CEBS GBA 2 EXAM – DIRECTING BENEFITS PROGRAMS PART 2
Questions and Answers| Updated| Pass Guaranteed
1. Which of the following is the largest single source of private health
coverage for people under age 65 in the U.S.?
A. Employer-sponsored coverage
B. Individually purchased coverage
C. Medicare
D. Direct primary care memberships
Answer: A. Employer-sponsored coverage
Rationale: Employer-sponsored insurance covers more non-elderly
Americans than any other source of private coverage, which is why plan
design and cost control are so central to benefits management.
2. Under the ACA employer shared responsibility provisions, which
employers are 'applicable large employers' (ALEs)?
A. Those with 10 or more employees
B. Those with an average of 50 or more full-time employees, including
full-time equivalents
C. Those with 100 or more employees only
D. Only public companies
Answer: B. Those with an average of 50 or more full-time employees,
including full-time equivalents
Rationale: ALEs (50+ full-time and full-time-equivalent employees) must
offer affordable, minimum value coverage to full-time employees (30+
hours per week) and dependents, or risk Section 4980H penalties.
CEBS GBA 2 Exam – Page 1
,3. To satisfy the 'minimum value' standard, an employer plan must:
A. Pay 90% of all costs
B. Cover only preventive services
C. Pay at least 60% of the total allowed cost of benefits and provide
substantial coverage of inpatient hospital and physician services
D. Have no deductible
Answer: C. Pay at least 60% of the total allowed cost of benefits and
provide substantial coverage of inpatient hospital and physician
services
Rationale: Minimum value is measured as an actuarial value of at least
60%, along with substantial coverage of inpatient hospital and physician
services.
4. How is employer coverage 'affordability' under the ACA generally
tested?
A. By comparing family coverage cost to total payroll
B. By the employer's profit margin
C. By the number of claims filed
D. By comparing the employee's required contribution for the lowest-
cost self-only minimum value plan with a percentage of income (using
safe harbors)
Answer: D. By comparing the employee's required contribution for the
lowest-cost self-only minimum value plan with a percentage of
income (using safe harbors)
Rationale: Affordability is based on the employee-only premium for the
lowest-cost eligible plan. Employers commonly use W-2, rate of pay or
federal poverty line safe harbors.
CEBS GBA 2 Exam – Page 2
,5. Which statement about ACA out-of-pocket maximums is correct?
A. They apply to non-grandfathered group health plans, including
large-group and self-funded plans
B. They apply only to individual plans
C. They apply only to HMOs
D. They apply only to Medicare
Answer: A. They apply to non-grandfathered group health plans,
including large-group and self-funded plans
Rationale: ACA annual limits on cost sharing apply to essential health
benefits in non-grandfathered group and individual plans, regardless of
funding method.
6. What is cost shifting in health care?
A. Employers moving to self-funding
B. Providers raising charges to private payers to make up for below-
cost payments from other payers such as Medicare, Medicaid or the
uninsured
C. Employees paying more premium
D. Insurers merging
Answer: B. Providers raising charges to private payers to make up for
below-cost payments from other payers such as Medicare, Medicaid
or the uninsured
Rationale: When government programs pay less than cost, providers may
negotiate higher rates with commercial insurers, pushing up premiums for
employer plans.
CEBS GBA 2 Exam – Page 3
, 7. What is the fundamental difference between fee-for-service
payment and value-based payment?
A. Fee-for-service pays a fixed salary
B. Value-based payment is used only for vision care
C. Fee-for-service pays per service delivered, while value-based
payment ties reimbursement to quality and cost outcomes
D. There is no difference
Answer: C. Fee-for-service pays per service delivered, while value-
based payment ties reimbursement to quality and cost outcomes
Rationale: Fee-for-service can encourage volume, while value-based
models (bundled payments, ACOs, pay-for-performance) reward outcomes
and efficiency.
8. Which of the following is NOT commonly listed as a driver of rising
health care costs?
A. An aging population
B. High-cost specialty drugs
C. Prevalence of chronic conditions
D. A decline in the use of medical technology
Answer: D. A decline in the use of medical technology
Rationale: Advances and greater use of technology, aging, chronic
disease and pricing/consolidation push spending up. Reduced technology
use is not a driver.
CEBS GBA 2 Exam – Page 4
Questions and Answers| Updated| Pass Guaranteed
1. Which of the following is the largest single source of private health
coverage for people under age 65 in the U.S.?
A. Employer-sponsored coverage
B. Individually purchased coverage
C. Medicare
D. Direct primary care memberships
Answer: A. Employer-sponsored coverage
Rationale: Employer-sponsored insurance covers more non-elderly
Americans than any other source of private coverage, which is why plan
design and cost control are so central to benefits management.
2. Under the ACA employer shared responsibility provisions, which
employers are 'applicable large employers' (ALEs)?
A. Those with 10 or more employees
B. Those with an average of 50 or more full-time employees, including
full-time equivalents
C. Those with 100 or more employees only
D. Only public companies
Answer: B. Those with an average of 50 or more full-time employees,
including full-time equivalents
Rationale: ALEs (50+ full-time and full-time-equivalent employees) must
offer affordable, minimum value coverage to full-time employees (30+
hours per week) and dependents, or risk Section 4980H penalties.
CEBS GBA 2 Exam – Page 1
,3. To satisfy the 'minimum value' standard, an employer plan must:
A. Pay 90% of all costs
B. Cover only preventive services
C. Pay at least 60% of the total allowed cost of benefits and provide
substantial coverage of inpatient hospital and physician services
D. Have no deductible
Answer: C. Pay at least 60% of the total allowed cost of benefits and
provide substantial coverage of inpatient hospital and physician
services
Rationale: Minimum value is measured as an actuarial value of at least
60%, along with substantial coverage of inpatient hospital and physician
services.
4. How is employer coverage 'affordability' under the ACA generally
tested?
A. By comparing family coverage cost to total payroll
B. By the employer's profit margin
C. By the number of claims filed
D. By comparing the employee's required contribution for the lowest-
cost self-only minimum value plan with a percentage of income (using
safe harbors)
Answer: D. By comparing the employee's required contribution for the
lowest-cost self-only minimum value plan with a percentage of
income (using safe harbors)
Rationale: Affordability is based on the employee-only premium for the
lowest-cost eligible plan. Employers commonly use W-2, rate of pay or
federal poverty line safe harbors.
CEBS GBA 2 Exam – Page 2
,5. Which statement about ACA out-of-pocket maximums is correct?
A. They apply to non-grandfathered group health plans, including
large-group and self-funded plans
B. They apply only to individual plans
C. They apply only to HMOs
D. They apply only to Medicare
Answer: A. They apply to non-grandfathered group health plans,
including large-group and self-funded plans
Rationale: ACA annual limits on cost sharing apply to essential health
benefits in non-grandfathered group and individual plans, regardless of
funding method.
6. What is cost shifting in health care?
A. Employers moving to self-funding
B. Providers raising charges to private payers to make up for below-
cost payments from other payers such as Medicare, Medicaid or the
uninsured
C. Employees paying more premium
D. Insurers merging
Answer: B. Providers raising charges to private payers to make up for
below-cost payments from other payers such as Medicare, Medicaid
or the uninsured
Rationale: When government programs pay less than cost, providers may
negotiate higher rates with commercial insurers, pushing up premiums for
employer plans.
CEBS GBA 2 Exam – Page 3
, 7. What is the fundamental difference between fee-for-service
payment and value-based payment?
A. Fee-for-service pays a fixed salary
B. Value-based payment is used only for vision care
C. Fee-for-service pays per service delivered, while value-based
payment ties reimbursement to quality and cost outcomes
D. There is no difference
Answer: C. Fee-for-service pays per service delivered, while value-
based payment ties reimbursement to quality and cost outcomes
Rationale: Fee-for-service can encourage volume, while value-based
models (bundled payments, ACOs, pay-for-performance) reward outcomes
and efficiency.
8. Which of the following is NOT commonly listed as a driver of rising
health care costs?
A. An aging population
B. High-cost specialty drugs
C. Prevalence of chronic conditions
D. A decline in the use of medical technology
Answer: D. A decline in the use of medical technology
Rationale: Advances and greater use of technology, aging, chronic
disease and pricing/consolidation push spending up. Reduced technology
use is not a driver.
CEBS GBA 2 Exam – Page 4
