Test - GBA 1 - Practice Exam: Directing Benefits Programs Part 1 Already Passed

Test - GBA 1 - Practice Exam: Directing Benefits Programs Part 1 Already Passed Which risk-handling techniques are being used by a firm that decides to not produce a dangerous chemical, to purchase insurance with a $10,000 deductible on its assets and to install a fire sprinkler system throughout the plant? Avoidance, retention, insurance and control Which of the following statements regarding prescription drug rebates is correct? A rebate occurs when there is an agreement between a pharmacy benefit manager and a drug manufacturer. There are several methods for evaluating health system performance. Accreditation by the NCQA is an example of which of the following methods? Audit performance evaluation When a participant of a cafeteria plan makes a one-time election on coverage that stays in force from plan year to plan year unless the participant elects to make a change during the applicable election period, it is referred to as a(n): Evergreen election The benefit-oriented philosophy of designing employee benefits tends to focus on: Needs of employees The amount of covered medical expenses that a participant must incur before any medical benefits for non-preventive care services or treatment become payable under a plan is known as the: Deductible The Supreme Court decision in National Federation of Independent Business v. Sebelius had a profound effect on the implementation of the Affordable Care Act (ACA). Which of the following statements summarizes the impact of this case? The decision made Medicare expansion by the states voluntary. The Affordable Care Act (ACA) aimed to make health insurance more affordable by providing tax credits to individuals ineligible for other affordable coverage and with income between which of the following limits: 100% and 400% of the federal poverty line. The concept designed to make victims of losses whole again reflects the principle of: Indemnification A mechanism by which one attempts either to prevent or reduce the probability of a loss taking place or to reduce the severity of the loss if it does take place is referred to as: Control The Affordable Care Act (ACA), in general, defined a full-time employee as one employed on average at least how many hours per week? 30 Dental treatments are placed into ten professional treatment categories. A restorative treatment is: If a cafeteria plan fails to pass the required nondiscrimination testing, then: The highly compensated and key employees are taxed based on the value of their benefits. An insured individual has $12,000 of covered medical expenses for in-network nonpreventive treatment. His plan is a high-deductible health policy with a $1,500 deductible and a 20% coinsurance arrangement. Also, the plan reimburses 100% after an individual reaches the plan's $6,000 out-of-pocket maximum. What will the insured pay out of the total medical expenses if this is the first claim of the plan year? $ 3,600 A behavioral health care carve-out program usually operates under a separate contract and from a separate company known as a(n): Managed behavioral health care organization (MBHO) A peril as the term applies to the insurance mechanism is defined as: The cause of a loss The "managed care backlash" of the late 1990s gave direct rise to which of the following types of health care organizations? Preferred provider organizations (PPOs) Which of the following is a requirement of the Health Insurance Portability and Accountability Act (HIPAA) as it applies to wellness programs? A program that is offered directly by an employer outside of a group plan is not subject to HIPAA privacy rules. The maximum annual contribution that can be made to a health savings account (HSA) is: A fixed, indexed amount Benefits for so-called lifestyle drugs: Have been routinely excluded from all employer plans. A dental plan in which certain procedures are reimbursed on a scheduled basis and others are reimbursed on a nonscheduled basis is called a(n): Combination plan A participant in a health care flexible spending account (FSA) elects to contribute $1,200 to the account for an entire plan year. One month into the year, $200 has been contributed to the account and the participant incurs $1,200 worth of eligible reimbursable expenses. Which of the following statements properly describes the maximum allowable claims and payments that can be made on the account? A claim of $1,200 can be made on the account, and $1,200 will be paid. Generally in a premium conversion cafeteria plan: There are no employer contributions. For a cafeteria plan to be afforded favorable tax treatment, the plan must allow participants to choose between how many benefits consisting of cash (or a taxable benefit that is treated as cash) and qualified benefits? Two or more A health care plan has no restrictions on a member's choice of provider, there is no "steerage," and there is no basic utilization management. This type of health care coverage is known as: Indemnity plan The highest level of accreditation granted to managed behavioral healthcare organizations (MBHOs) by the National Committee for Quality Assurance is: "Full" and is effective for three years In contributory employer-sponsored group life and health insurance plans, typically the following minimum percentage of eligible employees must participate: 75% The National Labor Relations Board (NLRB) ruled that the employer had the duty to bargain in good faith over wages, which also included insurance and fringe benefits, in the landmark case referred to as the: Inland Steel case Which of the following is a correct statement regarding return on investment (ROI) evaluations and calculations? ROI evaluations usually only consider the payback for the investor in terms of the money they get back for the money they put in. Which of the following statements regarding primary care physicians (PCPs) is correct? PCPs are usually a general, family or internal medicine doctor (internist). An example of a healthcare reform that is comprehensive and represents a longer-term set of change interventions to a range of services is: Enactment of the Affordable Care Act (ACA) Which of the following statements related to employer-sponsored wellness programs is correct? The objectives of such programs are to promote healthy lifestyles among employees by targeting the risks that result from poor nutrition, lack of physical activity, excessive stress, tobacco use and other unhealthy habits. The legislation that plays a fundamentally important role in protecting sensitive patient information gathered during behavioral treatment is the: Health Insurance Portability and Accountability Act (HIPAA) The three principal component parts of the nondiscrimination test that applies generally to a cafeteria plan include which of the following? I. Uniform measurement test II. Key employee concentration test III. Adaptability test Which of the following is (are) potential disadvantages for employers in sponsoring a cafeteria plan? Ongoing administrative complexity stemming, in part, from the need to comply with tax law provisions governing cafeteria plans, and higher operational costs than those under noncafeteria plans Which of the following statements is (are) descriptive of the functional approach to employee benefit plan design? 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. Which of the following statements describe(s) reforms enacted by the Affordable Care Act (ACA)? I. Precluding insurance companies from denying coverage due to a preexisting condition II. In general prohibiting group health plans from offering coverage with any lifetime or annual limits on the dollar value of essential health benefits III. Imposing coverage requirements on applicable large employers (ALEs) defined as those with more than 20 full-time employees (including full-time equivalent employees) All of the following statements regarding consumer-directed health plans (CDHPs) and "risk segmentation" in health insurance markets are correct EXCEPT: Which of the following incentives/rewards of wellness programs has (have) been shown to double worker participation? Cash, movie tickets and discounts on medical care A healthcare organization is contemplating a possible investment in a new technology and is conducting a return on investment (ROI) analysis. Which of the following are typically used to define the returns to be valued? Savings in cost & Cash returns An employer has only 12 employees, all of whom are full-time. The average annual wage is less than $50,000. According to the provisions enacted by the Affordable Care Act (ACA): This employer is exempt from the ACA's employer shared responsibility mandate, and Tax credits for health coverage might be available to this employer Disability policies can be purchased in which of the following ways? Pre-tax premium conversion through an employer and After-tax premium payments through an employer Which of the following accurately reflect(s) major federal tax advantages associated with employee benefit plans? In certain types of capital accumulation plans, benefits accumulate tax-free to the employee until distributed. Which of the following statements is (are) descriptive of the contributions and benefits test of Internal Revenue Code Section 125? Contributions and/or benefits may not be discriminatory in favor of highly compensated employees. Insurers deal with the problem of adverse selection by individual applicants through the use of which of the following techniques? Underwriting procedures Which of the following statements regarding the impact of the Genetic Information Nondiscrimination Act (GINA) on wellness programs and health risk assessments is (are) correct? Wellness programs that avoid implementing a health risk assessment which solicits genetic information are in general GINA-compliant, and GINA allows exceptions for inquiries through voluntary wellness programs. Managed behavioral healthcare organizations have the potential to offer significant savings because of which of the following? They allow large, self-funded employers to offer the same behavioral health benefits across all health plans offered, and they are equipped with sophisticated administrative, operational and care management capabilities. The usual steps in an evaluation of a health reform initiative include which of the following? Describing the reform instrument and the implementation process, gathering data about changes in health service performance and possibly also in health data, and assessing whether these data really are outcomes of the reform The usual steps in an evaluation of a health reform initiative include which of the following? Describing the reform instrument and the implementation process Gathering data about changes in health service performance and possibly also in health data Assessing whether these data really are outcomes of the reform A.) I only B.) II only C.) I and II only D.) II and III only E.) I, II and III Maximum limits in dental plans typically are expressed in which of the following ways? A separate inside maximum for orthodontics and a separate maximum per person per calendar year Which of the following factors affect(s) the cost of an employer-sponsored dental plan? Design of the plan, characteristics of the covered group, and employers' approach to plan implementation Evaluation of a health reform initiative should be conducted at which of the following times? Before it starts, During its implementation & After its implementation Insurance can be distinguished from gambling by which of the following factors? Insurance handles existing risk while gambling creates a new risk, and 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 are common ways pharmacy benefit managers (PBMs) typically generate profits? Charging payers an administrative fee per transaction based on the number of prescriptions or employees, and filling mail-service prescriptions from their wholly owned mail-order pharmacies. Which of the following statements concerning maximum allowable cost (MAC) for drug benefits is (are) correct? MAC programs reimburse up to a certain threshold on selected, common generics, and MAC pricing's genesis was the federal Medicaid program. In comparing high-deductible health plan/health savings accounts (HDHP/HSAs) with high deductible health plan/health reimbursement arrangements (HDHP/HRAs), which of the following statements regarding these plans is (are) correct? HSAs are linked to plans with higher annual deductibles than HRAs. Which of the following statements regarding Consolidated Omnibus Budget Reconciliation Act (COBRA) coverage is (are) correct? COBRA continuation coverage lasts only for a limited period of time. Which of the following is (are) primary factors that have contributed to cafeteria plans becoming a standard benefit offering today? The increasing costs of benefits, and the diverse workforce with differing benefit needs Which of the following is (are) features that are generally associated with consumer-directed health plans (CDHPs)? A personal spending account, and availability of information tools for enrollees A typical behavioral health specialty network includes which of the following health professionals? Individual practitioners and multispecialty group practices, Medical doctors that specialize in addictionology, & Developmental behavioral pediatricians As wellness programs invest in "total well-being," they are dealing with which of the following types of issues? Student loan repayment assistance, Financial education, & Emotional resiliency Which of the following statements regarding health-contingent wellness programs as authorized by the Affordable Care Act (ACA) is (are) correct? A small percentage of these programs are offered today, and most large firms offer the maximum incentives permitted by the ACA. Under the Genetic Information Nondiscrimination Act (GINA), which of the following statements is (are) correct? Group health plans and insurers are prohibited from requesting or requiring that individuals undergo a genetic test for determination of eligibility, and insurers are prohibited from purchasing genetic information at any time for underwriting purposes. Which of the following are recommended questions by which to assess an evaluation of a health reform? How good was the description of the actual implementation of the change? Were data gathered about all important and possible effects? Are all other explanations for the before/after differences considered (other than the intervention)? Which of the following conditions, if satisfied by a participant's spouse, would allow the participant to claim benefits under a dependent-care assistance plan for child-care expenses? Spouse is employed Which of the following is (are) basic differences between medicine and dentistry? Medical care is rarely cosmetic; dental care often is, and dental expenses generally are lower, more predictable and budgetable, with the average medical claim being much higher than the average dental claim. The three principal component parts of the nondiscrimination test that applies generally to a cafeteria plan include which of the following? Key employee concentration test