CEBS - GBA 1: Directing Benefits Programs
Part 1 CORRECT 100%
______ View is any type of plan sponsored and engaged in providing benefits that result from
employment relationship and that are not underwritten or paid directly by government -
ANSWERNarrow View
A behavioral health care carve-out program usually operates under a separate contract and from a
separate company known as a(n): - ANSWERManaged behavioral health care organization (MBHO)
A dental plan in which certain procedures are reimbursed on a scheduled basis and others are
reimbursed on a nonscheduled basis is called a(n): - ANSWERCombination plan
A health care plan has no restrictions on a member's choice of provider, there is no "steerage," and
there is no basic utilization management. This type of health care coverage is known as: -
ANSWERIndemnity plan
A healthcare organization is contemplating a possible investment in a new technology and is
conducting a return on investment (ROI) analysis. Which of the following are typically used to define
the returns to be valued?
I. Savings in time
II. Savings in cost
III. Cash returns - ANSWERII and III only
A healthcare organization is contemplating a possible investment in a new technology and is
conducting a return on investment (ROI) analysis. Which of the following are typically used to define
the returns to be valued?I. Savings in timeII. Savings in costIII. Cash returns - ANSWERII and III only
A mechanism by which one attempts either to prevent or reduce the probability of a loss taking place
or to reduce the severity of the loss if it does take place is referred to as: - ANSWERControl
A participant in a health care flexible spending account (FSA) elects to contribute $1,200 to the
account for an entire plan year. One month into the year, $200 has been contributed to the account
, and the participant incurs $1,200 worth of eligible reimbursable expenses. Which of the following
statements properly describes the maximum allowable claims and payments that can be made on
the account? - ANSWERA claim of $1,200 can be made on the account, and $1,200 will be paid.
A peril as the term applies to the insurance mechanism is defined as: - ANSWERThe cause of a loss
A typical behavioral health specialty network includes which of the following healthprofessionals?
I. Individual practitioners and multispecialty group practices
II. Medical doctors that specialize in addictionology
III. Developmental behavioral pediatricians - ANSWERI, II and III
An employer has only 12 employees, all of whom are full-time. The average annual wage is less than
$50,000. According to the provisions enacted by the Affordable Care Act (ACA):
I. This employer is exempt from the ACA's employer shared responsibility mandate.
II. Tax credits for health coverage might be available to this employer for a limited period if certain
requirements are met.
III. To be eligible for the Small Business Health Options Program (SHOP), insurance must be
purchased for 100% of their full-time employees. - ANSWERI and II only
An example of a healthcare reform that is comprehensive and represents a longer-term set of change
interventions to a range of services is: - ANSWEREnactment of the Affordable Care Act (ACA)
An insured individual has $12,000 of covered medical expenses for in-network nonpreventive
treatment. His plan is a high-deductible health policy with a $1,500 deductible and a 20%
coinsurance arrangement. Also, the plan reimburses 100% after an individual reaches the plan's
$6,000 out-of-pocket maximum. What will the insured pay out of the total medical expenses if this is
the first claim of the plan year? - ANSWER$ 3,600
Are lifestyle drugs covered under prescription benefits? If so, what tier? - ANSWERHave been
routinely excluded from all employer plans.
As wellness programs invest in "total well-being," they are dealing with which of the following types
of issues?
I. Student loan repayment assistance
II. Financial education
Part 1 CORRECT 100%
______ View is any type of plan sponsored and engaged in providing benefits that result from
employment relationship and that are not underwritten or paid directly by government -
ANSWERNarrow View
A behavioral health care carve-out program usually operates under a separate contract and from a
separate company known as a(n): - ANSWERManaged behavioral health care organization (MBHO)
A dental plan in which certain procedures are reimbursed on a scheduled basis and others are
reimbursed on a nonscheduled basis is called a(n): - ANSWERCombination plan
A health care plan has no restrictions on a member's choice of provider, there is no "steerage," and
there is no basic utilization management. This type of health care coverage is known as: -
ANSWERIndemnity plan
A healthcare organization is contemplating a possible investment in a new technology and is
conducting a return on investment (ROI) analysis. Which of the following are typically used to define
the returns to be valued?
I. Savings in time
II. Savings in cost
III. Cash returns - ANSWERII and III only
A healthcare organization is contemplating a possible investment in a new technology and is
conducting a return on investment (ROI) analysis. Which of the following are typically used to define
the returns to be valued?I. Savings in timeII. Savings in costIII. Cash returns - ANSWERII and III only
A mechanism by which one attempts either to prevent or reduce the probability of a loss taking place
or to reduce the severity of the loss if it does take place is referred to as: - ANSWERControl
A participant in a health care flexible spending account (FSA) elects to contribute $1,200 to the
account for an entire plan year. One month into the year, $200 has been contributed to the account
, and the participant incurs $1,200 worth of eligible reimbursable expenses. Which of the following
statements properly describes the maximum allowable claims and payments that can be made on
the account? - ANSWERA claim of $1,200 can be made on the account, and $1,200 will be paid.
A peril as the term applies to the insurance mechanism is defined as: - ANSWERThe cause of a loss
A typical behavioral health specialty network includes which of the following healthprofessionals?
I. Individual practitioners and multispecialty group practices
II. Medical doctors that specialize in addictionology
III. Developmental behavioral pediatricians - ANSWERI, II and III
An employer has only 12 employees, all of whom are full-time. The average annual wage is less than
$50,000. According to the provisions enacted by the Affordable Care Act (ACA):
I. This employer is exempt from the ACA's employer shared responsibility mandate.
II. Tax credits for health coverage might be available to this employer for a limited period if certain
requirements are met.
III. To be eligible for the Small Business Health Options Program (SHOP), insurance must be
purchased for 100% of their full-time employees. - ANSWERI and II only
An example of a healthcare reform that is comprehensive and represents a longer-term set of change
interventions to a range of services is: - ANSWEREnactment of the Affordable Care Act (ACA)
An insured individual has $12,000 of covered medical expenses for in-network nonpreventive
treatment. His plan is a high-deductible health policy with a $1,500 deductible and a 20%
coinsurance arrangement. Also, the plan reimburses 100% after an individual reaches the plan's
$6,000 out-of-pocket maximum. What will the insured pay out of the total medical expenses if this is
the first claim of the plan year? - ANSWER$ 3,600
Are lifestyle drugs covered under prescription benefits? If so, what tier? - ANSWERHave been
routinely excluded from all employer plans.
As wellness programs invest in "total well-being," they are dealing with which of the following types
of issues?
I. Student loan repayment assistance
II. Financial education
