CEBS GBA 1 ACTUAL 2026 STUDY GUIDE QUESTIONS AND
ANSWERS GRADED A+
✔✔All of the following are common key characteristics of the group insurance technique
used in employee benefit plans except:
1. A minimum number of individuals eligible
2. A waiting period applied before benefits commence
3. A steady flow of new entrants
4. A disallowance of any commission payments
5. An automatic determination of benefits - ✔✔4. A disallowance of any commission
payments
✔✔All of the following are common basic features of a health maintenance organization
(HMO) except:
1. An HMO plan requires an individual to select a primary care physician (PCP) from a
network of providers
2. Reduced benefits are available for care received outside of the HMO network of
providers
3. An individual's out-of-pocket expense is routinely a flat dollar amount called a copay
4. The PCP is empowered to authorize, via referrals, access to additional or specialty
care
5. With rare exceptions, individuals have no need to file claims for reimbursement.
6. Generally, premiums are lower premiums compared to other models due to the level
of managed care from the PCP system - ✔✔2. Reduced benefits are available for care
received outside of the HMO network of providers
An HMO is a closed network of providers - no out-of-network care is covered
✔✔All of the following are requirements for an ideal insurable risk except:
1. There must be a large number of heterogeneous exposure units that have different
loss characteristics being insured against.
2. The insurer must be able to determine if the loss is covered under the policy, and if it
is, how much the insurer will pay.
3. The premium must be subject to calculation
4. The premium must be reasonable or economically feasible.
5. The loss should be accidental and unintentional from the standpoint of the insured. -
✔✔1. There must be a large number of heterogeneous exposure units that have
different loss characteristics being insured against.
✔✔All of the following statements regarding the ADA are true except:
1. The act in general forbids workers from inquiring about another worker's health
status.
2. The act makes exceptions for certain medical inquiries.
3. A wellness program is deemed a voluntary one under the act as long as an employer
neither requires participation nor penalizes employees who do not participate
,4. In case of violations of the act's privacy rules, employees' recourse is to file a
complaint with their state's enforcement authority
5. The act is applicable to employers with 15 or more workers - ✔✔4. In case of
violations of the act's privacy rules, employees' recourse is to file a complaint with their
state's enforcement authority
✔✔All of the following are key factors of the covered group that are usually considered
in the cost of a dental plan except:
1. Gender distribution
2. Length of service
3. Geographic location and presence of fluoridation
4. Income levels
5. Occupations - ✔✔2. Length of service
✔✔All of the following are correct statements concerning the Taft-Hartley Act except:
1. It is also called the Labor Management Relations Act (LMRA)
2. It sets forth the framework for good-faith collective bargaining over wages, hours,
conditions and terms of employment
3. The Act includes the rules for the collective bargaining for employee benefits
4. It relies on the Fair Labor Standards Act (FLSA) to establish the distinction between
retirement and welfare benefits
5. It is the legislative basis on which jointly trusteed benefit plan are founded. - ✔✔4. It
relies on the Fair Labor Standards Act (FLSA) to establish the distinction between
retirement and welfare benefits
✔✔All of the following statements describe common characteristics of a pharmacy
benefit manager (PBM) except:
1. It is considered a licensed insurance carrier
2. It is designed to control costs associated with the delivery of pharmaceutical care
3. It aims to streamline and improve the prescribing and dispensing process through
online and real-time claims adjudication
4. It may maintain a retail network of pharmacies
5. It offers limited drug utilization review at the point of sale or dispensing - ✔✔1. It is
considered a licensed insurance carrier
✔✔All of the following types of benefits may be included in a cafeteria plan except:
1. Individually-owned health insurance
2. 401(k) plan
3. Contributions to a health savings account (HSA)
4. Employer-provided dependent-care assistance
5. Employer-provided adoption assistance - ✔✔1. Individually-owned health insurance
✔✔All the following are characteristics of mail service programs (MSPs) for prescription
drug programs except:
,1. These programs typically allow a more generous quantity amount to be filled (a 90-
day supply compared to a 30-day supply)
2. MSPs are typically used for chronic conditions that require maintenance medications
for long periods of time
3. These programs essentially eliminate the possibility of waste
4. MSPs are typically underused because enrollees are not familiar with a plan's mail
service benefit or are not sure how to access the service
5. MSPs offer a lower cost of dispensing and allow quality control through automation
that is uncommon in retail pharmacy - ✔✔3. These programs essentially eliminate the
possibility of waste
✔✔All the following statements regarding vision care plans are correct except:
1. Generally these plans use frequency limits on the number of times a participant can
receive benefits during a period
2. A schedule-of-benefits plan sets maximum dollar amounts on the amount that will be
paid toward a specific benefit
3. Preferred provider networks for vision benefits are similar to those for medical care
4. Vision benefits cannot be included in a flexible benefit health plan
5. Adult vision benefits are not covered under the ACA - ✔✔4. Vision benefits cannot be
included in a flexible benefit health plan
✔✔All the following are advantages to employers and employees of cafeteria plans
except:
1. Contributions to cafeteria plans are exempt from federal income tax
2. Contributions to cafeteria plans are exempt from Social Security (FICA-Federal
Insurance Contributions Act) taxes
3. Contributions to cafeteria plans are exempt from unemployment Federal
Unemployment Tact Act (FUTA) taxes
4. Deferral amounts usually has the effect of increasing a worker's social security
benefits
5. Deferral amounts are not considered wages for purposes of determining workers'
compensation premiums and other payroll-related expenses - ✔✔4. Deferral amounts
usually has the effect of increasing a worker's social security benefits
✔✔All of the following are factors contributing to high prescription drug costs except:
1. Rigorous standards for pharmacy and therapeutics (P&T) committees' deliberations
2. Not all prescription discount, rebates and other savings are passed along to plan
sponsors
3. Direct-to-consumer marketing
4. Aging of the population
5. Growth of biotechnology drugs - ✔✔1. Rigorous standards for pharmacy and
therapeutics (P&T) committees' deliberations
✔✔All of the following are advantages to using insurance to fund an employee benefit
plan except:
, 1. The presence of a known premium is set in advance by the insurance company
2. The use of an outside administrator distances the employer from disputes with
employees involving plan coverage
3. The use of an insurance company provides the financial backing of the Federal
Surety Insurance Corporation (FSIC)
4. Insurance companies often are leaders in the area of loss control and can implement
systems established to limit employee benefit costs for an employer
5. It may be more economical for an employer to use an insurance than other funding
alternatives. - ✔✔3. The use of an insurance company provides the financial backing of
the Federal Surety Insurance Corporation (FSIC)
✔✔All of the following statements concerning formularies are correct except:
1. A formulary is a list of drugs preferred by a health plan or pharmacy benefit manager
(PBM)
2. Formulary development typically centers on generic drugs rather than brand products
3. A pharmacy and therapeutics committee involved in the development of a formulary
may be composed of physicians, pharmacists, nurses and others
4. A formulary selects drugs within the category that are most cost-effective
5. The use of formularies is common because they are very effective at moving patients
to lower cost drugs. - ✔✔2. Formulary development typically centers on generic drugs
rather than brand products
✔✔All of the following questions concerning dependent-care assistance plans are
correct except:
1. Dependent care assistance plans can be offered either on a standalone basis or part
of a cafeteria plan
2. The benefits provided by these plans are taxable income to those who receive the
benefits
3. A dependent care assistance plan must be in writing
4. To obtain benefits under these plans, the participant's spouse also must be
employed, a full-time student, or physically or mentally incapable of self-care
5. Benefits cannot be provided for care provided by a person for whom a personal tax
exemption is taken on the participant's tax return - ✔✔2. The benefits provided by these
plans are taxable income to those who receive the benefits
✔✔All of the following are care management and cost-containment practices of
managed behavioral healthcare organizations (MBHO) except:
1. Predictive modeling and risk assessment
2. Minimum coverage for high-risk, potentially high-cost members
3. Preauthorization to access treatment
4. Performance measurement
5. Outcomes management - ✔✔2. Minimum coverage for high-risk, potentially high-cost
members
ANSWERS GRADED A+
✔✔All of the following are common key characteristics of the group insurance technique
used in employee benefit plans except:
1. A minimum number of individuals eligible
2. A waiting period applied before benefits commence
3. A steady flow of new entrants
4. A disallowance of any commission payments
5. An automatic determination of benefits - ✔✔4. A disallowance of any commission
payments
✔✔All of the following are common basic features of a health maintenance organization
(HMO) except:
1. An HMO plan requires an individual to select a primary care physician (PCP) from a
network of providers
2. Reduced benefits are available for care received outside of the HMO network of
providers
3. An individual's out-of-pocket expense is routinely a flat dollar amount called a copay
4. The PCP is empowered to authorize, via referrals, access to additional or specialty
care
5. With rare exceptions, individuals have no need to file claims for reimbursement.
6. Generally, premiums are lower premiums compared to other models due to the level
of managed care from the PCP system - ✔✔2. Reduced benefits are available for care
received outside of the HMO network of providers
An HMO is a closed network of providers - no out-of-network care is covered
✔✔All of the following are requirements for an ideal insurable risk except:
1. There must be a large number of heterogeneous exposure units that have different
loss characteristics being insured against.
2. The insurer must be able to determine if the loss is covered under the policy, and if it
is, how much the insurer will pay.
3. The premium must be subject to calculation
4. The premium must be reasonable or economically feasible.
5. The loss should be accidental and unintentional from the standpoint of the insured. -
✔✔1. There must be a large number of heterogeneous exposure units that have
different loss characteristics being insured against.
✔✔All of the following statements regarding the ADA are true except:
1. The act in general forbids workers from inquiring about another worker's health
status.
2. The act makes exceptions for certain medical inquiries.
3. A wellness program is deemed a voluntary one under the act as long as an employer
neither requires participation nor penalizes employees who do not participate
,4. In case of violations of the act's privacy rules, employees' recourse is to file a
complaint with their state's enforcement authority
5. The act is applicable to employers with 15 or more workers - ✔✔4. In case of
violations of the act's privacy rules, employees' recourse is to file a complaint with their
state's enforcement authority
✔✔All of the following are key factors of the covered group that are usually considered
in the cost of a dental plan except:
1. Gender distribution
2. Length of service
3. Geographic location and presence of fluoridation
4. Income levels
5. Occupations - ✔✔2. Length of service
✔✔All of the following are correct statements concerning the Taft-Hartley Act except:
1. It is also called the Labor Management Relations Act (LMRA)
2. It sets forth the framework for good-faith collective bargaining over wages, hours,
conditions and terms of employment
3. The Act includes the rules for the collective bargaining for employee benefits
4. It relies on the Fair Labor Standards Act (FLSA) to establish the distinction between
retirement and welfare benefits
5. It is the legislative basis on which jointly trusteed benefit plan are founded. - ✔✔4. It
relies on the Fair Labor Standards Act (FLSA) to establish the distinction between
retirement and welfare benefits
✔✔All of the following statements describe common characteristics of a pharmacy
benefit manager (PBM) except:
1. It is considered a licensed insurance carrier
2. It is designed to control costs associated with the delivery of pharmaceutical care
3. It aims to streamline and improve the prescribing and dispensing process through
online and real-time claims adjudication
4. It may maintain a retail network of pharmacies
5. It offers limited drug utilization review at the point of sale or dispensing - ✔✔1. It is
considered a licensed insurance carrier
✔✔All of the following types of benefits may be included in a cafeteria plan except:
1. Individually-owned health insurance
2. 401(k) plan
3. Contributions to a health savings account (HSA)
4. Employer-provided dependent-care assistance
5. Employer-provided adoption assistance - ✔✔1. Individually-owned health insurance
✔✔All the following are characteristics of mail service programs (MSPs) for prescription
drug programs except:
,1. These programs typically allow a more generous quantity amount to be filled (a 90-
day supply compared to a 30-day supply)
2. MSPs are typically used for chronic conditions that require maintenance medications
for long periods of time
3. These programs essentially eliminate the possibility of waste
4. MSPs are typically underused because enrollees are not familiar with a plan's mail
service benefit or are not sure how to access the service
5. MSPs offer a lower cost of dispensing and allow quality control through automation
that is uncommon in retail pharmacy - ✔✔3. These programs essentially eliminate the
possibility of waste
✔✔All the following statements regarding vision care plans are correct except:
1. Generally these plans use frequency limits on the number of times a participant can
receive benefits during a period
2. A schedule-of-benefits plan sets maximum dollar amounts on the amount that will be
paid toward a specific benefit
3. Preferred provider networks for vision benefits are similar to those for medical care
4. Vision benefits cannot be included in a flexible benefit health plan
5. Adult vision benefits are not covered under the ACA - ✔✔4. Vision benefits cannot be
included in a flexible benefit health plan
✔✔All the following are advantages to employers and employees of cafeteria plans
except:
1. Contributions to cafeteria plans are exempt from federal income tax
2. Contributions to cafeteria plans are exempt from Social Security (FICA-Federal
Insurance Contributions Act) taxes
3. Contributions to cafeteria plans are exempt from unemployment Federal
Unemployment Tact Act (FUTA) taxes
4. Deferral amounts usually has the effect of increasing a worker's social security
benefits
5. Deferral amounts are not considered wages for purposes of determining workers'
compensation premiums and other payroll-related expenses - ✔✔4. Deferral amounts
usually has the effect of increasing a worker's social security benefits
✔✔All of the following are factors contributing to high prescription drug costs except:
1. Rigorous standards for pharmacy and therapeutics (P&T) committees' deliberations
2. Not all prescription discount, rebates and other savings are passed along to plan
sponsors
3. Direct-to-consumer marketing
4. Aging of the population
5. Growth of biotechnology drugs - ✔✔1. Rigorous standards for pharmacy and
therapeutics (P&T) committees' deliberations
✔✔All of the following are advantages to using insurance to fund an employee benefit
plan except:
, 1. The presence of a known premium is set in advance by the insurance company
2. The use of an outside administrator distances the employer from disputes with
employees involving plan coverage
3. The use of an insurance company provides the financial backing of the Federal
Surety Insurance Corporation (FSIC)
4. Insurance companies often are leaders in the area of loss control and can implement
systems established to limit employee benefit costs for an employer
5. It may be more economical for an employer to use an insurance than other funding
alternatives. - ✔✔3. The use of an insurance company provides the financial backing of
the Federal Surety Insurance Corporation (FSIC)
✔✔All of the following statements concerning formularies are correct except:
1. A formulary is a list of drugs preferred by a health plan or pharmacy benefit manager
(PBM)
2. Formulary development typically centers on generic drugs rather than brand products
3. A pharmacy and therapeutics committee involved in the development of a formulary
may be composed of physicians, pharmacists, nurses and others
4. A formulary selects drugs within the category that are most cost-effective
5. The use of formularies is common because they are very effective at moving patients
to lower cost drugs. - ✔✔2. Formulary development typically centers on generic drugs
rather than brand products
✔✔All of the following questions concerning dependent-care assistance plans are
correct except:
1. Dependent care assistance plans can be offered either on a standalone basis or part
of a cafeteria plan
2. The benefits provided by these plans are taxable income to those who receive the
benefits
3. A dependent care assistance plan must be in writing
4. To obtain benefits under these plans, the participant's spouse also must be
employed, a full-time student, or physically or mentally incapable of self-care
5. Benefits cannot be provided for care provided by a person for whom a personal tax
exemption is taken on the participant's tax return - ✔✔2. The benefits provided by these
plans are taxable income to those who receive the benefits
✔✔All of the following are care management and cost-containment practices of
managed behavioral healthcare organizations (MBHO) except:
1. Predictive modeling and risk assessment
2. Minimum coverage for high-risk, potentially high-cost members
3. Preauthorization to access treatment
4. Performance measurement
5. Outcomes management - ✔✔2. Minimum coverage for high-risk, potentially high-cost
members
