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