Practice Exam: Directing Benefits Progra
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ms Questions And Answers
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Whichiorisk-
handlingiotechniquesioareiobeingiousediobyioaiofirmiothatiodecidesiotoionotioproduceioaiodangerousi
ochemical,iotoiopurchaseioinsuranceiowithioaio$10,000iodeductibleioonioitsioassetsioandiotoioinstallio
aiofireiosprinkleriosystemiothroughoutiotheioplant?io-iocorrectioans-
Avoidance,ioretention,ioinsuranceioandiocontrol
Whichioofiotheiofollowingiostatementsioregardingioprescriptioniodrugiorebatesioisiocorrect?io-
iocorrectioans-
Aiorebateiooccursiowheniothereioisioanioagreementiobetweenioaiopharmacyiobenefitiomanagerioan
dioaiodrugiomanufacturer.
Thereioareioseveraliomethodsioforioevaluatingiohealthiosystemioperformance.ioAccreditationiobyi
otheioNCQAioisioanioexampleioofiowhichioofiotheiofollowingiomethods?io-iocorrectioans-
Auditioperformanceioevaluation
Whenioaioparticipantioofioaiocafeteriaioplaniomakesioaioone-
timeioelectioniooniocoverageiothatiostaysioinioforceiofromioplanioyeariotoioplanioyeariounlessiotheiopar
ticipantioelectsiotoiomakeioaiochangeioduringiotheioapplicableioelectionioperiod,ioitioisioreferrediotoio
asioa(n):io-iocorrectioans-Evergreenioelection
Theiobenefit-orientediophilosophyioofiodesigningioemployeeiobenefitsiotendsiotoiofocusioon:io-
iocorrectioans-Needsioofioemployees
Theioamountioofiocoverediomedicalioexpensesiothatioaioparticipantiomustioincuriobeforeioanyiomed
icaliobenefitsioforionon-
preventiveiocareioservicesiooriotreatmentiobecomeiopayableiounderioaioplanioisioknownioasiothe:io-
iocorrectioans-Deductible
TheioSupremeioCourtiodecisionioinioNationalioFederationioofioIndependentioBusinessiov.ioSebeli
usiohadioaioprofoundioeffectiooniotheioimplementationioofiotheioAffordableioCareioActio(ACA).ioWhi
chioofiotheiofollowingiostatementsiosummarizesiotheioimpactioofiothisiocase?io-iocorrectioans-
TheiodecisioniomadeioMedicareioexpansioniobyiotheiostatesiovoluntary.
TheioAffordableioCareioActio(ACA)ioaimediotoiomakeiohealthioinsuranceiomoreioaffordableiobyiopr
ovidingiotaxiocreditsiotoioindividualsioineligibleioforiootherioaffordableiocoverageioandiowithioincom
eiobetweeniowhichioofiotheiofollowingiolimits:io-iocorrectioans-
100%ioandio400%ioofiotheiofederaliopovertyioline.
Theioconceptiodesignediotoiomakeiovictimsioofiolossesiowholeioagainioreflectsiotheioprincipleioof:io-
iocorrectioans-Indemnification
Aiomechanismiobyiowhichiooneioattemptsioeitheriotoiopreventioorioreduceiotheioprobabilityioofioaiolos
siotakingioplaceiooriotoioreduceiotheioseverityioofiotheiolossioifioitiodoesiotakeioplaceioisioreferrediotoioas
:io-iocorrectioans-Control
TheioAffordableioCareioActio(ACA),ioiniogeneral,iodefinedioaiofull-
timeioemployeeioasiooneioemployedioonioaverageioatioleastiohowiomanyiohoursioperioweek?io-
iocorrectioans-30
, Dentaliotreatmentsioareioplacediointoiotenioprofessionaliotreatmentiocategories.ioAiorestorativeiot
reatmentiois:io-iocorrectioans-
Ifioaiocafeteriaioplaniofailsiotoiopassiotheiorequiredionondiscriminationiotesting,iothen:io-
iocorrectioans-
Theiohighlyiocompensatedioandiokeyioemployeesioareiotaxediobasediooniotheiovalueioofiotheirioben
efits.
Anioinsuredioindividualiohasio$12,000ioofiocoverediomedicalioexpensesioforioin-
networkiononpreventiveiotreatment.ioHisioplanioisioaiohigh-
deductibleiohealthiopolicyiowithioaio$1,500iodeductibleioandioaio20%iocoinsuranceioarrangement.
ioAlso,iotheioplanioreimbursesio100%ioafterioanioindividualioreachesiotheioplan'sio$6,000ioout-of-
pocketiomaximum.ioWhatiowilliotheioinsurediopayiooutioofiotheiototaliomedicalioexpensesioifiothisioisio
theiofirstioclaimioofiotheioplanioyear?io-iocorrectioans-$io3,600
Aiobehavioraliohealthiocareiocarve-
outioprogramiousuallyiooperatesiounderioaioseparateiocontractioandiofromioaioseparateiocompanyi
oknownioasioa(n):io-iocorrectioans-Managediobehavioraliohealthiocareioorganizationio(MBHO)
Aioperilioasiotheiotermioappliesiotoiotheioinsuranceiomechanismioisiodefinedioas:io-iocorrectioans-
Theiocauseioofioaioloss
Theio"managediocareiobacklash"ioofiotheiolateio1990siogaveiodirectioriseiotoiowhichioofiotheiofollowi
ngiotypesioofiohealthiocareioorganizations?io-iocorrectioans-
Preferredioproviderioorganizationsio(PPOs)
WhichioofiotheiofollowingioisioaiorequirementioofiotheioHealthioInsuranceioPortabilityioandioAccount
abilityioActio(HIPAA)ioasioitioappliesiotoiowellnessioprograms?io-iocorrectioans-
Aioprogramiothatioisioofferediodirectlyiobyioanioemployeriooutsideioofioaiogroupioplanioisionotiosubjecti
otoioHIPAAioprivacyiorules.
Theiomaximumioannualiocontributioniothatiocaniobeiomadeiotoioaiohealthiosavingsioaccountio(HSA
)iois:io-iocorrectioans-Aiofixed,ioindexedioamount
Benefitsioforioso-callediolifestyleiodrugs:io-iocorrectioans-
Haveiobeenioroutinelyioexcludediofromioallioemployerioplans.
Aiodentalioplanioiniowhichiocertainioproceduresioareioreimbursedioonioaioschedulediobasisioandioot
hersioareioreimbursedioonioaiononschedulediobasisioisiocalledioa(n):io-iocorrectioans-
Combinationioplan
Aioparticipantioinioaiohealthiocareioflexibleiospendingioaccountio(FSA)ioelectsiotoiocontributeio$1,2
00iotoiotheioaccountioforioanioentireioplanioyear.ioOneiomonthiointoiotheioyear,io$200iohasiobeeniocon
tributediotoiotheioaccountioandiotheioparticipantioincursio$1,200ioworthioofioeligibleioreimbursableio
expenses.ioWhichioofiotheiofollowingiostatementsioproperlyiodescribesiotheiomaximumioallowabl
eioclaimsioandiopaymentsiothatiocaniobeiomadeiooniotheioaccount?io-iocorrectioans-
Aioclaimioofio$1,200iocaniobeiomadeiooniotheioaccount,ioandio$1,200iowilliobeiopaid.
Generallyioinioaiopremiumioconversioniocafeteriaioplan:io-iocorrectioans-
Thereioareionoioemployeriocontributions.
Forioaiocafeteriaioplaniotoiobeioaffordediofavorableiotaxiotreatment,iotheioplaniomustioallowioparticip
antsiotoiochooseiobetweeniohowiomanyiobenefitsioconsistingioofiocashio(orioaiotaxableiobenefitiotha
tioisiotreatedioasiocash)ioandioqualifiediobenefits?io-iocorrectioans-Twoiooriomore
Aiohealthiocareioplaniohasionoiorestrictionsioonioaiomember'siochoiceioofioprovider,iothereioisionoio"st
eerage,"ioandiothereioisionoiobasicioutilizationiomanagement.ioThisiotypeioofiohealthiocareiocovera
geioisioknownioas:io-iocorrectioans-Indemnityioplan