CEBS GBA 1 Practice Exam – Group Benefits Certification
Study & Prep
A predefined maximum quantity for specific medications that restricts the
number of dosage units. It may be used to prevent abuse or overuse of the
medication. - -- answer --Quantity limits
A drug utilization program that requires the pharmacist or nurse to review the
patient profile to determine if they are complying with drug therapy or to suggest
alternative therapies. - -- answer --Retrospective Review
A program that measures/manages all healthcare outcomes and costs associated
with a particular disease across the entire continuum of healthcare delivery. - --
answer --Disease state management program
A type of disease state management program that uses call centers staffed by
nurses to triage patients with select diseases to appropriate levels of care and to
follow up with them - -- answer --Medical model
A type of disease state management program administered by PBMs,
pharmaceutical manufacturers, or health plans to improve compliance with
medication therapy, educate patients, and test outcomes. - -- answer --Therapy-
directed model
,Which legislation established the distinction between retirement benefits and
welfare benefits and set forth a basic regulatory framework in administering
these type of benefits under collective bargaining?
A. The National Labor Relations Act
B. The Labor Management Reconciliation Act
C. Employee Retirement Income Security Act
D. The Labor Management Relations Act
E. The Retirement and Welfare Benefits Act - -- answer --D. The Labor
Management Relations Act is administered by the National Labor Relations Board
and is also referred to as the Taft-Hartley Act.
The cause of a personal or property loss, destruction, or damage is:
A. Risk
B. Catastrophe
C. Peril
D. Hazard
E. Calamity. - -- answer --C. Peril
Which of the following is true regarding Health Reimbursement Accounts?
A. They operates on a use-or-lose basis; if the funds are not exhausted by the end
of the plan year, they are forfeited.
B. Employees and employers fund the account.
C. The account is owned by the employee.
D. They can be utilized to pay for over-the-counter medications.
E. Unused funds at the end of the year do not have to be rolled over. - -- answer -
-E is the correct -- answer --. Employers fund this type of account and, thus own
,the monies. Employers have the choice to roll over unused funds, but they
generally do not do so.
One of the eight basic payment methods that is based on case rates, payment per
stay, or bundled payments is:
A. Per service
B. Per dollar cost
C. Per dollar of charges
D. Per episode
E. Per time period. - -- answer --D is the correct -- answer --. Think of it in terms
of payment being paid for the whole medical episode. This is generally wrapped
up by diagnosis-related groups and then, billed
Construction, replacement, and repair of missing teeth is which category of
covered dental expenses?
A. Endodontics
B. Prosthodontics
C. Restorative
D. Implantology
E. Oral surgery - -- answer --B. Prosthodontics
The payment method in health care based on a flat rate per participant is called:
A. Scheduled plans
B. Capitation
C. Managed care
D. Fee-for-service
, E. Bundling - -- answer --B. Capitation
A cost savings approach where the pharmacy collects the full copay, even when
the cost of the drug is less than the copay, is called:
A. Edited charge billing
B. Zero-balance billing
C. Reimbursement billing
D. Indemnity billing
E. Prepaid billing - -- answer --B. Zero-balance billing
According to the Financial Accounting Standards Board (FASB) of Financial
Accounting Standard (FAS) 106, employers' accounting for post-retirement
benefits other than pensions must adhere to:
I. The accrual of the benefit cost of post-retirement benefits as a current business
expense
II. The recognition of liabilities for post-retirement benefits for the balance sheet
III. The consideration of other regulations such as COBRA
A. None
B. I only
C. I and II only
D. III only
E. I, II and III - -- answer --E. I, II and III
Additionally, employers must recognize the funding assets for post-retirement
benefits.
Study & Prep
A predefined maximum quantity for specific medications that restricts the
number of dosage units. It may be used to prevent abuse or overuse of the
medication. - -- answer --Quantity limits
A drug utilization program that requires the pharmacist or nurse to review the
patient profile to determine if they are complying with drug therapy or to suggest
alternative therapies. - -- answer --Retrospective Review
A program that measures/manages all healthcare outcomes and costs associated
with a particular disease across the entire continuum of healthcare delivery. - --
answer --Disease state management program
A type of disease state management program that uses call centers staffed by
nurses to triage patients with select diseases to appropriate levels of care and to
follow up with them - -- answer --Medical model
A type of disease state management program administered by PBMs,
pharmaceutical manufacturers, or health plans to improve compliance with
medication therapy, educate patients, and test outcomes. - -- answer --Therapy-
directed model
,Which legislation established the distinction between retirement benefits and
welfare benefits and set forth a basic regulatory framework in administering
these type of benefits under collective bargaining?
A. The National Labor Relations Act
B. The Labor Management Reconciliation Act
C. Employee Retirement Income Security Act
D. The Labor Management Relations Act
E. The Retirement and Welfare Benefits Act - -- answer --D. The Labor
Management Relations Act is administered by the National Labor Relations Board
and is also referred to as the Taft-Hartley Act.
The cause of a personal or property loss, destruction, or damage is:
A. Risk
B. Catastrophe
C. Peril
D. Hazard
E. Calamity. - -- answer --C. Peril
Which of the following is true regarding Health Reimbursement Accounts?
A. They operates on a use-or-lose basis; if the funds are not exhausted by the end
of the plan year, they are forfeited.
B. Employees and employers fund the account.
C. The account is owned by the employee.
D. They can be utilized to pay for over-the-counter medications.
E. Unused funds at the end of the year do not have to be rolled over. - -- answer -
-E is the correct -- answer --. Employers fund this type of account and, thus own
,the monies. Employers have the choice to roll over unused funds, but they
generally do not do so.
One of the eight basic payment methods that is based on case rates, payment per
stay, or bundled payments is:
A. Per service
B. Per dollar cost
C. Per dollar of charges
D. Per episode
E. Per time period. - -- answer --D is the correct -- answer --. Think of it in terms
of payment being paid for the whole medical episode. This is generally wrapped
up by diagnosis-related groups and then, billed
Construction, replacement, and repair of missing teeth is which category of
covered dental expenses?
A. Endodontics
B. Prosthodontics
C. Restorative
D. Implantology
E. Oral surgery - -- answer --B. Prosthodontics
The payment method in health care based on a flat rate per participant is called:
A. Scheduled plans
B. Capitation
C. Managed care
D. Fee-for-service
, E. Bundling - -- answer --B. Capitation
A cost savings approach where the pharmacy collects the full copay, even when
the cost of the drug is less than the copay, is called:
A. Edited charge billing
B. Zero-balance billing
C. Reimbursement billing
D. Indemnity billing
E. Prepaid billing - -- answer --B. Zero-balance billing
According to the Financial Accounting Standards Board (FASB) of Financial
Accounting Standard (FAS) 106, employers' accounting for post-retirement
benefits other than pensions must adhere to:
I. The accrual of the benefit cost of post-retirement benefits as a current business
expense
II. The recognition of liabilities for post-retirement benefits for the balance sheet
III. The consideration of other regulations such as COBRA
A. None
B. I only
C. I and II only
D. III only
E. I, II and III - -- answer --E. I, II and III
Additionally, employers must recognize the funding assets for post-retirement
benefits.
