CEBS GBA Exam 1
3 Examples of Tax Advantages of Employee Benefit Plans (Mod 1.2) - ANS-1: Employer
Contributions are Tax Deductible
2: Employer Contributions are not taken into consideration income to Employees
3: Certain Retirement Benefits Accumulate Tax-Free until allotted.
ACA created "Simple Cafeteria Plans." In what ways are these extraordinary? (Mod 10.Five) -
ANS-For eligible small Employers; have to be designed with specific eligibility/contribution
requirements. In exchange, plans are example from non-discrimination trying out.
ADA requirements for Wellness applications (Mod 8.2) - ANS-(2000) The application is
considered voluntary as long as the company does no longer require participation and does not
penalize personnel who do no longer take part. (2014) Employer companies urge that financial
incentives ought to be authorised for wellbeing participation. (2016) EEOC problems rule
allowing the use of monetary incentive for programs that consist of medical inquiries with a most
of 30% of the whole value of employee simplest coverage.
After WWII, why did insurers location limits on outpatient hospital therapy? (Mod 7.1) -
ANS-Treatment endured for indefinite durations of time, tons subjectivity regarding remedy.
Broad view of Employee Benefits (Mod 1.1) - ANS-Considers Employee Benefits to be really
any shape of repayment apart from direct wages paid to Employees (Ex: WC, Unemployment,
State DI, SS, Vacation, Holidays, 401K/Retirement, Employer proportion of Medical, Severance
Pay, Child Care, and many others..)
Cafe Plans are subject to coverage and nondiscrimination exams. Some apply to plot as an
entire at the same time as a few follow to underlying advantages. Provide assessment of every
testing shape (Mod 10.5) - ANS-3 Overall Tests:
Eligibility Test: May not discriminate in prefer of extraordinarily compensated EEs because the
capability to take part
-type/duration of services/participation test
-no EE required to complete extra than 3 YOS
-defining especially comped EE (5% proprietor, or fantastically paid man or woman -
subjectively)
-Aug 2007 introduced blessings thing dedication to make sure blessings similarly to be had to all
EEs
Contributions and Benefits Test: Plan ought to make contributions and blessings to be had on a
non-discriminatory foundation and plan fails check if noticeably comped EEs choose greater
nontaxable blessings than non quite comped EEs
,-Benefits issue to determine if blessings/contributions are equally to be had to all EEs
-Utilization thing: tremendously comped EEs are disproportionately the usage of all benefits;
uniformed possibility to elect advantages
-If supplying health advantages, now not discriminatory if any contributions made on behalf of
the EE are identical to: 100% of price of health underneath the plan of the bulk of surprisingly
comped are similarly situated; 75% of the price of most pricey benefits elected via any further
situated participant
Key EE Concentration Test: Plan's Key EE contributions can't exceed 25% of the full
contributions into the plan.
-Key EE: Officer incomes $one hundred seventy five,000+, five% Owner or 1% Owner Earning
$a hundred and fifty,000+
-Test is primarily based on degree of coverage instead of stage of reimbursements
Cafe Plans are difficulty to what different laws (Mod 9.5) - ANS--COBRA
-FMLA
-HIPAA
-MHPA
-MHPAEA
-NMHPA
-WHCRA
-MMA
-WFTRA
-HEART
-Michelle's Law
-GINA
-PPACA
Common strategies to govern pharmacy charges (Mod 6.Three) - ANS-1 = Review layout of
blessings to peer if they match usual medical software (flat copays/no incr)
2 = Analyze enjoy to discover regions that need higher control
3 = Reduce pharmacy community to smallest length w/o compromising access
4 = Offer mail provider
5 = Promote generics
6 = Use/increase price effective formulary
7 = Practice utilization management
8 = Physician profiling
9 = Educate and talk to participants the plan
10 = Anticipate monetary effect of recent tablets
Compare Compensation/Service Oriented Benefit Philosophy with the Needs-Oriented (Mod
1.Four) - ANS-Compensation/Service: EBP produced from ordinarily compensation, carrier or
each. Level of benefits tied to profits or pay degrees/years of provider
Needs Orientated: Focuses on Needs of EE's and their dependents
,Compare differences of behavioral fitness treatments: inpatient, partial (day), outpatient (Mod
7.Five) - ANS--Acute inpatient: most excessive, unable to care for themselves: suicidal,
homicidal
-Partial sanatorium: provide intensive day treatment but affected person returns domestic
overnight
-Intensive Outpatient: affected person desires extra in depth than weekly, but fewer hours each
day than partial centers
Compare coverage mechanism to playing (Mod 2.Three) - ANS-Insurance is a mechanism to
managing current risk - gambling creates risk in which one did now not formerly exist. Risk
resulting from gambling is one hundred% speculative, even as coverage offers with natural risk.
Gambling includes a gain for one birthday celebration while coverage is a mutual sharing of any
losses. The loser inside the gambling transaction stays in a terrible situation even as the insured
is financially restored in complete or element to previous situation.
Compare premiums, contributions and deductibles of HDHP/HRAs vs HDHP/HSAs (Mod four.2)
- ANS-HDHP/HSAs have a tendency to have lower premiums, decrease employee contributions
and better deductibles than HDHP/HRAs. EE's own manage of HSA, even as ER controls HRA.
Contrast between an In-Network (Preferred) vs an Out-of-Network (Non-Preferred) Provider
(Mod 3.3) - ANS-In-Network: Contract with person's health insurance plan to offer services to
the member at a discount (for accelerated volume). Some plans can also have a tiered structure
with various out of pocket fees.
Out-of-Network: No settlement with coverage plan...When available, fees are substantially
better.
Contrast PPO's vs POS' (Mod 3.1) - ANS-Both overlap considerably. Differences do include
primary care issuer requirement by means of POS however now not PPO; lower copay amounts
for desired care in POS than in PPO; smaller community in a POS than PPO.
Define a Cafeteria Plan (Mod nine.1) - ANS-A plan below which all members are personnel (not
proprietors or shareholders) and all contributors may pick out from a mixture of options- certified
blessings or cash.
Benefits can not be supplied: Whole Life Insurance and Long-Term Care Insurance.
Define a mixture dental plan (Mod five.2) - ANS-Certain tactics on a scheduled basis whilst a
few are on a non-scheduled basis.
Define a Welfare benefit plan (Mod nine.5) - ANS-Any plan, fund or program this is set up or
maintained by using an organization or employee organization for the functions of presenting
participants medical, disability or unemployment blessings. Also may also include vacation,
education packages and felony services.
, Define Accumulation-Orientated Benefits (Mod 1.Five) - ANS-Consist of Pension Plans,
Profit-Sharing, Savings, 401K, and many others...Which praise an Employee for lengthy carrier
with an Employer. Involve an extended probationary duration due to the fact viewed as a reward
- no longer a disadvantage for lengthy-term personnel.
Define an incentive dental plan (Mod 5.2) - ANS-Program that incentivizes sound dental hygiene
via growing compensation ranges - handiest applies to preventative and renovation. When
deductibles practice, handiest on lifetime foundation.
Define and give an explanation for three sorts of health machine performance opinions (Mod
12.3) - ANS-Audit Performance Evaluations (APE):
-compares fitness gadget with a announcement of what's anticipated; if ER desires to provide
fitness benefits, they may settlement with a fitness machine; ER desires to recognize whether
health system gives the services wanted, so may use evaluator to specify; every other instance
is National Committee for Quality Assurance (NCQA) accreditation of ACO - accountable care
corporation which is a community of docs and hospitals that count on financial responsibility
handling the health care of a selected institution of sufferers - if capable of provide decrease
fees, they receive economic awards. NCQA affords accreditation to all ACOs, which is ex of
APE
Single-case time fashion performance eval:
-music overall performance of fitness system over time; use routinely collected and reported
information and examine at specific times
Service-contrast overall performance assessment:
-evaluate performance of a hard and fast of services at one time, in relation to one or greater
dimensions of carrier overall performance; maximum evolved and longest walking systems
report exceptional and protection records however not expenses, so price evaluation no longer
viable.
Define AWP, WAC and MAC (Mod 6.1) - ANS-AWP = Average Wholesale Price - assigned by
using drug producer, reference fee for all reductions paid to pharmacies and PBMs.
WAC = Wholesale acquisition cost (common producers fee) - fee at which wholesalers buy
pharmaceuticals from producers.
MAC = Maximum Allowable Cost - of time-honored places a ceiling on reimbursement for
universal medicinal drug. Concept of Medicaid/Medicare by means of Centers for
Medicaid/Medicare Services (CMS). PBMs and TPAs advanced their personal MAC to cowl all
generics - due to variety, may be common price of all manufacturers AWPs, lowest AWP, or a
few derived system.
3 Examples of Tax Advantages of Employee Benefit Plans (Mod 1.2) - ANS-1: Employer
Contributions are Tax Deductible
2: Employer Contributions are not taken into consideration income to Employees
3: Certain Retirement Benefits Accumulate Tax-Free until allotted.
ACA created "Simple Cafeteria Plans." In what ways are these extraordinary? (Mod 10.Five) -
ANS-For eligible small Employers; have to be designed with specific eligibility/contribution
requirements. In exchange, plans are example from non-discrimination trying out.
ADA requirements for Wellness applications (Mod 8.2) - ANS-(2000) The application is
considered voluntary as long as the company does no longer require participation and does not
penalize personnel who do no longer take part. (2014) Employer companies urge that financial
incentives ought to be authorised for wellbeing participation. (2016) EEOC problems rule
allowing the use of monetary incentive for programs that consist of medical inquiries with a most
of 30% of the whole value of employee simplest coverage.
After WWII, why did insurers location limits on outpatient hospital therapy? (Mod 7.1) -
ANS-Treatment endured for indefinite durations of time, tons subjectivity regarding remedy.
Broad view of Employee Benefits (Mod 1.1) - ANS-Considers Employee Benefits to be really
any shape of repayment apart from direct wages paid to Employees (Ex: WC, Unemployment,
State DI, SS, Vacation, Holidays, 401K/Retirement, Employer proportion of Medical, Severance
Pay, Child Care, and many others..)
Cafe Plans are subject to coverage and nondiscrimination exams. Some apply to plot as an
entire at the same time as a few follow to underlying advantages. Provide assessment of every
testing shape (Mod 10.5) - ANS-3 Overall Tests:
Eligibility Test: May not discriminate in prefer of extraordinarily compensated EEs because the
capability to take part
-type/duration of services/participation test
-no EE required to complete extra than 3 YOS
-defining especially comped EE (5% proprietor, or fantastically paid man or woman -
subjectively)
-Aug 2007 introduced blessings thing dedication to make sure blessings similarly to be had to all
EEs
Contributions and Benefits Test: Plan ought to make contributions and blessings to be had on a
non-discriminatory foundation and plan fails check if noticeably comped EEs choose greater
nontaxable blessings than non quite comped EEs
,-Benefits issue to determine if blessings/contributions are equally to be had to all EEs
-Utilization thing: tremendously comped EEs are disproportionately the usage of all benefits;
uniformed possibility to elect advantages
-If supplying health advantages, now not discriminatory if any contributions made on behalf of
the EE are identical to: 100% of price of health underneath the plan of the bulk of surprisingly
comped are similarly situated; 75% of the price of most pricey benefits elected via any further
situated participant
Key EE Concentration Test: Plan's Key EE contributions can't exceed 25% of the full
contributions into the plan.
-Key EE: Officer incomes $one hundred seventy five,000+, five% Owner or 1% Owner Earning
$a hundred and fifty,000+
-Test is primarily based on degree of coverage instead of stage of reimbursements
Cafe Plans are difficulty to what different laws (Mod 9.5) - ANS--COBRA
-FMLA
-HIPAA
-MHPA
-MHPAEA
-NMHPA
-WHCRA
-MMA
-WFTRA
-HEART
-Michelle's Law
-GINA
-PPACA
Common strategies to govern pharmacy charges (Mod 6.Three) - ANS-1 = Review layout of
blessings to peer if they match usual medical software (flat copays/no incr)
2 = Analyze enjoy to discover regions that need higher control
3 = Reduce pharmacy community to smallest length w/o compromising access
4 = Offer mail provider
5 = Promote generics
6 = Use/increase price effective formulary
7 = Practice utilization management
8 = Physician profiling
9 = Educate and talk to participants the plan
10 = Anticipate monetary effect of recent tablets
Compare Compensation/Service Oriented Benefit Philosophy with the Needs-Oriented (Mod
1.Four) - ANS-Compensation/Service: EBP produced from ordinarily compensation, carrier or
each. Level of benefits tied to profits or pay degrees/years of provider
Needs Orientated: Focuses on Needs of EE's and their dependents
,Compare differences of behavioral fitness treatments: inpatient, partial (day), outpatient (Mod
7.Five) - ANS--Acute inpatient: most excessive, unable to care for themselves: suicidal,
homicidal
-Partial sanatorium: provide intensive day treatment but affected person returns domestic
overnight
-Intensive Outpatient: affected person desires extra in depth than weekly, but fewer hours each
day than partial centers
Compare coverage mechanism to playing (Mod 2.Three) - ANS-Insurance is a mechanism to
managing current risk - gambling creates risk in which one did now not formerly exist. Risk
resulting from gambling is one hundred% speculative, even as coverage offers with natural risk.
Gambling includes a gain for one birthday celebration while coverage is a mutual sharing of any
losses. The loser inside the gambling transaction stays in a terrible situation even as the insured
is financially restored in complete or element to previous situation.
Compare premiums, contributions and deductibles of HDHP/HRAs vs HDHP/HSAs (Mod four.2)
- ANS-HDHP/HSAs have a tendency to have lower premiums, decrease employee contributions
and better deductibles than HDHP/HRAs. EE's own manage of HSA, even as ER controls HRA.
Contrast between an In-Network (Preferred) vs an Out-of-Network (Non-Preferred) Provider
(Mod 3.3) - ANS-In-Network: Contract with person's health insurance plan to offer services to
the member at a discount (for accelerated volume). Some plans can also have a tiered structure
with various out of pocket fees.
Out-of-Network: No settlement with coverage plan...When available, fees are substantially
better.
Contrast PPO's vs POS' (Mod 3.1) - ANS-Both overlap considerably. Differences do include
primary care issuer requirement by means of POS however now not PPO; lower copay amounts
for desired care in POS than in PPO; smaller community in a POS than PPO.
Define a Cafeteria Plan (Mod nine.1) - ANS-A plan below which all members are personnel (not
proprietors or shareholders) and all contributors may pick out from a mixture of options- certified
blessings or cash.
Benefits can not be supplied: Whole Life Insurance and Long-Term Care Insurance.
Define a mixture dental plan (Mod five.2) - ANS-Certain tactics on a scheduled basis whilst a
few are on a non-scheduled basis.
Define a Welfare benefit plan (Mod nine.5) - ANS-Any plan, fund or program this is set up or
maintained by using an organization or employee organization for the functions of presenting
participants medical, disability or unemployment blessings. Also may also include vacation,
education packages and felony services.
, Define Accumulation-Orientated Benefits (Mod 1.Five) - ANS-Consist of Pension Plans,
Profit-Sharing, Savings, 401K, and many others...Which praise an Employee for lengthy carrier
with an Employer. Involve an extended probationary duration due to the fact viewed as a reward
- no longer a disadvantage for lengthy-term personnel.
Define an incentive dental plan (Mod 5.2) - ANS-Program that incentivizes sound dental hygiene
via growing compensation ranges - handiest applies to preventative and renovation. When
deductibles practice, handiest on lifetime foundation.
Define and give an explanation for three sorts of health machine performance opinions (Mod
12.3) - ANS-Audit Performance Evaluations (APE):
-compares fitness gadget with a announcement of what's anticipated; if ER desires to provide
fitness benefits, they may settlement with a fitness machine; ER desires to recognize whether
health system gives the services wanted, so may use evaluator to specify; every other instance
is National Committee for Quality Assurance (NCQA) accreditation of ACO - accountable care
corporation which is a community of docs and hospitals that count on financial responsibility
handling the health care of a selected institution of sufferers - if capable of provide decrease
fees, they receive economic awards. NCQA affords accreditation to all ACOs, which is ex of
APE
Single-case time fashion performance eval:
-music overall performance of fitness system over time; use routinely collected and reported
information and examine at specific times
Service-contrast overall performance assessment:
-evaluate performance of a hard and fast of services at one time, in relation to one or greater
dimensions of carrier overall performance; maximum evolved and longest walking systems
report exceptional and protection records however not expenses, so price evaluation no longer
viable.
Define AWP, WAC and MAC (Mod 6.1) - ANS-AWP = Average Wholesale Price - assigned by
using drug producer, reference fee for all reductions paid to pharmacies and PBMs.
WAC = Wholesale acquisition cost (common producers fee) - fee at which wholesalers buy
pharmaceuticals from producers.
MAC = Maximum Allowable Cost - of time-honored places a ceiling on reimbursement for
universal medicinal drug. Concept of Medicaid/Medicare by means of Centers for
Medicaid/Medicare Services (CMS). PBMs and TPAs advanced their personal MAC to cowl all
generics - due to variety, may be common price of all manufacturers AWPs, lowest AWP, or a
few derived system.
