HSA 4109 Final Exam Questions 100% Solved Correctly
Which of the following is not a type of managed Medicaid plan? - Answers PFFS
Dual Eligible Special Needs Plans enroll only which type of individual? - Answers Individuals who are
eligible for medicare and medicaid
Plans can receive bonus payments for high star quality ratings. The bonus payments can be used to: -
Answers All of the aboveProvide additional benefits, reduce cost sharing, reduce enrollee payments
Which of the following is not a measure in the Medicare Quality Bonus Program (QBP; i.e. the "Stars"
program) for Medicare Advantage plans? - Answers Reducing costs
Marketing and sales activities of Medicare Advantage or managed Medicaid plans do not allow -
Answers All of the above
ERISA and the ACA both require expedited review for benefits determinations involving urgent medical
care. T or F - Answers True
Which of the following is not a federal law affecting health insurance, health benefits plans, or HMOs? -
Answers CSNY
States regulate all employer-sponsored health benefit plans. T or F - Answers False
State mandated benefits laws apply to self-funded employee benefits plans. T or F - Answers False
Federal preemptions under ERISA, HIPAA, and/or the ACA apply to all but which of the following? -
Answers Provider Payment
T or F Medicare is provided without cost to the medicare beneficiary - Answers False
Medicare advantage plans can receive bonus payments for high star quality ratings. The bonus
payments cannot be used to: - Answers Take as profit
T/F Medicare advantage plans are authorized under Part D - Answers False
Federal preemptions under ERISA, HIPAA, and or the ACA apply to all, but which of the following? -
Answers Provider Payment
T/F Under the ACA, the federal government is now responsible for regulating health insurance premium
rates in the small group market, not the states. - Answers False
T/F ERISA and the ACA both require expedited review for benefits determinations involving medical care
- Answers True
Which of the following certificate is the state-issued operating license for an HMO? - Answers Certificate
of authority (COA)
, T/F State mandated benefits laws apply to self funded employee benefits plans. - Answers False
T/F Medicaid is enabled as a FFS system, so states must first obtain a federal waiver if they want use
managed care for their Medicaid program - Answers True
T/F Medicare is provided without cost to the Medicare beneficiary - Answers False
T/F Under the ACA, each state has expanded their Medicaid eligibility criteria - Answers False
T/F States regulate all employer-sponsored health benefit plans - Answers False
T/F The National Association of the Insurance Commissioners (NAIC) has no power to regulate insurers
or state regulators - Answers True
Which of the following is not a key function of state regulation affecting health insurers and HMOs? -
Answers Plan compliance with Medicare Advantage network adequacy requirements
Which of the following is not a federal law affecting health insurance, health benefit plans, or HMOs? -
Answers CSNY
Which of the following federal agencies is not involved in regulating health benefit plans? - Answers
Department of the Interior
Which of the following is not a measure in the Medicare Quality Bonus Program for Medicare Advantage
plans? - Answers Reducing costs
Blue Cross began as a physician Service Bureau in the 1930s - Answers false
The integral components of managed care are: - Answers All of the above
PPOs differ from HMOs because they do not accept capitation risk and enrollees who are willing to pay
higher cost sharing may access providers that are not in the contracted network. T/F - Answers True
The Balanced Budget Act (BBA) of 1997 resulted in a major increase in HMO enrollment. T/F - Answers
False
Prior to the 1970s, organized health maintenance organizations (HMOs) such as Kaiser Permanente
were often referred to as: - Answers Prepaid Group Practices
Which of the following is not used in the Affordable Care Act to describe a benefit level based on the
amount of cost-sharing: - Answers Copper
Which of the following is not considered to be a type of defined health benefits plan? - Answers A
Medical Savings Account
Identify which of the following comes the closest to describing a "Rental PPO," also called a "Leased
Network" - Answers A provider network that contracts with various payers to provide access and claims
repricing
Which of the following is not a type of managed Medicaid plan? - Answers PFFS
Dual Eligible Special Needs Plans enroll only which type of individual? - Answers Individuals who are
eligible for medicare and medicaid
Plans can receive bonus payments for high star quality ratings. The bonus payments can be used to: -
Answers All of the aboveProvide additional benefits, reduce cost sharing, reduce enrollee payments
Which of the following is not a measure in the Medicare Quality Bonus Program (QBP; i.e. the "Stars"
program) for Medicare Advantage plans? - Answers Reducing costs
Marketing and sales activities of Medicare Advantage or managed Medicaid plans do not allow -
Answers All of the above
ERISA and the ACA both require expedited review for benefits determinations involving urgent medical
care. T or F - Answers True
Which of the following is not a federal law affecting health insurance, health benefits plans, or HMOs? -
Answers CSNY
States regulate all employer-sponsored health benefit plans. T or F - Answers False
State mandated benefits laws apply to self-funded employee benefits plans. T or F - Answers False
Federal preemptions under ERISA, HIPAA, and/or the ACA apply to all but which of the following? -
Answers Provider Payment
T or F Medicare is provided without cost to the medicare beneficiary - Answers False
Medicare advantage plans can receive bonus payments for high star quality ratings. The bonus
payments cannot be used to: - Answers Take as profit
T/F Medicare advantage plans are authorized under Part D - Answers False
Federal preemptions under ERISA, HIPAA, and or the ACA apply to all, but which of the following? -
Answers Provider Payment
T/F Under the ACA, the federal government is now responsible for regulating health insurance premium
rates in the small group market, not the states. - Answers False
T/F ERISA and the ACA both require expedited review for benefits determinations involving medical care
- Answers True
Which of the following certificate is the state-issued operating license for an HMO? - Answers Certificate
of authority (COA)
, T/F State mandated benefits laws apply to self funded employee benefits plans. - Answers False
T/F Medicaid is enabled as a FFS system, so states must first obtain a federal waiver if they want use
managed care for their Medicaid program - Answers True
T/F Medicare is provided without cost to the Medicare beneficiary - Answers False
T/F Under the ACA, each state has expanded their Medicaid eligibility criteria - Answers False
T/F States regulate all employer-sponsored health benefit plans - Answers False
T/F The National Association of the Insurance Commissioners (NAIC) has no power to regulate insurers
or state regulators - Answers True
Which of the following is not a key function of state regulation affecting health insurers and HMOs? -
Answers Plan compliance with Medicare Advantage network adequacy requirements
Which of the following is not a federal law affecting health insurance, health benefit plans, or HMOs? -
Answers CSNY
Which of the following federal agencies is not involved in regulating health benefit plans? - Answers
Department of the Interior
Which of the following is not a measure in the Medicare Quality Bonus Program for Medicare Advantage
plans? - Answers Reducing costs
Blue Cross began as a physician Service Bureau in the 1930s - Answers false
The integral components of managed care are: - Answers All of the above
PPOs differ from HMOs because they do not accept capitation risk and enrollees who are willing to pay
higher cost sharing may access providers that are not in the contracted network. T/F - Answers True
The Balanced Budget Act (BBA) of 1997 resulted in a major increase in HMO enrollment. T/F - Answers
False
Prior to the 1970s, organized health maintenance organizations (HMOs) such as Kaiser Permanente
were often referred to as: - Answers Prepaid Group Practices
Which of the following is not used in the Affordable Care Act to describe a benefit level based on the
amount of cost-sharing: - Answers Copper
Which of the following is not considered to be a type of defined health benefits plan? - Answers A
Medical Savings Account
Identify which of the following comes the closest to describing a "Rental PPO," also called a "Leased
Network" - Answers A provider network that contracts with various payers to provide access and claims
repricing
