GBA 1 Study Guide Questions with
All Correct Answers
What key distinction in level of coverage between HMOs and the PPO and POS plans?
- Answer-HMO - members receive no coverage for medical care or treatment outside of
the network.
PPO/POS - members can still obtain care out of network and receive benefits, though at
a reduced rate.
What techniques are now used by some insurers? - Answer-Insurers have applied
managed care techniques, particular utilization management, first used for health plans,
to their disability insurance products. The most successful approaches employ a team
approach, coordinate by a nurse consultant, starting from the onset of the disability.
Fundamental components of the managed care spectrum that can be used to compare
managed care plans with traditional fee-for-service comprehensive medical plans -
Answer-1)Degree of freedom
2)Degree of steerage
3)Responsibility for claims handling
4)Degree of external utilization management controls
5)Referral management
6)Provider reimbursement methods
7)Whether the patient is responsible for any balance billing if actual charges exceed the
amount the provider reimbursement.
8)Rating and financial methods
The PPO value to purchasers lies in what it delivers relative to its cost - Answer-1)A
contracted network with some level of discounts off of full charges and some provider
credentialing.
2) Possibly some medical management features within the network, typically for an
additional fee.
What are PPOs expected to do as a new care models emerge that focus on
preventative and primary care? - Answer-Adapt their offerings to take advantage of
market demands.
What changes are likely to come to PPOs as a result of quality measurements that are
part of the Patient Protection and Affordable Care Act of 2010 (PPACA) - Answer--
Accountability and value
, -PPO will need to focus on how to improve quality and safety, decrease costs, keep
healthy people in a state of good health, and overall wellness, improve chronic illness
care, keep people from needing to use the emergency room (ER) unnecessarily, and
provide access to community resources.
Broad View of Employee Benefits - Answer-Any form of compensation other than direct
wages paid to employees
Narrow View of Employee Benefits - Answer-The employment relationship that are not
underwritten or paid directly by goverment
Categories that generally are considered to fall under a broad view of employee benefits
- Answer--Legally required benefits (Old Age/Disability/Unemployment)
-Payments for time not worked (lunch/vacations)
-Employers share of medical and medically related benefits
-Employers share of retirement and saving plan payments
-Misc. Benefits (employee discounts, severance pay, education, child care)
Why do firms have established employee benefit plans? - Answer--To attract and retain
capable employees
-Foster corporate efficiency, productivity, and improved employee morale.
-Employees' welfare and social objectives
Inland Steel Case Study - Answer-Duty to bargain in good faith over wages also
included insurance and fringes such as pension benefits. Event occurred in 1948.
Explain the significance of the Taft-Hartley Act? - Answer-The Labor-Management
Relations Act, also called the Taft Hartley Act, sets forth the framework for good-faith
collective bargaining over wages, hours, conditions and terms of employment and
employee benefits.
3 Major federal tax advantages associated with employee benefits - Answer--Most
contributions to employee benefit plans by employers are deductible as long as they are
reasonable business expenses.
-Employer contributions are generally not considered income to employees.
-Certain types of retirement and capital accumulation plans, benefits accumulate tax-
free to the employee until distributed.
Why is the employee benefit mechanism an effective and efficient way of providing
insurance coverage? - Answer--Convenient for employees
-Dont need to search for individual coverage
-Less expensive
What is the starting point in the design of any employee benefit plans? - Answer-Setting
overall objective
All Correct Answers
What key distinction in level of coverage between HMOs and the PPO and POS plans?
- Answer-HMO - members receive no coverage for medical care or treatment outside of
the network.
PPO/POS - members can still obtain care out of network and receive benefits, though at
a reduced rate.
What techniques are now used by some insurers? - Answer-Insurers have applied
managed care techniques, particular utilization management, first used for health plans,
to their disability insurance products. The most successful approaches employ a team
approach, coordinate by a nurse consultant, starting from the onset of the disability.
Fundamental components of the managed care spectrum that can be used to compare
managed care plans with traditional fee-for-service comprehensive medical plans -
Answer-1)Degree of freedom
2)Degree of steerage
3)Responsibility for claims handling
4)Degree of external utilization management controls
5)Referral management
6)Provider reimbursement methods
7)Whether the patient is responsible for any balance billing if actual charges exceed the
amount the provider reimbursement.
8)Rating and financial methods
The PPO value to purchasers lies in what it delivers relative to its cost - Answer-1)A
contracted network with some level of discounts off of full charges and some provider
credentialing.
2) Possibly some medical management features within the network, typically for an
additional fee.
What are PPOs expected to do as a new care models emerge that focus on
preventative and primary care? - Answer-Adapt their offerings to take advantage of
market demands.
What changes are likely to come to PPOs as a result of quality measurements that are
part of the Patient Protection and Affordable Care Act of 2010 (PPACA) - Answer--
Accountability and value
, -PPO will need to focus on how to improve quality and safety, decrease costs, keep
healthy people in a state of good health, and overall wellness, improve chronic illness
care, keep people from needing to use the emergency room (ER) unnecessarily, and
provide access to community resources.
Broad View of Employee Benefits - Answer-Any form of compensation other than direct
wages paid to employees
Narrow View of Employee Benefits - Answer-The employment relationship that are not
underwritten or paid directly by goverment
Categories that generally are considered to fall under a broad view of employee benefits
- Answer--Legally required benefits (Old Age/Disability/Unemployment)
-Payments for time not worked (lunch/vacations)
-Employers share of medical and medically related benefits
-Employers share of retirement and saving plan payments
-Misc. Benefits (employee discounts, severance pay, education, child care)
Why do firms have established employee benefit plans? - Answer--To attract and retain
capable employees
-Foster corporate efficiency, productivity, and improved employee morale.
-Employees' welfare and social objectives
Inland Steel Case Study - Answer-Duty to bargain in good faith over wages also
included insurance and fringes such as pension benefits. Event occurred in 1948.
Explain the significance of the Taft-Hartley Act? - Answer-The Labor-Management
Relations Act, also called the Taft Hartley Act, sets forth the framework for good-faith
collective bargaining over wages, hours, conditions and terms of employment and
employee benefits.
3 Major federal tax advantages associated with employee benefits - Answer--Most
contributions to employee benefit plans by employers are deductible as long as they are
reasonable business expenses.
-Employer contributions are generally not considered income to employees.
-Certain types of retirement and capital accumulation plans, benefits accumulate tax-
free to the employee until distributed.
Why is the employee benefit mechanism an effective and efficient way of providing
insurance coverage? - Answer--Convenient for employees
-Dont need to search for individual coverage
-Less expensive
What is the starting point in the design of any employee benefit plans? - Answer-Setting
overall objective
