CEBS GBA 2 Practice Exam Questions– Group
Benefits Certification Prep
Which of the following statements regarding different approaches by which to
compensate physicians in managed care plans is (are) correct?
I. Some managed care organizations may prefer to use arrangements that provide
no direct link between quality or quantity of physician effort and compensation.
II. Some managed care organizations preferring to provide a link between
quantity of physician effort and compensation will use a fee-for-service
arrangement.
III. Some managed care organization will use a capitation arrangement to create
incentives for physicians to provide visits and referrals that cost less than the
capitated amount. - -- answer --E.) I, II and III
Which of the following statements regarding insurer payments and consumer out-
of-pocket payments for out-of-network providers is (are) correct?
I. Out-of-network providers are not limited to an insurer fee schedule when
setting price and often charge more than insurers are willing to reimburse.
II. There is evidence that cost-sharing for using an out-of- network provider is
decreasing.
III. Some out-of-network providers will accept as full payments reimbursements
made by insurers or they will negotiate with consumers on price. - -- answer --D.)
I and III only
,Which of the following statements regarding the methodology used by the
Affordable Care Act's risk adjustment program is (are) correct?
I. The risk adjustment program transfers funds from plans with lower-risk
enrollees to plans with higher-risk enrollees.
II. Individual risk scores based on an individual's age and sex are specifically
prohibited.
III. If an enrollee is receiving subsidies to reduce his or her cost sharing, an
induced utilization factor is applied to account for induced demand. - -- answer --
C.) I and III only
Which of the following statements regarding the strategies that can be used to
pursue quality improvement (QI) is (are) correct?
I. One of the top strategies that has been identified is to delegate authority to the
implementation planners.
II. It is now believed that a universal implementation approach for the various
practice settings is better than a tailored implementation approach for each
practice setting.
III. One of the best strategies is to focus on special projects using a team of
volunteers. - -- answer --A.) I only
Which of the following statements regarding the self-funding of health benefits by
small firms are correct?
I. Total costs in self-funded plans are lower relative to fully insured product
options in large part because traditional insurance premiums include carrier
marketing costs and profit margins—factors that are not applicable to self-funded
plans.
II. With a self-funded plan, a small employer can personalize a benefits package to
reflect the needs of its workers.
,III. A shift to self-insurance may lead to adverse selection in the fully insured
market for small groups. - -- answer --E.) I, II and III
Which of the following statements regarding the financing of workers'
compensation programs is (are) correct?
I. Workers' compensation programs are based on the principle that the cost of
work-related accidents is a business expense.
II. Employers can purchase workers' compensation insurance from a private
carrier or state fund but no state allows this exposure to be self-insured.
III. Most state workers' compensation programs rely heavily on the general taxing
power of the state to finance workers' compensation. - -- answer --A.) I only
Disadvantages of group term life insurance for employees include which of the
following?
I. Coverage is rarely portable
II. Only pure protection is provided
III. Coverage is not guaranteed to be permanent - -- answer --E.) I, II and III
Research has shown which of the following statements regarding managed health
care to be correct?
I. While the prevailing public view is that managed health care results in lower
quality, little evidence exists on this issue in part because of the difficulty in
measuring quality.
II. Favorable selection of patients does contribute to the overall lower claims
experience that managed care plans enjoy over indemnity plans.
III. Managed care plans can provide actual cost savings because of their ability to
selectively contract with providers. - -- answer --E.) I, II and III
, Which of the following statements regarding the amount of benefits provided in
private long-term disability income (PLTDI) and Social Security Disability Income
(SSDI) plans is (are) correct?
I. Most PLTDI plans replace 60 percent of the insured's predisability income, and
60 percent generally exceeds what he would receive if he met the SSDI definition
of disability and applied for and received Social Security disability benefits.
II. High income workers often get more than 60 percent of their predisability
income replaced by SSDI.
III. SSDI benefits replace about 85 percent of lifetime predisability earnings for the
average worker even if he does not receive the maximum family benefit. - --
answer --A.) I only
Which of the following statements regarding the advantages of private health
exchanges is (are) correct?
I. They provide more health insurance options to employees.
II. They have provided substantial administrative cost savings.
III. They can relieve the employer of having to choose one or two plans for an
entire workforce. - -- answer --C.) I and III only
Which of the following statements regarding the so-called "death spiral" in health
insurance premiums is (are) correct?
I. The fundamental cause of the "death spiral" is the great disparity between the
size of large health insurance plans and the size of small health insurance plans.
II. To counter problems arising from adverse selection, risk adjustment methods
can be used to transfer funds from plans with below-average costs to plans with
above-average costs.
III. Several industry reports argue that risk adjustment is needed in the
multicarrier exchange market, and there is strong evidence and detailed
procedures for such adjustments. - -- answer --A.) II only
Benefits Certification Prep
Which of the following statements regarding different approaches by which to
compensate physicians in managed care plans is (are) correct?
I. Some managed care organizations may prefer to use arrangements that provide
no direct link between quality or quantity of physician effort and compensation.
II. Some managed care organizations preferring to provide a link between
quantity of physician effort and compensation will use a fee-for-service
arrangement.
III. Some managed care organization will use a capitation arrangement to create
incentives for physicians to provide visits and referrals that cost less than the
capitated amount. - -- answer --E.) I, II and III
Which of the following statements regarding insurer payments and consumer out-
of-pocket payments for out-of-network providers is (are) correct?
I. Out-of-network providers are not limited to an insurer fee schedule when
setting price and often charge more than insurers are willing to reimburse.
II. There is evidence that cost-sharing for using an out-of- network provider is
decreasing.
III. Some out-of-network providers will accept as full payments reimbursements
made by insurers or they will negotiate with consumers on price. - -- answer --D.)
I and III only
,Which of the following statements regarding the methodology used by the
Affordable Care Act's risk adjustment program is (are) correct?
I. The risk adjustment program transfers funds from plans with lower-risk
enrollees to plans with higher-risk enrollees.
II. Individual risk scores based on an individual's age and sex are specifically
prohibited.
III. If an enrollee is receiving subsidies to reduce his or her cost sharing, an
induced utilization factor is applied to account for induced demand. - -- answer --
C.) I and III only
Which of the following statements regarding the strategies that can be used to
pursue quality improvement (QI) is (are) correct?
I. One of the top strategies that has been identified is to delegate authority to the
implementation planners.
II. It is now believed that a universal implementation approach for the various
practice settings is better than a tailored implementation approach for each
practice setting.
III. One of the best strategies is to focus on special projects using a team of
volunteers. - -- answer --A.) I only
Which of the following statements regarding the self-funding of health benefits by
small firms are correct?
I. Total costs in self-funded plans are lower relative to fully insured product
options in large part because traditional insurance premiums include carrier
marketing costs and profit margins—factors that are not applicable to self-funded
plans.
II. With a self-funded plan, a small employer can personalize a benefits package to
reflect the needs of its workers.
,III. A shift to self-insurance may lead to adverse selection in the fully insured
market for small groups. - -- answer --E.) I, II and III
Which of the following statements regarding the financing of workers'
compensation programs is (are) correct?
I. Workers' compensation programs are based on the principle that the cost of
work-related accidents is a business expense.
II. Employers can purchase workers' compensation insurance from a private
carrier or state fund but no state allows this exposure to be self-insured.
III. Most state workers' compensation programs rely heavily on the general taxing
power of the state to finance workers' compensation. - -- answer --A.) I only
Disadvantages of group term life insurance for employees include which of the
following?
I. Coverage is rarely portable
II. Only pure protection is provided
III. Coverage is not guaranteed to be permanent - -- answer --E.) I, II and III
Research has shown which of the following statements regarding managed health
care to be correct?
I. While the prevailing public view is that managed health care results in lower
quality, little evidence exists on this issue in part because of the difficulty in
measuring quality.
II. Favorable selection of patients does contribute to the overall lower claims
experience that managed care plans enjoy over indemnity plans.
III. Managed care plans can provide actual cost savings because of their ability to
selectively contract with providers. - -- answer --E.) I, II and III
, Which of the following statements regarding the amount of benefits provided in
private long-term disability income (PLTDI) and Social Security Disability Income
(SSDI) plans is (are) correct?
I. Most PLTDI plans replace 60 percent of the insured's predisability income, and
60 percent generally exceeds what he would receive if he met the SSDI definition
of disability and applied for and received Social Security disability benefits.
II. High income workers often get more than 60 percent of their predisability
income replaced by SSDI.
III. SSDI benefits replace about 85 percent of lifetime predisability earnings for the
average worker even if he does not receive the maximum family benefit. - --
answer --A.) I only
Which of the following statements regarding the advantages of private health
exchanges is (are) correct?
I. They provide more health insurance options to employees.
II. They have provided substantial administrative cost savings.
III. They can relieve the employer of having to choose one or two plans for an
entire workforce. - -- answer --C.) I and III only
Which of the following statements regarding the so-called "death spiral" in health
insurance premiums is (are) correct?
I. The fundamental cause of the "death spiral" is the great disparity between the
size of large health insurance plans and the size of small health insurance plans.
II. To counter problems arising from adverse selection, risk adjustment methods
can be used to transfer funds from plans with below-average costs to plans with
above-average costs.
III. Several industry reports argue that risk adjustment is needed in the
multicarrier exchange market, and there is strong evidence and detailed
procedures for such adjustments. - -- answer --A.) II only
