CEBS GBA Exam 1 Latest Update 232 Questions and Verified Correct Answers Guaranteed Success
- Examples of Tax Advantages of Employee Benefit Plans (Mod 1.2) - Correct Answer:
1: Employer Contributions are Tax Deductible
2: Employer Contributions are not considered income to Employees
3: Certain Retirement Benefits Accumulate Tax-Free until distributed.
ACA created "Simple Cafeteria Plans." In what ways are these different? (Mod 10.5) -
Correct Answer: For eligible small Employers; must be designed with specific
eligibility/contribution requirements. In exchange, plans are example from non- discrimination testing.
ADA standards for Wellness programs (Mod 8.2) - Correct Answer: (2000) The
program is considered voluntary so long as the employer does not require participation and does not penalize employees who do not participate. (2014) Employer groups urge that financial incentives should be permitted for wellness participation. (2016) EEOC issues rule allowing the use of financial incentive for programs that include medical inquiries with a maximum of 30% of the total cost of employee only coverage.
After WWII, why did insurers place limits on outpatient medical care? (Mod 7.1) - Correct Answer: Treatment continued for indefinite periods of time, much subjectivity regarding treatment.
Broad view of Employee Benefits (Mod 1.1) - Correct Answer: Considers Employee
Benefits to be virtually any form of compensation other than direct wages paid to
Employees (Ex: WC, Unemployment, State DI, SS, Vacation, Holidays,
401K/Retirement, Employer share of Medical, Severance Pay, Child Care, etc..)
Cafe Plans are subject to coverage and nondiscrimination tests. Some apply to plan as a whole while some apply to underlying benefits. Provide overview of each testing structure (Mod 10.5) - Correct Answer: 3 Overall Tests:
Eligibility Test: May not discriminate in favor of highly compensated EEs as the ability to participate -classification/length of services/participation test -no EE required to complete more than 3 YOS -defining highly comped EE (5% owner, or highly paid person - subjectively) -Aug 2007 added benefits component determination to ensure benefits equally available to all EEs
Contributions and Benefits Test: Plan must make contributions and benefits available on a non-discriminatory basis and plan fails test if highly comped EEs select more nontaxable benefits than non highly comped EEs 1 / 4
-Benefits component to determine if benefits/contributions are equally available to all EEs -Utilization component: highly comped EEs are disproportionately using all benefits; uniformed opportunity to elect benefits -If providing health benefits, not discriminatory if any contributions made on behalf of the EE are equal to: 100% of cost of health under the plan of the majority of highly comped are similarly situated; 75% of the cost of most expensive benefits elected by any similarly situated participant
Key EE Concentration Test: Plan's Key EE contributions cannot exceed 25% of the total contributions into the plan.
-Key EE: Officer earning $175,000+, 5% Owner or 1% Owner Earning $150,000+
-Test is based on level of coverage as opposed to level of reimbursements
Cafe Plans are subject to what other laws (Mod 9.5) - Correct Answer: -COBRA
-FMLA
-HIPAA
-MHPA
-MHPAEA
-NMHPA
-WHCRA
-MMA
-WFTRA
-HEART
-Michelle's Law -GINA
-PPACA
Common techniques to control pharmacy costs (Mod 6.3) - Correct Answer: 1 = Review design of benefits to see if they fit overall medical program (flat copays/no incr)
- = Analyze experience to identify areas that need better management
- = Reduce pharmacy network to smallest size w/o compromising access
- = Offer mail service
- = Promote generics
- = Use/develop cost effective formulary
- = Practice utilization management
- = Physician profiling
- = Educate and communicate to members the plan
10 = Anticipate financial impact of new drugs
Compare Compensation/Service Oriented Benefit Philosophy with the Needs-Oriented (Mod 1.4) - Correct Answer: Compensation/Service: EBP comprised of primarily compensation, service or both. Level of benefits tied to salary or pay levels/years of service
Needs Orientated: Focuses on Needs of EE's and their dependents
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Compare differences of behavioral health treatments: inpatient, partial (day), outpatient (Mod 7.5) - Correct Answer: -Acute inpatient: most severe, unable to care for
themselves: suicidal, homicidal
-Partial hospital: offer intensive day treatment but patient returns home overnight -Intensive Outpatient: patient needs more intensive than weekly, but fewer hours each day than partial facilities
Compare insurance mechanism to gambling (Mod 2.3) - Correct Answer: Insurance is a mechanism to handling existing risk - gambling creates risk where one did not previously exist. Risk caused by gambling is 100% speculative, while insurance deals with pure risk. Gambling involves a gain for one party while insurance is a mutual sharing of any losses. The loser in the gambling transaction remains in a negative situation while the insured is financially restored in whole or part to prior condition.
Compare premiums, contributions and deductibles of HDHP/HRAs vs HDHP/HSAs (Mod 4.2) - Correct Answer: HDHP/HSAs tend to have lower premiums, lower employee contributions and higher deductibles than HDHP/HRAs. EE's own control of HSA, while ER controls HRA.
Contrast between an In-Network (Preferred) vs an Out-of-Network (Non-Preferred) Provider (Mod 3.3) - Correct Answer: In-Network: Contract with individual's health insurance plan to provide services to the member at a discount (for increased volume).Some plans may have a tiered structure with varying out of pocket costs.
Out-of-Network: No contract with insurance plan...when available, costs are
considerably higher.
Contrast PPO's vs POS' (Mod 3.1) - Correct Answer: Both overlap significantly.
Differences do include primary care provider requirement by POS but not PPO; lower copay amounts for preferred care in POS than in PPO; smaller network in a POS than PPO.
Define a Cafeteria Plan (Mod 9.1) - Correct Answer: A plan under which all participants are employees (not owners or shareholders) and all participants may choose from a combination of options- qualified benefits or cash.
Benefits can't be offered: Whole Life Insurance and Long-Term Care Insurance.
Define a combination dental plan (Mod 5.2) - Correct Answer: Certain procedures on a scheduled basis while some are on a non-scheduled basis.
Define a Welfare benefit plan (Mod 9.5) - Correct Answer: Any plan, fund or program that is established or maintained by an employer or employee organization for the purposes of providing participants medical, disability or unemployment benefits. Also may include vacation, training programs and legal services.
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Define Accumulation-Orientated Benefits (Mod 1.5) - Correct Answer: Consist of
Pension Plans, Profit-Sharing, Savings, 401K, etc...which reward an Employee for long service with an Employer. Involve a longer probationary period since viewed as a reward - not a disadvantage for long-term employees.
Define an incentive dental plan (Mod 5.2) - Correct Answer: Program that incentivizes sound dental hygiene through increasing reimbursement levels - only applies to preventative and maintenance. When deductibles apply, only on lifetime basis.
Define and explain 3 types of health system performance evaluations (Mod 12.3) - Correct Answer: Audit Performance Evaluations (APE): -compares health system with a statement of what is expected; if ER wants to offer health benefits, they could contract with a health system; ER wants to know whether health system provides the services needed, so might use evaluator to specify; another example is National Committee for Quality Assurance (NCQA) accreditation of ACO - accountable care organization which is a network of doctors and hospitals that assume financial responsibility managing the health care of a specific group of patients - if able to provide lower costs, they receive financial awards. NCQA provides accreditation to all ACOs, which is ex of APE
Single-case time trend performance eval:
-track performance of health system over time; use routinely collected and reported data and compare at different times
Service-comparison performance evaluation:
-compare performance of a set of services at one time, in relation to one or more dimensions of service performance; most developed and longest running systems report quality and safety data but not costs, so value assessment not possible.
Define AWP, WAC and MAC (Mod 6.1) - Correct Answer: AWP = Average Wholesale
Price - assigned by drug manufacturer, reference price for all discounts paid to pharmacies and PBMs.
WAC = Wholesale acquisition cost (average manufacturers price) - price at which wholesalers buy pharmaceuticals from manufacturers.
MAC = Maximum Allowable Cost - of generic places a ceiling on reimbursement for generic medicine. Concept of Medicaid/Medicare by Centers for Medicaid/Medicare Services (CMS). PBMs and TPAs developed their own MAC to cover all generics - due to variety, may be average cost of all manufacturers AWPs, lowest AWP, or some derived formula.
Define common types of Employer Sponsored Health Plans (Mod 3.1) - Correct Answer: 1: HMO (Health Maintenance Organization)
2: PPO (Preferred Provider Organization)
3: POS (Point of Service Plan)
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