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Global Exam #4 (Final) questions with correct answers
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Global Exam #4 (Final) questions with correct answers
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Global Exam #4 (Final)True or False. Because tiered pharmacy benefit designs encourage the use of high-cost drugs, they also
encourage the enrollment of high-risk consumers. - correct answer ✔✔False
True or False. Benefit mandates often generate significant controversy and debate about the balance
between comprehensiveness and the affordability of coverage. - correct answer ✔✔True
True or False. Coverage exclusions are services or products that are never covered by the plan, even
when medically necessary. - correct answer ✔✔True
True or False. Health insurance plans generally cover a comprehensive array of benefits because
purchasing individual benefits piece by piece would lead to substantial adverse selection. - correct
answer ✔✔True
In 1974, what state enacted the Prepaid Health Care Act, which required employers to offer health
insurance to all employees who work over 20 hours per week?
A. Oregon
B. Hawaii
C. Massachusetts
D. California - correct answer ✔✔B
In 2006, what city passed a pair of laws to expand health coverage to its residents and workers?
A. Portland
,B. Boston
C. New York City
D. San Francisco - correct answer ✔✔D
In 2006, what state passed broad legislation expanding healthcare coverage, similar to the ACA, in which
one study found improved credit scores and reduced household debt and personal bankruptcy?
A. Oregon
B. Hawaii
C. Massachusetts
D. California - correct answer ✔✔C
In 2014, a point-in-time estimate for the number of people uninsured is about what percent of the
population?
A. 8 percent
B. 10 percent
C. 12 percent
D. 14 percent - correct answer ✔✔C
True or False. In 2014, as part of the Affordable Care Act, almost all Americans were required to have
health insurance. - correct answer ✔✔True
,In a classic four-tier formulary, the first tier contains the lowest copayment for what type of drugs?
A. Generic drugs
B. Preferred branded drugs
C. Nonpreferred branded drugs
D. Biologics - correct answer ✔✔A
True or False. In an open formulary, drugs not listed may still be covered but at a higher copayment. -
correct answer ✔✔True
True or False. Many private health insurers model their coverage and reimbursement decisions after the
Medicaid program. - correct answer ✔✔False
True or False.
Massachusetts's health reform in 2006 resulted in improved self-reported health for the previously
uninsured. - correct answer ✔✔True
True or False. New plans must offer some preventive services, like routine immunizations, without cost-
sharing. - correct answer ✔✔True
True or False. Over half (54 percent) of the uninsured population work in full-time jobs. - correct answer
✔✔True
True or False. Prior to the ACA, federal law included some benefit mandates, but they applied only to
plans that covered certain services. - correct answer ✔✔True
Referral and prior authorization are two tools used for which of the following purposes?
, A. Care management
B. Risk management
C. Utilization management
D. Medical necessity - correct answer ✔✔C
True or False. Since changes to the Medicare program often influence the benefits that private insurers
offer and the prices they pay, plans are required to align their policies with Medicare. - correct answer
✔✔False
True or False. Since the uninsured do not have as much contact with the medical system, the insured
accrue medical debt and report difficulty paying medical bills more than the uninsured. - correct answer
✔✔True
True or False. The Emergency Treatment and Active Labor Act (EMTALA) restricts hospitals and providers
from billing uninsured consumers for services as well as turning them away from the hospital. - correct
answer ✔✔False
The SCHIP program expands coverage to:
A. low- and middle-income adults who do not qualify for public insurance and who have not been
uninsured for 3 months.
B. employees who work over 20 hours per week and are not offered insurance under their employer.
C. children whose parents' incomes are too high to qualify for Medicaid.
D. disabled individuals without insurance. - correct answer ✔✔C
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