MAA 102 CHAPTER 8 EXAM PRACTICE
QUESTIONS WITH VERIFIED ANSWERS
Group health plans (GHPs)
Plan of an employer or employee organization to provide healthcare to employees, former
employees and their families
*Note; that when an individual is covered under a GHP, the group is the "policyholder" and the
individual is a "certificate holder"
Riders
also called options; document modifying an insurance contract
May be purchased by employees to add voluntary benefits such as vision and dental services
Carve out
part of a standard health plan changed under an employer-sponsored plan
Open enrollment period
time when a policyholder selects from offered benefits
Federal Employees Health Benefits (FEHB) program
Covers employees and retirees and their families of the federal government
Self-funded (or self-insured)
when large employers cover the costs of employee medical benefits themselves rather than
buying insurance from other companies
People who are not covered by government-sponsored health insurance are often covered
by____
private insurance
Which of the following apply to group health plans? (Select all that apply.)
-Employer's human resource departments manage GHP benefits
-The group is considered the policyholder
-The individual is considered the certificate holder
When an employer changes standard coverage or providers during negotiations to reduce
the price of medical insurance, it is referred to as _____
carving out
During open enrollment periods, the employer provides tools (often web-based) and
information to do which of the following?
, Help employees match their personal and family needs with the best-priced plans
The FEHB is administered by which of the following?
Office of Personnel Management (OPM)
Which of the following statements apply to self-funded or self-insured health plans? (Select
all that apply.)
-Self-insured employers cover more than half of all employees in the United States
-Self-funded health plans also may buy other types of insurance, such as vision, instead of
insuring the benefit themselves
-The employer establishes the benefit levels and the plan types offered
Which of the following apply to the regulation of health care plans? (Select all that apply.)
-Self-funded health plans are regulated by the federal government (Employee Retirement Income
Security Act [ERISA] of 1974)
-Employer-sponsored "fully insured" plans are regulated by state laws
Under income tax law, the employer can collect an employee's insurance costs through a
_____.
pretax payroll deduction
The amount of time that must pass before a newly hired employee or a dependent is eligible
to enroll in many plans is known as a(n) _____.
waiting period
Which of the following apply to deductibles? (Select all that apply.)
-Deductibles are due per time period
-Noncovered services under the plan that the patient pays out of pocket are not counted toward
the deductible
The act that gives an employee who is leaving a job the right to continue health coverage
under the employer's plan is abbreviated as ____.
Consolidated Omnibus Budget Reconciliation Act (COBRA)
Which of the following apply to medical home model plans? (Select all that apply.)
-Emphasize communication among a patient's physicians
-Primary care physician is responsible for arranging patients' visits to specialists
-Replace Illness-based primary care with coordinated care
Which of the following statements apply to private payers? (Select all that apply.)
-Few employees choose indemnity health plans. (Because they would have to play more)
-CDHPs (consumer-driven health plan) combine a high deductible plan with a funding option of
QUESTIONS WITH VERIFIED ANSWERS
Group health plans (GHPs)
Plan of an employer or employee organization to provide healthcare to employees, former
employees and their families
*Note; that when an individual is covered under a GHP, the group is the "policyholder" and the
individual is a "certificate holder"
Riders
also called options; document modifying an insurance contract
May be purchased by employees to add voluntary benefits such as vision and dental services
Carve out
part of a standard health plan changed under an employer-sponsored plan
Open enrollment period
time when a policyholder selects from offered benefits
Federal Employees Health Benefits (FEHB) program
Covers employees and retirees and their families of the federal government
Self-funded (or self-insured)
when large employers cover the costs of employee medical benefits themselves rather than
buying insurance from other companies
People who are not covered by government-sponsored health insurance are often covered
by____
private insurance
Which of the following apply to group health plans? (Select all that apply.)
-Employer's human resource departments manage GHP benefits
-The group is considered the policyholder
-The individual is considered the certificate holder
When an employer changes standard coverage or providers during negotiations to reduce
the price of medical insurance, it is referred to as _____
carving out
During open enrollment periods, the employer provides tools (often web-based) and
information to do which of the following?
, Help employees match their personal and family needs with the best-priced plans
The FEHB is administered by which of the following?
Office of Personnel Management (OPM)
Which of the following statements apply to self-funded or self-insured health plans? (Select
all that apply.)
-Self-insured employers cover more than half of all employees in the United States
-Self-funded health plans also may buy other types of insurance, such as vision, instead of
insuring the benefit themselves
-The employer establishes the benefit levels and the plan types offered
Which of the following apply to the regulation of health care plans? (Select all that apply.)
-Self-funded health plans are regulated by the federal government (Employee Retirement Income
Security Act [ERISA] of 1974)
-Employer-sponsored "fully insured" plans are regulated by state laws
Under income tax law, the employer can collect an employee's insurance costs through a
_____.
pretax payroll deduction
The amount of time that must pass before a newly hired employee or a dependent is eligible
to enroll in many plans is known as a(n) _____.
waiting period
Which of the following apply to deductibles? (Select all that apply.)
-Deductibles are due per time period
-Noncovered services under the plan that the patient pays out of pocket are not counted toward
the deductible
The act that gives an employee who is leaving a job the right to continue health coverage
under the employer's plan is abbreviated as ____.
Consolidated Omnibus Budget Reconciliation Act (COBRA)
Which of the following apply to medical home model plans? (Select all that apply.)
-Emphasize communication among a patient's physicians
-Primary care physician is responsible for arranging patients' visits to specialists
-Replace Illness-based primary care with coordinated care
Which of the following statements apply to private payers? (Select all that apply.)
-Few employees choose indemnity health plans. (Because they would have to play more)
-CDHPs (consumer-driven health plan) combine a high deductible plan with a funding option of
