CEBS GBA 2 Practice Exam | Latest
Questions With 100% Correct Answers
(2025/2026)
1. A preferred provider organization (PPO) plan controls costs primarily
through:
A. Mandating primary care gatekeepers
B. Negotiated discounts with network providers and utilization review
C. Capitation payments to physicians
D. Requiring all care to be received within an integrated delivery system
Answer: B
,rational,: PPOs steer members to in-network providers who have agreed to
discounted fees. They also employ utilization management techniques such as
preauthorization and concurrent review. Gatekeepers are typical of HMOs, not
PPOs; capitation is more common in HMOs; integrated delivery systems are a
feature of some HMOs.
2. Which of the following is a defining characteristic of a consumer-driven
health plan (CDHP)?
A. First-dollar coverage for all preventive care
B. A high-deductible health plan (HDHP) paired with a health savings account
(HSA) or health reimbursement arrangement (HRA)
C. An exclusive provider network with no out-of-network coverage
D. Employer-funded health reimbursement accounts with no employee
contribution
Answer: B
,rational,: CDHPs combine a high-deductible health plan (which lowers premiums)
with a personal account (HSA or HRA) that can be used to pay for qualified medical
,expenses. This design encourages consumer engagement and cost-conscious
decision-making. First-dollar coverage for preventive care is allowed but not the
defining feature; exclusive networks describe EPOs.
3. Under the Mental Health Parity and Addiction Equity Act (MHPAEA), if a
group health plan offers both medical/surgical and mental health/substance
use disorder benefits, the financial requirements and treatment limitations
applied to mental health benefits must be:
A. Exactly the same as medical benefits
B. No more restrictive than the predominant requirements applied to substantially
all medical/surgical benefits
C. Less restrictive than medical benefits
D. Subject to a separate, higher deductible
Answer: B
,rational,: MHPAEA prohibits plans from imposing financial requirements
(deductibles, copays) and treatment limitations (visit limits) on mental
health/substance use disorder benefits that are more restrictive than those applied
to medical/surgical benefits. Parity is measured against the predominant level
applied to substantially all medical/surgical benefits in a classification.
4. In a health reimbursement arrangement (HRA), unused funds at the end of
the year:
A. Are forfeited to the employer
B. May be carried over to future years at the employer’s discretion, but cannot be
taken if the employee leaves the company
C. Can be withdrawn in cash by the employee
D. Must be rolled into an HSA
Answer: B
,rational,: HRAs are employer-funded accounts; the employer may permit rollover
of unused balances, but the funds remain employer property. If the employee
,terminates employment, the HRA balance typically reverts to the employer. Unlike
HSAs, HRAs are not portable and funds cannot be cashed out.
5. Which of the following best describes a "specialty pharmacy" benefit
management strategy?
A. Providing only generic drugs through retail pharmacies
B. Managing high-cost, complex medications that often require special handling,
administration, and monitoring
C. Using only mail-order for all prescriptions
D. Eliminating coverage for biologic drugs
Answer: B
,rational,: Specialty drugs treat complex conditions like cancer, rheumatoid
arthritis, multiple sclerosis. Specialty pharmacies focus on managing these drugs,
providing patient education, coordinating delivery, and managing side effects.
These drugs are typically high-cost and may require prior authorization.
6. An employer with 60 employees has a self-funded health plan. To protect
against unexpectedly large claims, they purchase stop-loss insurance with a
specific attachment point of $50,000. If an employee incurs $200,000 in
covered claims, how much will the stop-loss carrier pay?
A. $50,000
B. $150,000
C. $200,000
D. $0, because it's a self-funded plan
Answer: B
,rational,: Specific stop-loss insurance reimburses the employer for claims
exceeding the specific deductible (attachment point) per individual. Here, the
employer pays the first $50,000, and the stop-loss carrier reimburses $150,000.
Aggregate stop-loss covers all claims exceeding a threshold for the entire group.
7. Under COBRA continuation coverage, an employee who is terminated for
gross misconduct:
, A. Is eligible for 36 months of continuation coverage
B. Is eligible for 18 months of continuation coverage
C. Is not eligible for COBRA for themselves, but their dependents may elect
D. Is not eligible for COBRA coverage
Answer: D
,rational,: COBRA does not require continuation coverage for an employee (or their
covered dependents) if the termination was for gross misconduct. The employer
determines what constitutes gross misconduct. Other qualifying events (e.g.,
reduction in hours, divorce) trigger eligibility.
8. The Affordable Care Act (ACA) requires non-grandfathered group health
plans to cover certain preventive services without cost sharing. Which of the
following is an example of such a service?
A. Acupuncture for back pain
B. Lipid panel (cholesterol screening) for adults at risk
C. Bariatric surgery
D. LASIK eye surgery
Answer: B
,rational,: ACA requires coverage with no copay/coinsurance/deductible for
evidence-based preventive services rated A or B by the U.S. Preventive Services
Task Force, such as cholesterol screening, immunizations, mammograms, and
colonoscopies. Acupuncture, bariatric surgery, and LASIK are not required
preventive services under the ACA.
9. What is the primary purpose of a pharmacy benefit manager (PBM) in a group
health plan?
A. To manufacture generic drugs
B. To process claims, negotiate rebates with drug manufacturers, manage
formularies, and control drug costs
C. To replace the health insurer entirely
D. To provide direct patient care at pharmacies
Questions With 100% Correct Answers
(2025/2026)
1. A preferred provider organization (PPO) plan controls costs primarily
through:
A. Mandating primary care gatekeepers
B. Negotiated discounts with network providers and utilization review
C. Capitation payments to physicians
D. Requiring all care to be received within an integrated delivery system
Answer: B
,rational,: PPOs steer members to in-network providers who have agreed to
discounted fees. They also employ utilization management techniques such as
preauthorization and concurrent review. Gatekeepers are typical of HMOs, not
PPOs; capitation is more common in HMOs; integrated delivery systems are a
feature of some HMOs.
2. Which of the following is a defining characteristic of a consumer-driven
health plan (CDHP)?
A. First-dollar coverage for all preventive care
B. A high-deductible health plan (HDHP) paired with a health savings account
(HSA) or health reimbursement arrangement (HRA)
C. An exclusive provider network with no out-of-network coverage
D. Employer-funded health reimbursement accounts with no employee
contribution
Answer: B
,rational,: CDHPs combine a high-deductible health plan (which lowers premiums)
with a personal account (HSA or HRA) that can be used to pay for qualified medical
,expenses. This design encourages consumer engagement and cost-conscious
decision-making. First-dollar coverage for preventive care is allowed but not the
defining feature; exclusive networks describe EPOs.
3. Under the Mental Health Parity and Addiction Equity Act (MHPAEA), if a
group health plan offers both medical/surgical and mental health/substance
use disorder benefits, the financial requirements and treatment limitations
applied to mental health benefits must be:
A. Exactly the same as medical benefits
B. No more restrictive than the predominant requirements applied to substantially
all medical/surgical benefits
C. Less restrictive than medical benefits
D. Subject to a separate, higher deductible
Answer: B
,rational,: MHPAEA prohibits plans from imposing financial requirements
(deductibles, copays) and treatment limitations (visit limits) on mental
health/substance use disorder benefits that are more restrictive than those applied
to medical/surgical benefits. Parity is measured against the predominant level
applied to substantially all medical/surgical benefits in a classification.
4. In a health reimbursement arrangement (HRA), unused funds at the end of
the year:
A. Are forfeited to the employer
B. May be carried over to future years at the employer’s discretion, but cannot be
taken if the employee leaves the company
C. Can be withdrawn in cash by the employee
D. Must be rolled into an HSA
Answer: B
,rational,: HRAs are employer-funded accounts; the employer may permit rollover
of unused balances, but the funds remain employer property. If the employee
,terminates employment, the HRA balance typically reverts to the employer. Unlike
HSAs, HRAs are not portable and funds cannot be cashed out.
5. Which of the following best describes a "specialty pharmacy" benefit
management strategy?
A. Providing only generic drugs through retail pharmacies
B. Managing high-cost, complex medications that often require special handling,
administration, and monitoring
C. Using only mail-order for all prescriptions
D. Eliminating coverage for biologic drugs
Answer: B
,rational,: Specialty drugs treat complex conditions like cancer, rheumatoid
arthritis, multiple sclerosis. Specialty pharmacies focus on managing these drugs,
providing patient education, coordinating delivery, and managing side effects.
These drugs are typically high-cost and may require prior authorization.
6. An employer with 60 employees has a self-funded health plan. To protect
against unexpectedly large claims, they purchase stop-loss insurance with a
specific attachment point of $50,000. If an employee incurs $200,000 in
covered claims, how much will the stop-loss carrier pay?
A. $50,000
B. $150,000
C. $200,000
D. $0, because it's a self-funded plan
Answer: B
,rational,: Specific stop-loss insurance reimburses the employer for claims
exceeding the specific deductible (attachment point) per individual. Here, the
employer pays the first $50,000, and the stop-loss carrier reimburses $150,000.
Aggregate stop-loss covers all claims exceeding a threshold for the entire group.
7. Under COBRA continuation coverage, an employee who is terminated for
gross misconduct:
, A. Is eligible for 36 months of continuation coverage
B. Is eligible for 18 months of continuation coverage
C. Is not eligible for COBRA for themselves, but their dependents may elect
D. Is not eligible for COBRA coverage
Answer: D
,rational,: COBRA does not require continuation coverage for an employee (or their
covered dependents) if the termination was for gross misconduct. The employer
determines what constitutes gross misconduct. Other qualifying events (e.g.,
reduction in hours, divorce) trigger eligibility.
8. The Affordable Care Act (ACA) requires non-grandfathered group health
plans to cover certain preventive services without cost sharing. Which of the
following is an example of such a service?
A. Acupuncture for back pain
B. Lipid panel (cholesterol screening) for adults at risk
C. Bariatric surgery
D. LASIK eye surgery
Answer: B
,rational,: ACA requires coverage with no copay/coinsurance/deductible for
evidence-based preventive services rated A or B by the U.S. Preventive Services
Task Force, such as cholesterol screening, immunizations, mammograms, and
colonoscopies. Acupuncture, bariatric surgery, and LASIK are not required
preventive services under the ACA.
9. What is the primary purpose of a pharmacy benefit manager (PBM) in a group
health plan?
A. To manufacture generic drugs
B. To process claims, negotiate rebates with drug manufacturers, manage
formularies, and control drug costs
C. To replace the health insurer entirely
D. To provide direct patient care at pharmacies
