CEBS: GBA 2, Module 1 Questions & Answers(GRADED A+)
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CEBS: GBA 2, Module 1
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CEBS: GBA 2, Module 1
attraction of private exchanges for employers - ANSWEROne big attraction of private exchanges for employers is the opportunity to change
from a traditional premium contribution model, where the employer typically pays
75-80% of the premium, or premium equivalent rate, to a defined contribution
m...
CEBS: GBA 2, Module 1 Questions &
Answers(GRADED A+)
attraction of private exchanges for employers - ANSWEROne big attraction of private exchanges for
employers is the opportunity to change
from a traditional premium contribution model, where the employer typically pays
75-80% of the premium, or premium equivalent rate, to a defined contribution
model. Because private exchanges provide a wider array of choices to
employees, the employer can more easily change from the traditional contribution
model to a defined contribution model where a flat amount, like a voucher, is
provided to employees who then apply that flat amount to the plan they select. In
subsequent years, the employer may increase the defined contribution but at a level
that is not directly tied to cost trend. Private exchanges, however, can operate with or
without defined contributions.
Basic assumption of free markets - ANSWERRational consumers will make informed decisions about
value, quality and price, while producers meeting consumers' demands will be rewarded with market
share and profit.
Benefits of free markets - ANSWERPeople who do not like their provider or health plan should be
able to "vote with their feet" and select other options. The theory is that choice empowers
consumers, regulates producers and, under the right conditions, drives efficiency.
Bounded Rationality - ANSWERthe rational consumer is only functional up to a certain point, in
which their choices are constrained or bound by limited knowledge and an understanding
of available choices
Cadillac tax in ACA - ANSWERThe Cadillac tax in ACA is a 40% tax that will be levied on the value of all
affected
health care programs a participant elects that exceed certain dollar thresholds in
2020 and beyond. This nondeductible excise tax must be paid by the employer. While the minimum
, requirements constitute the floor, the Cadillac tax is thought of as a ceiling, or the
top value, for health benefits. Employers will need to manage their benefits within
the health reform house between the floor and ceiling. Despite continuing efforts to
rein in rising health care costs, roughly half of large U.S. employers will begin to hit the excise tax
threshold in 2020
consumer benefits and efficiency of Medicare Part C - ANSWERMedicare
Advantage's health maintenance organization (HMO) and preferred provider
organization (PPO) programs have a better record than traditional fee-for-service
plans in the provision of preventive services and the more efficient use of resources.
consumer choices for physicians and hospitals in the Medicaid program. - ANSWERThe federal
government mandates that Medicaid recipients have open choice to
physicians and hospitals. However, in the 1990s states could obtain waivers from this
provision and require Medicaid recipients to enroll in limited-network managed care
plans and most took advantage.Surveys indicate a continued steady movement to
Medicaid Managed Care Organizations (MMCOs) with comprehensive coverage
paid on a risk basis.Traditionally, the Medicaid
program pays physicians considerably less than private insurance or Medicare. This
limits the number of physicians that take Medicaid and thereby limits choice.
Describe private health insurance coverage with regard to :
(a) size of firm
(b) high-deductible health plans (HDHPs) with medical savings accounts and
(c)variability of coverage by states - ANSWER(a) In a recent study, 98% of employers with 200 or
more employees offer health
insurance, but fewer than 45% of firms with three to nine employees do so.
Larger employers offer more choice of health plans than smaller employers, and
smaller firms tend to offer point-of-service (POS) plans that require higher
employee cost-sharing to go outside a designated network.
(b) In 2006, HDHPs with medical savings accounts accounted for 4% of the
employer-sponsored market, but by 2012 they accounted for over 20% of the
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