GBA 2 PRACTICE QUESTIONS AND ANSWERS
Losses are spread over a large group of individuals, so that each individual realizes the
average loss of the pool (plus administrative expenses). Pooling the sharing of losses
for the entire group helps predict future losses with some accuracy - Answers :Pooling
of losses
A large number of individuals in a homogeneous group, which is referred to in this
context as exposure units—people or things with the same risk characteristics—so that
the law of large numbers applies. "Spreading risk over a large homogenous group" -
Answers :Pooling
As the size of a sample increases, the mean of the sample gets ever closer to the mean
of the population - Answers :Law of large numbers
The sole exception to the element of risk transfer is - Answers :self-insured/self-funded.
Self-insurers bear the risks associated with health care costs and then, set aside (or
have available) funds to pay future costs as they occur
This happens when the individuals/businesses that are most likely to have claims are
more inclined to purchase comprehensive insurance than those that are less likely to
have claims - Answers :Adverse selection
When individual buyers of health insurance know more about their health status than
insurers do - Answers :Asymmetric information
The generic term referring to a private insurer or a public government program, which
pays for part or all of a patient's health care services. - Answers :Third-party payers
Private insurers include - Answers :Blue Cross Blue Shield, commercial insurers, and
self-insured plans
Established by Congress in 1965 primarily to provide medical benefits to individuals
aged 65 or older as well as eligible people with long-term disabilities - Answers
:Medicare.
Medicare also covers health care costs associated with select disabilities and illnesses,
such as end stage kidney failure, regardless of age. It is a NOT needs-based.
Medicare is financed through payroll tax deductions, general revenue, beneficiary
premiums, and copayments.
Covers physician services, ambulatory surgical services, outpatient services, and other
miscellaneous services (diagnostics). It provides great choice in accessing care from
doctors. - Answers :Medicare B
,Part B is optional and it requires enrollees pay a monthly premium that varies with their
household's income level.
Also called Medicare Advantage, provides an alternative managed care plan option.
There are many choices of Advantage plans available. This option is selected by about
1/3 of managed care enrollees. - Answers :Medicare C.
This managed care coverage is offered by private insurance companies and can be
selected in lieu of Parts A and B.
Covers hospital services and some skilled nursing facility coverage - Answers :Medicare
A.
Part A coverage is free to all individuals who are eligible for Social Security benefits.
Most individuals who worked enough quarters, or have a spouse who did, do not pay a
premium for this. However, those not eligible for Medicare Part A of Social Security pay
a monthly premium for coverage.
Covers prescription drugs. There are many choices (and state variations) of Part D
programs. The Medicare Part D law currently prohibits the government from using its
purchasing power to negotiate widespread discounts with drug plans. - Answers
:Medicare D
How did ACA affect Medicare? - Answers :ACA expanded Medicare's wellness and
prevention benefits, improved prescription drug coverage, and financed initiatives such
as testing alternative payment methods and delivery systems with the goal of helping
control total health care costs
A state-administered program that is jointly funded by a state and the federal
government. There is wide coverage, eligibility, and benefit differences between
different states. Provides health coverage to low income families and individuals. -
Answers :Medicaid
A delivery system that attempts to manage the quality and cost of medical services that
individuals receive. Insurers own a provider network or create one through contractual
arrangements with independent providers - Answers :Managed care plan
To charge the same premium rate to all applicants of the same age and geographic
location (part of ACA provision) regardless of preexisting conditions or sex - Answers
:Community rating
Regulation whereby insurers must spend at least 80% (85% for large groups) of
premium dollars on health costs (not administrative costs and profits) or face the
consequences of having to issue rebates to policyholders - Answers :Medical loss ratio
,Marketplaces of health insurance and other related products where individuals may pick
from a pre-selected variety of plans offered by one or more insurance companies -
Answers :Public health insurance exchanges (HIEs). Marketplace is government-run,
but the health plans available for sale in the exchange are from private health insurance
companies.
A type of reimbursement methodology in which a doctor or hospital is paid a fixed
amount per patient for a prescribed period of time by an insurer - Answers :Capitation
When doctors and other health care providers are paid for each service performed.
Examples of services include tests and office visits. - Answers :Fee-for-service
What insurance carriers strive to use to incentivize providers to not see the provider
payment as a "blank check", but rather as a purchasing payment made with a focus on
value-based, cost effective, quality services (not based on volume like lots of tests) -
Answers :Alternative reimbursement methodologies
An unforeseen, unexpected, nonspeculative event - Answers :Random loss
They give consumers "skin in the game" - Answers :High-deductible health plans
Federal level and/or state level rules that required people to purchase health insurance
or face a penalty - Answers :Individual mandate
The provision of care is based on value, not volume. - Answers :Value-Based Care
Which of the following is/are true about health care reform giving states the option to
expand their existing Medicaid programs to cover more low-income, uninsured adults?
A. A 2012 Supreme Court ruling clarified it's a decision up to states.
B. The ACA focuses on assisting all adults under age 65 with low incomes.
C. The subsidies individuals could receive under the ACA are set with income-based
standards.
D. All of the above. - Answers :D. All of the above.
All the following statements about health care reform initiatives are true, EXCEPT:
A. The ACA created health insurance exchanges (HIEs) for small businesses and
people without employer coverage to shop for insurance and compare prices/benefits.
B. Federal income tax credit subsidies toward the premium appeal to low- and moderate
income workers.
C. In addition to tax credit subsidies, some plans may have cost-sharing subsidies.
D. High-deductible health plans were reintroduced, providing high monthly premiums as
compared to other insurance options.
, E. Health insurance exchanges (HIEs) evolved, providing online information about rates
for participating insurance companies. - Answers :D. High-deductible health plans have
the lowest monthly premium and the highest out-of-pocket costs
Which of the following are out-of-pocket costs that a consumer may face at the time of
service?
- coinsurnace
- copays
- deductibles
- premiums - Answers :Coinsurance, copays, deductibles
Prospective payments to providers include which of the following:
- per procedure
- cost-based reimbursement
- charge based reimbursement
- per diagnosis
- per diem
- bundled
- global payment - Answers :per procedure, per diagnosis, per diem, bundled, global
payment
Value-based purchasing (care) includes improving access to appropriate medical care:
- at the right time
- at the right cost
- at the right place
- at a cost-based fee-for-service model
- with the right results - Answers :- at the right time
- at the right cost
- at the right place
- with the right results
True or false? Expected claims are the probability of loss times the magnitude of loss. -
Answers :True
True or false? Gross premium = pure premium/(1- loading percentage) - Answers :True
True or False? Pure premium (aka actuarially fair premium) is based on expected
claims. - Answers :True
True or False? Manual rating is based on a pooled approach. - Answers :False
True or false? Subjective risk is found when we examine an individual. - Answers :True
Losses are spread over a large group of individuals, so that each individual realizes the
average loss of the pool (plus administrative expenses). Pooling the sharing of losses
for the entire group helps predict future losses with some accuracy - Answers :Pooling
of losses
A large number of individuals in a homogeneous group, which is referred to in this
context as exposure units—people or things with the same risk characteristics—so that
the law of large numbers applies. "Spreading risk over a large homogenous group" -
Answers :Pooling
As the size of a sample increases, the mean of the sample gets ever closer to the mean
of the population - Answers :Law of large numbers
The sole exception to the element of risk transfer is - Answers :self-insured/self-funded.
Self-insurers bear the risks associated with health care costs and then, set aside (or
have available) funds to pay future costs as they occur
This happens when the individuals/businesses that are most likely to have claims are
more inclined to purchase comprehensive insurance than those that are less likely to
have claims - Answers :Adverse selection
When individual buyers of health insurance know more about their health status than
insurers do - Answers :Asymmetric information
The generic term referring to a private insurer or a public government program, which
pays for part or all of a patient's health care services. - Answers :Third-party payers
Private insurers include - Answers :Blue Cross Blue Shield, commercial insurers, and
self-insured plans
Established by Congress in 1965 primarily to provide medical benefits to individuals
aged 65 or older as well as eligible people with long-term disabilities - Answers
:Medicare.
Medicare also covers health care costs associated with select disabilities and illnesses,
such as end stage kidney failure, regardless of age. It is a NOT needs-based.
Medicare is financed through payroll tax deductions, general revenue, beneficiary
premiums, and copayments.
Covers physician services, ambulatory surgical services, outpatient services, and other
miscellaneous services (diagnostics). It provides great choice in accessing care from
doctors. - Answers :Medicare B
,Part B is optional and it requires enrollees pay a monthly premium that varies with their
household's income level.
Also called Medicare Advantage, provides an alternative managed care plan option.
There are many choices of Advantage plans available. This option is selected by about
1/3 of managed care enrollees. - Answers :Medicare C.
This managed care coverage is offered by private insurance companies and can be
selected in lieu of Parts A and B.
Covers hospital services and some skilled nursing facility coverage - Answers :Medicare
A.
Part A coverage is free to all individuals who are eligible for Social Security benefits.
Most individuals who worked enough quarters, or have a spouse who did, do not pay a
premium for this. However, those not eligible for Medicare Part A of Social Security pay
a monthly premium for coverage.
Covers prescription drugs. There are many choices (and state variations) of Part D
programs. The Medicare Part D law currently prohibits the government from using its
purchasing power to negotiate widespread discounts with drug plans. - Answers
:Medicare D
How did ACA affect Medicare? - Answers :ACA expanded Medicare's wellness and
prevention benefits, improved prescription drug coverage, and financed initiatives such
as testing alternative payment methods and delivery systems with the goal of helping
control total health care costs
A state-administered program that is jointly funded by a state and the federal
government. There is wide coverage, eligibility, and benefit differences between
different states. Provides health coverage to low income families and individuals. -
Answers :Medicaid
A delivery system that attempts to manage the quality and cost of medical services that
individuals receive. Insurers own a provider network or create one through contractual
arrangements with independent providers - Answers :Managed care plan
To charge the same premium rate to all applicants of the same age and geographic
location (part of ACA provision) regardless of preexisting conditions or sex - Answers
:Community rating
Regulation whereby insurers must spend at least 80% (85% for large groups) of
premium dollars on health costs (not administrative costs and profits) or face the
consequences of having to issue rebates to policyholders - Answers :Medical loss ratio
,Marketplaces of health insurance and other related products where individuals may pick
from a pre-selected variety of plans offered by one or more insurance companies -
Answers :Public health insurance exchanges (HIEs). Marketplace is government-run,
but the health plans available for sale in the exchange are from private health insurance
companies.
A type of reimbursement methodology in which a doctor or hospital is paid a fixed
amount per patient for a prescribed period of time by an insurer - Answers :Capitation
When doctors and other health care providers are paid for each service performed.
Examples of services include tests and office visits. - Answers :Fee-for-service
What insurance carriers strive to use to incentivize providers to not see the provider
payment as a "blank check", but rather as a purchasing payment made with a focus on
value-based, cost effective, quality services (not based on volume like lots of tests) -
Answers :Alternative reimbursement methodologies
An unforeseen, unexpected, nonspeculative event - Answers :Random loss
They give consumers "skin in the game" - Answers :High-deductible health plans
Federal level and/or state level rules that required people to purchase health insurance
or face a penalty - Answers :Individual mandate
The provision of care is based on value, not volume. - Answers :Value-Based Care
Which of the following is/are true about health care reform giving states the option to
expand their existing Medicaid programs to cover more low-income, uninsured adults?
A. A 2012 Supreme Court ruling clarified it's a decision up to states.
B. The ACA focuses on assisting all adults under age 65 with low incomes.
C. The subsidies individuals could receive under the ACA are set with income-based
standards.
D. All of the above. - Answers :D. All of the above.
All the following statements about health care reform initiatives are true, EXCEPT:
A. The ACA created health insurance exchanges (HIEs) for small businesses and
people without employer coverage to shop for insurance and compare prices/benefits.
B. Federal income tax credit subsidies toward the premium appeal to low- and moderate
income workers.
C. In addition to tax credit subsidies, some plans may have cost-sharing subsidies.
D. High-deductible health plans were reintroduced, providing high monthly premiums as
compared to other insurance options.
, E. Health insurance exchanges (HIEs) evolved, providing online information about rates
for participating insurance companies. - Answers :D. High-deductible health plans have
the lowest monthly premium and the highest out-of-pocket costs
Which of the following are out-of-pocket costs that a consumer may face at the time of
service?
- coinsurnace
- copays
- deductibles
- premiums - Answers :Coinsurance, copays, deductibles
Prospective payments to providers include which of the following:
- per procedure
- cost-based reimbursement
- charge based reimbursement
- per diagnosis
- per diem
- bundled
- global payment - Answers :per procedure, per diagnosis, per diem, bundled, global
payment
Value-based purchasing (care) includes improving access to appropriate medical care:
- at the right time
- at the right cost
- at the right place
- at a cost-based fee-for-service model
- with the right results - Answers :- at the right time
- at the right cost
- at the right place
- with the right results
True or false? Expected claims are the probability of loss times the magnitude of loss. -
Answers :True
True or false? Gross premium = pure premium/(1- loading percentage) - Answers :True
True or False? Pure premium (aka actuarially fair premium) is based on expected
claims. - Answers :True
True or False? Manual rating is based on a pooled approach. - Answers :False
True or false? Subjective risk is found when we examine an individual. - Answers :True
