correctly indicates the rating methods used by Dover and Rolling Hills.

1. A. Dover = modified community ratingRolling Hills = factored rating
2. B. Dover = modified community ratingRolling Hills = adjusted community rating (ACR)
3. C. Dover = community rating by class (CRC)Rolling Hills = factored rating
4. D. Dover = community rating by class (CRC)Rolling Hills = adjusted community rating (ACR) — đáp án hiện tại