CEBS GBA1 Exam Questions with Correct Answers

CEBS GBA1 Exam Questions with Correct Answers Predictive Modeling and Risk Assessment - Answer-A cost containment practice that analyzes claims data and identifies high risk potentially high cost members and intervenes to avoid preventable cost Performance Measurement - Answer-A cost containment practice that collects data after the fact via a provider assessments, reports, and claims data Case Management - Answer-Cost containment that uses a manager to coordinate members care in collaboration with treating providers, facilities, community resources and family members to ensure the patient receives the right level of care Woman Cancer Act 1998 - Answer-Law that requires health plans to provide mastectomy prosthetic devices and reconstructive surgery coverage Mental Health Parity and Addiction Equity 2008 - Answer-Law requiring parity with respect to aggregate lifetime and annual dollar limits for mental health benefits. ERISA - Answer-Regulation that requires minimum standards of a plan, providing information, exercising fiduciary responsibilities in plan admin and establishes appeal process Welfare plans - Answer-Another term for other employee benefits under ERISA Simple Cafeteria Plan - Answer-Special plans allowed under ACA amendment to Section 125 for eligible small employers which are exempt from otherwise applicable non discrimination testing Contribution and Benefits Test - Answer-A non discrimination test that examines the level of non-taxable benefits for highly compensated vs. Non HCE Eligibility Test - Answer-A non discrimination test that examines whether the plan favors HCEs in participation levels HSA - Answer-Employee owned trusts or custodial accounts for reimbursement of medical expenses that may be funded with EE or ER contributions through a cafeteria plan Non Elective - Answer-Paid time off that is not subject to an election by the employee FSA - Answer-Type of healthcare spending account that requires forfeiture of any unused funds at the end of the plan year HEART - Answer-Enhanced USERRA by permitting plan sponsors to allow employees called to active duty for a certain duration to receive a distribution of the unused balance of their healthcare FSA HIPAA - Answer-Regulation that allows for changes of health coverage or if a person becomes a spouse or dependent through marriage birth or adoption Evergreen Election - Answer-A type of benefits election that stays in force from plan year to plan year unless a deliberate change is made during the election period Negative Election - Answer-An automatic enrollment doesnt require positive action on the part of the employee to enroll in a benefit plan and is called Benefits for Life Style Drugs - Answer-Routinely excluded from all employer plans Control - Answer-A mechanism which one attempts to either prevent or reduce the probability of a loss taking place or to reduce the severity of the loss if it does not take place Evergreen election - Answer-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 is referred to as an Pharmacy Rebate - Answer-A rebate occurs when there is an agreement between a PBM and a drug manufacturer ACA - Answer-Example of a healthcare reform that is comprehensive and represents a longer term set of change interventions to a range of services 75% - Answer-In contributory employer sponsored group life and health insurance plans typically the following is the minimum percentage of eligible employees that must participate Indemnity plan - Answer-A health care plan has no restrictions on a members choice or provider there is no steerage and there is no basic utilization management based on a % of losses for hospital diagnostic and physician expenses PPO - Answer-The managed care backlash of the late 1990s gave direct rise to this type of health care organization Deductible - Answer-The amount of covered medical expenses a participant must incur before any medical benefits for non preventive care services or treatment become payable under the plan Inland Steel - Answer-NLRB ruled the employer had the duty to bargain in good faith over wages which also included insurance and fringe benefits Audit Performance Evaluation - Answer-Accreditation by the NCQA is an example of 100-400% of the poverty line - Answer-The ACA aimed to make health insurance more affordable by providing tax credits to individuals ineligible for other affordable coverage with income between Highly compensated and key employees are taxed - Answer-If a cafeteria plan fails to pass nondiscrimination testing PCP - Answer-Usually a general, family or internal medicine doctor (Internist) ROI Evaluation and Calc. - Answer-Usually only consider the payback for the investor in terms of money they get back for the money they put in HIPAA - Answer-Legislation plays a fundamentally important role in protecting sensitive information gather during behavioral treatment