CEBS GBA 1 ACTUAL 2026 TEST PAPER QUESTIONS AND
ANSWERS GRADED A+
✔✔The amount of covered medical expenses that a participant must incur before any
medical benefits for non-preventative care services or treatment become payable under
a plan is known as the: - ✔✔Deductible
✔✔The Small Business Health Care Relief Act created the qualified small employer
HRA (QSEHRA). This act applies to businesses with fewer than how many employees?
- ✔✔50
✔✔The ACA aimed to make health insurance more affordable by providing tax credits
to individuals ineligible for other affordable coverage and with income between which
limits: - ✔✔100% and 400% of the federal poverty line
✔✔Which of the following statements regarding primary care physicians (PCPs) is
correct?
- PCPs are not used in preferred provider organizations
- Pediatricians cannot be a PCP.
- PCPs are usually a general, family or internal medicine doctor (internist)
- OB/GYN doctors cannot be PCPs - ✔✔PCPs are usually a general, family or internal
medicine doctor (internist)
✔✔Insurance can be distinguished from gambling by which of the following factors?
(More than one factor is possible)
1. Insurance handles existing risk while gambling creates a new risk
2. Insurance is speculative risk and gambling is pure risk
3. Insurance is based on a mutual sharing of losses that occur while gambling involves
a gain for one party at the expense of another. - ✔✔1 & 3
Insurance handles existing risk while gambling creates a new risk
Insurance is based on a mutual sharing of losses that occur while gambling involves a
gain for one party at the expense of another.
✔✔Which of the following is/are primary factors that have contributed to cafeteria plans
becoming a standard benefit offering today?
1. The increasing costs of benefits
2. Cafeteria plans allow participants to pay for dependent care expenses through the
plan and, at the same time, claim personal tax credits on their personal income tax
returns.
3. The diverse workforce with differing benefit needs - ✔✔1 & 3
The increasing costs of benefits
The diverse workforce with differing benefit needs
,✔✔Which of the following statements regarding Consolidated Omnibus Budget
Reconciliation Act (COBRA) coverage is/are correct?
1. The cost of coverage under COBRA is limited, by law, to no more than 98% of the full
cost of coverage for active employees
2. Employers are required to pay a significant portion of the cost of insurance for
employees who continue their COBRA coverage
3. COBRA continuation coverage lasts only for a limited period of time - ✔✔COBRA
continuation coverage lasts only for a limited period of time.
✔✔Which of the following statements regarding self-funding or self-insurance is (are)
correct?
1. Self-insurance is sometimes used for property exposures but it cannot be used for
employee benefit plans
2. Stop loss insurance utilizes the concept of self-insurance
3. An effective self-insurance program requires a large enough number of exposure
units to make losses predictable - ✔✔2 & 3.
Stop loss insurance utilizes the concept of self-insurance
An effective self-insurance program requires a large enough number of exposure units
to make losses predictable
✔✔Which of the following statements regarding the effectiveness of workplace wellness
programs is (are) correct?
1. Health risk assessments, conducted at the conclusion of the program, can provide a
complete diagnosis of a worker's health.
2. Incentives, such as cash, movie tickets, discounts on medical care, have been shown
to be very effective in increasing worker participation in wellness programs.
3. Biometric testing for wellness programs is prohibited by Genetic Information
Nondiscrimination Act (GINA) - ✔✔Incentives, such as cash, movie tickets, discounts on
medical care, have been shown to be very effective in increasing worker participation in
wellness programs.
✔✔An effective behavioral health program should include which of the following?
1. An integrated mental health/chemical dependency benefit.
2. Inpatient and outpatient services
3. An employee assistance program (EAP) - ✔✔1, 2 & 3
✔✔Which of the following is (are) characteristics of modern prescription drug plans?
1. Plan members pay the full cost at the pharmacy and then file a claim for
reimbursement
2. These plans are usually carved out from the medical benefit and are typically
administered by a pharmacy benefit manager (PBM) or third party administrator (TPA)
3. These plans have not yet used mail service and the Internet but are expected to do
so after regulatory permission is obtained. - ✔✔1 & 2
Plan members pay the full cost at the pharmacy and then file a claim for reimbursement
,These plans are usually carved out from the medical benefit and are typically
administered by a pharmacy benefit manager (PBM) or third party administrator (TPA)
✔✔Which of the following is (are) features that are generally associated with consumer-
directed health plans (CDHPs)?
1. Relatively low deductible
2. A personal spending account
3. Availability of information tools for enrollees - ✔✔2 & 3
A personal spending account
Availability of information tools for enrollees
✔✔Which of the following is (are) major requirements of the ACA for employers who
sponsor group health plans?
1. The Act eliminated the use of the "essential health benefits" list.
2. The Act eliminated lifetime maximum limitations.
3. The Act expanded coverage for preventative services. - ✔✔2. The Act eliminated
lifetime maximum limitations.
3. The Act expanded coverage for preventative services.
✔✔A typical behavioral health speciality network might include which of the following
health professionals?
1. Individual practitioners and multispecialty group practices
2. Medical doctors that specialize in addictionology
3. Developmental behavioral pediatricians - ✔✔All.
1. Individual practitioners and multispecialty group practices
2. Medical doctors that specialize in addictionology
3. Developmental behavioral pediatricians
✔✔Which of the following is (are) descriptive of the functional approach to employee to
benefit plan design?
1. It involves the evaluation of each benefit plan on a product-oriented basis
2. Using Social Security integration concepts is inconsistent with this approach
3. It is an organized system for classifying and analyzing the risks and needs of various
categories of persons into logical categories of exposure to loss and employee needs -
✔✔3. It is an organized system for classifying and analyzing the risks and needs of
various categories of persons into logical categories of exposure to loss and employee
needs
✔✔In addition to medical flexible spending accounts (FSAs), the law permits which of
the following other types of FSAs?
1. Dependent care FSAs that allow participants to set aside funds on a pretax basis to
pay for certain dependent care expenses
2. FSAs to pay for parking and transit reimbursement
, 3. FSAs to pay for adoption assistance. - ✔✔1. Dependent care FSAs that allow
participants to set aside funds on a pretax basis to pay for certain dependent care
expenses
2. FSAs to pay for parking and transit reimbursement
3. FSAs to pay for adoption assistance.
✔✔Which of the following statements regarding the distinctions between health
reimbursement accounts (HRAs) and health savings accounts (HSAs) is/are correct?
1. There is no federal limit on contributions to HSAs, but HRAs are subject to a rather
low federal limit
2. An HRA must be funded solely by the employee, but HSAs are funded only by
employers.
3. Nonmedical use is not allowed with HRAs, but such withdrawals are permitted with
HSAs, subject to income tax and penalties if the participant is under age 65. - ✔✔3.
Nonmedical use is not allowed with HRAs, but such withdrawals are permitted with
HSAs, subject to income tax and penalties if the participant is under age 65.
✔✔Managed behavioral healthcare organizations have the potential to offer significant
savings because of which of the following?
1. They allow large, self-funded employers to offer the same behavioral health benefits
across all health plans offered.
2. They are usually managed by firms that specialize in behavioral health treatment.
3. The ACA strongly encourages the practice of carving out behavioral health benefits
rather than covering them in more comprehensive health plans. - ✔✔1. They allow
large, self-funded employers to offer the same behavioral health benefits across all
health plans offered.
2. They are usually managed by firms that specialize in behavioral health treatment.
✔✔Which of the following is (are) basic differences between medicine and dentistry?
1. Medical care is rarely cosmetic; dental care often is.
2. Dental expenses generally are lower, more predictable and budgetable with the
average medical claim being much higher than the average dental claim
3. There is greater emphasis on prevention in medicine than in dentistry. - ✔✔1.
Medical care is rarely cosmetic; dental care often is.
2. Dental expenses generally are lower, more predictable and budgetable with the
average medical claim being much higher than the average dental claim
✔✔Which of the following statements concerning maximum allowable cost (MAC) for
drug benefits is (are) correct?
1. MAC programs reimburse up to a certain threshold on selected common generics.
2. Maximum allowable cost (MAC) is synonymous with average wholesale price (AWP).
3. The concept of MAC is only used by Medicaid. - ✔✔1. MAC programs reimburse up
to a certain threshold on selected common generics.
ANSWERS GRADED A+
✔✔The amount of covered medical expenses that a participant must incur before any
medical benefits for non-preventative care services or treatment become payable under
a plan is known as the: - ✔✔Deductible
✔✔The Small Business Health Care Relief Act created the qualified small employer
HRA (QSEHRA). This act applies to businesses with fewer than how many employees?
- ✔✔50
✔✔The ACA aimed to make health insurance more affordable by providing tax credits
to individuals ineligible for other affordable coverage and with income between which
limits: - ✔✔100% and 400% of the federal poverty line
✔✔Which of the following statements regarding primary care physicians (PCPs) is
correct?
- PCPs are not used in preferred provider organizations
- Pediatricians cannot be a PCP.
- PCPs are usually a general, family or internal medicine doctor (internist)
- OB/GYN doctors cannot be PCPs - ✔✔PCPs are usually a general, family or internal
medicine doctor (internist)
✔✔Insurance can be distinguished from gambling by which of the following factors?
(More than one factor is possible)
1. Insurance handles existing risk while gambling creates a new risk
2. Insurance is speculative risk and gambling is pure risk
3. Insurance is based on a mutual sharing of losses that occur while gambling involves
a gain for one party at the expense of another. - ✔✔1 & 3
Insurance handles existing risk while gambling creates a new risk
Insurance is based on a mutual sharing of losses that occur while gambling involves a
gain for one party at the expense of another.
✔✔Which of the following is/are primary factors that have contributed to cafeteria plans
becoming a standard benefit offering today?
1. The increasing costs of benefits
2. Cafeteria plans allow participants to pay for dependent care expenses through the
plan and, at the same time, claim personal tax credits on their personal income tax
returns.
3. The diverse workforce with differing benefit needs - ✔✔1 & 3
The increasing costs of benefits
The diverse workforce with differing benefit needs
,✔✔Which of the following statements regarding Consolidated Omnibus Budget
Reconciliation Act (COBRA) coverage is/are correct?
1. The cost of coverage under COBRA is limited, by law, to no more than 98% of the full
cost of coverage for active employees
2. Employers are required to pay a significant portion of the cost of insurance for
employees who continue their COBRA coverage
3. COBRA continuation coverage lasts only for a limited period of time - ✔✔COBRA
continuation coverage lasts only for a limited period of time.
✔✔Which of the following statements regarding self-funding or self-insurance is (are)
correct?
1. Self-insurance is sometimes used for property exposures but it cannot be used for
employee benefit plans
2. Stop loss insurance utilizes the concept of self-insurance
3. An effective self-insurance program requires a large enough number of exposure
units to make losses predictable - ✔✔2 & 3.
Stop loss insurance utilizes the concept of self-insurance
An effective self-insurance program requires a large enough number of exposure units
to make losses predictable
✔✔Which of the following statements regarding the effectiveness of workplace wellness
programs is (are) correct?
1. Health risk assessments, conducted at the conclusion of the program, can provide a
complete diagnosis of a worker's health.
2. Incentives, such as cash, movie tickets, discounts on medical care, have been shown
to be very effective in increasing worker participation in wellness programs.
3. Biometric testing for wellness programs is prohibited by Genetic Information
Nondiscrimination Act (GINA) - ✔✔Incentives, such as cash, movie tickets, discounts on
medical care, have been shown to be very effective in increasing worker participation in
wellness programs.
✔✔An effective behavioral health program should include which of the following?
1. An integrated mental health/chemical dependency benefit.
2. Inpatient and outpatient services
3. An employee assistance program (EAP) - ✔✔1, 2 & 3
✔✔Which of the following is (are) characteristics of modern prescription drug plans?
1. Plan members pay the full cost at the pharmacy and then file a claim for
reimbursement
2. These plans are usually carved out from the medical benefit and are typically
administered by a pharmacy benefit manager (PBM) or third party administrator (TPA)
3. These plans have not yet used mail service and the Internet but are expected to do
so after regulatory permission is obtained. - ✔✔1 & 2
Plan members pay the full cost at the pharmacy and then file a claim for reimbursement
,These plans are usually carved out from the medical benefit and are typically
administered by a pharmacy benefit manager (PBM) or third party administrator (TPA)
✔✔Which of the following is (are) features that are generally associated with consumer-
directed health plans (CDHPs)?
1. Relatively low deductible
2. A personal spending account
3. Availability of information tools for enrollees - ✔✔2 & 3
A personal spending account
Availability of information tools for enrollees
✔✔Which of the following is (are) major requirements of the ACA for employers who
sponsor group health plans?
1. The Act eliminated the use of the "essential health benefits" list.
2. The Act eliminated lifetime maximum limitations.
3. The Act expanded coverage for preventative services. - ✔✔2. The Act eliminated
lifetime maximum limitations.
3. The Act expanded coverage for preventative services.
✔✔A typical behavioral health speciality network might include which of the following
health professionals?
1. Individual practitioners and multispecialty group practices
2. Medical doctors that specialize in addictionology
3. Developmental behavioral pediatricians - ✔✔All.
1. Individual practitioners and multispecialty group practices
2. Medical doctors that specialize in addictionology
3. Developmental behavioral pediatricians
✔✔Which of the following is (are) descriptive of the functional approach to employee to
benefit plan design?
1. It involves the evaluation of each benefit plan on a product-oriented basis
2. Using Social Security integration concepts is inconsistent with this approach
3. It is an organized system for classifying and analyzing the risks and needs of various
categories of persons into logical categories of exposure to loss and employee needs -
✔✔3. It is an organized system for classifying and analyzing the risks and needs of
various categories of persons into logical categories of exposure to loss and employee
needs
✔✔In addition to medical flexible spending accounts (FSAs), the law permits which of
the following other types of FSAs?
1. Dependent care FSAs that allow participants to set aside funds on a pretax basis to
pay for certain dependent care expenses
2. FSAs to pay for parking and transit reimbursement
, 3. FSAs to pay for adoption assistance. - ✔✔1. Dependent care FSAs that allow
participants to set aside funds on a pretax basis to pay for certain dependent care
expenses
2. FSAs to pay for parking and transit reimbursement
3. FSAs to pay for adoption assistance.
✔✔Which of the following statements regarding the distinctions between health
reimbursement accounts (HRAs) and health savings accounts (HSAs) is/are correct?
1. There is no federal limit on contributions to HSAs, but HRAs are subject to a rather
low federal limit
2. An HRA must be funded solely by the employee, but HSAs are funded only by
employers.
3. Nonmedical use is not allowed with HRAs, but such withdrawals are permitted with
HSAs, subject to income tax and penalties if the participant is under age 65. - ✔✔3.
Nonmedical use is not allowed with HRAs, but such withdrawals are permitted with
HSAs, subject to income tax and penalties if the participant is under age 65.
✔✔Managed behavioral healthcare organizations have the potential to offer significant
savings because of which of the following?
1. They allow large, self-funded employers to offer the same behavioral health benefits
across all health plans offered.
2. They are usually managed by firms that specialize in behavioral health treatment.
3. The ACA strongly encourages the practice of carving out behavioral health benefits
rather than covering them in more comprehensive health plans. - ✔✔1. They allow
large, self-funded employers to offer the same behavioral health benefits across all
health plans offered.
2. They are usually managed by firms that specialize in behavioral health treatment.
✔✔Which of the following is (are) basic differences between medicine and dentistry?
1. Medical care is rarely cosmetic; dental care often is.
2. Dental expenses generally are lower, more predictable and budgetable with the
average medical claim being much higher than the average dental claim
3. There is greater emphasis on prevention in medicine than in dentistry. - ✔✔1.
Medical care is rarely cosmetic; dental care often is.
2. Dental expenses generally are lower, more predictable and budgetable with the
average medical claim being much higher than the average dental claim
✔✔Which of the following statements concerning maximum allowable cost (MAC) for
drug benefits is (are) correct?
1. MAC programs reimburse up to a certain threshold on selected common generics.
2. Maximum allowable cost (MAC) is synonymous with average wholesale price (AWP).
3. The concept of MAC is only used by Medicaid. - ✔✔1. MAC programs reimburse up
to a certain threshold on selected common generics.
