Adjusted community rating - ANSWERNot giving credit to a plan for favorable risk attributes associated with a healthy population. This makes health insurance more affordable for those with higher risk.
Administrative enhancements when opting to self-fund - ANSWERMore transparency and use of bund...
administrative enhancements when opting to self fu
Written for
Module 8 CEBs GBA 2
Module 8 CEBs GBA 2
Seller
Follow
papersbyjol
Reviews received
Content preview
Module 8 CEBs GBA 2 CORRECT 100%
Adjusted community rating - ANSWERNot giving credit to a plan for favorable risk attributes
associated with a healthy population. This makes health insurance more affordable for those with
higher risk.
Administrative enhancements when opting to self-fund - ANSWERMore transparency and use of
bundled pricing and direct contracting to reduce claims costs
Aggregate stop-loss insurance - ANSWERThis policy caps how much an employer is obligated to pay
for all its claims across a full plan year.
Arguments countering substantial exodus of healthy risks from insured marketplace - ANSWERSimilar
health risks; transition costs and barriers; and additional compliance, financial, and plan
management obligations
Attachment point - ANSWERStop-loss insurance reimburses the plan sponsor for health payments in
excess of this pre-determined level.
Contractual provisions to examine when opting for a level-funded plan - ANSWER"Minimum
premium" language, which requires employer payments even if workers are laid off, and a 12/18
clause.
Determinants of the viability to self-fund - ANSWERThe employer's economic condition, financial risk
tolerance, and desire for plan flexibility and lower administrative costs.
HIPAA non-discrimination prohibitions for group health plans - ANSWERThey prohibit a plan from
denying an individual eligibility for benefits based on a health factor & from charging a person a
higher premium than a similarly situated person based on a health factor.
Individual specific stop-loss insurance - ANSWERThis policy caps how much an employer pays for any
one person's claims during the policy period.
The benefits of buying summaries with Stuvia:
Guaranteed quality through customer reviews
Stuvia customers have reviewed more than 700,000 summaries. This how you know that you are buying the best documents.
Quick and easy check-out
You can quickly pay through EFT, credit card or Stuvia-credit for the summaries. There is no membership needed.
Focus on what matters
Your fellow students write the study notes themselves, which is why the documents are always reliable and up-to-date. This ensures you quickly get to the core!
Frequently asked questions
What do I get when I buy this document?
You get a PDF, available immediately after your purchase. The purchased document is accessible anytime, anywhere and indefinitely through your profile.
Satisfaction guarantee: how does it work?
Our satisfaction guarantee ensures that you always find a study document that suits you well. You fill out a form, and our customer service team takes care of the rest.
Who am I buying this summary from?
Stuvia is a marketplace, so you are not buying this document from us, but from seller papersbyjol. Stuvia facilitates payment to the seller.
Will I be stuck with a subscription?
No, you only buy this summary for R242,92. You're not tied to anything after your purchase.
