CEBS GBA Exam 1
3 Examples of Tax Advantages of Employee Benefit Plans (Mod 1.2) - ANS-1: Employer
Contributions are Tax Deductible
2: Employer Contributions aren't taken into consideration earnings to Employees
three: Certain Retirement Benefits Accumulate Tax-Free until dispensed.
ACA created "Simple Cafeteria Plans." In what approaches are these extraordinary? (Mod
10.Five) - ANS-For eligible small Employers; must be designed with specific
eligibility/contribution necessities. In exchange, plans are instance from non-discrimination
trying out.
ADA standards for Wellness programs (Mod eight.2) - ANS-(2000) The program is
considered voluntary so long as the business enterprise does now not require participation
and does no longer penalize employees who do not participate. (2014) Employer companies
urge that economic incentives must be approved for wellbeing participation. (2016) EEOC
problems rule permitting using monetary incentive for packages that encompass scientific
inquiries with a most of 30% of the whole cost of worker simplest coverage.
After WWII, why did insurers region limits on outpatient hospital treatment? (Mod 7.1) -
ANS-Treatment persisted for indefinite durations of time, a whole lot subjectivity concerning
remedy.
Broad view of Employee Benefits (Mod 1.1) - ANS-Considers Employee Benefits to be
sincerely any shape of compensation apart from direct wages paid to Employees (Ex: WC,
Unemployment, State DI, SS, Vacation, Holidays, 401K/Retirement, Employer proportion of
Medical, Severance Pay, Child Care, and so on..)
Cafe Plans are difficulty to insurance and nondiscrimination exams. Some observe to plan
as a whole while a few apply to underlying benefits. Provide evaluation of every trying out
shape (Mod 10.5) - ANS-3 Overall Tests:
Eligibility Test: May now not discriminate in prefer of tremendously compensated EEs as the
ability to take part
-classification/period of services/participation test
-no EE required to finish greater than three YOS
-defining pretty comped EE (5% proprietor, or particularly paid character - subjectively)
-Aug 2007 delivered blessings thing determination to make sure advantages similarly to be
had to all EEs
Contributions and Benefits Test: Plan have to contribute and benefits to be had on a
non-discriminatory foundation and plan fails take a look at if relatively comped EEs select
more nontaxable advantages than non extraordinarily comped EEs
-Benefits element to decide if blessings/contributions are similarly to be had to all EEs
,-Utilization element: rather comped EEs are disproportionately using all blessings; uniformed
possibility to choose blessings
-If presenting health benefits, not discriminatory if any contributions made on behalf of the
EE are same to: 100% of price of fitness below the plan of the majority of incredibly comped
are similarly situated; seventy five% of the fee of maximum steeply-priced benefits elected
via any similarly situated participant
Key EE Concentration Test: Plan's Key EE contributions can not exceed 25% of the entire
contributions into the plan.
-Key EE: Officer incomes $175,000+, 5% Owner or 1% Owner Earning $a hundred and
fifty,000+
-Test is based totally on stage of coverage rather than degree of reimbursements
Cafe Plans are problem to what different laws (Mod nine.Five) - ANS--COBRA
-FMLA
-HIPAA
-MHPA
-MHPAEA
-NMHPA
-WHCRA
-MMA
-WFTRA
-HEART
-Michelle's Law
-GINA
-PPACA
Common techniques to govern pharmacy costs (Mod 6.Three) - ANS-1 = Review design of
advantages to peer in the event that they suit basic scientific program (flat copays/no incr)
2 = Analyze revel in to pick out areas that need better management
3 = Reduce pharmacy network to smallest length w/o compromising get admission to
four = Offer mail provider
5 = Promote generics
6 = Use/develop fee effective formulary
7 = Practice utilization control
8 = Physician profiling
nine = Educate and talk to participants the plan
10 = Anticipate monetary impact of recent capsules
Compare Compensation/Service Oriented Benefit Philosophy with the Needs-Oriented (Mod
1.4) - ANS-Compensation/Service: EBP created from typically compensation, carrier or both.
Level of benefits tied to income or pay stages/years of service
Needs Orientated: Focuses on Needs of EE's and their dependents
Compare variations of behavioral health treatments: inpatient, partial (day), outpatient (Mod
7.Five) - ANS--Acute inpatient: maximum severe, not able to care for themselves: suicidal,
homicidal
,-Partial medical institution: offer intensive day remedy however patient returns home
overnight
-Intensive Outpatient: patient needs greater extensive than weekly, but fewer hours every
day than partial facilities
Compare insurance mechanism to gambling (Mod 2.Three) - ANS-Insurance is a
mechanism to handling present chance - playing creates hazard in which one did no longer
previously exist. Risk as a result of gambling is 100% speculative, even as coverage deals
with natural danger. Gambling includes a benefit for one birthday celebration while coverage
is a mutual sharing of any losses. The loser in the playing transaction stays in a bad
scenario whilst the insured is financially restored in whole or part to earlier situation.
Compare rates, contributions and deductibles of HDHP/HRAs vs HDHP/HSAs (Mod 4.2) -
ANS-HDHP/HSAs have a tendency to have lower premiums, lower worker contributions and
higher deductibles than HDHP/HRAs. EE's personal manipulate of HSA, at the same time as
ER controls HRA.
Contrast between an In-Network (Preferred) vs an Out-of-Network (Non-Preferred) Provider
(Mod 3.Three) - ANS-In-Network: Contract with man or woman's medical insurance plan to
offer services to the member at a discount (for extended extent). Some plans may
additionally have a tiered shape with various out of pocket costs.
Out-of-Network: No settlement with insurance plan...When available, costs are substantially
better.
Contrast PPO's vs POS' (Mod three.1) - ANS-Both overlap substantially. Differences do
consist of primary care provider requirement through POS however not PPO; decrease
copay quantities for desired care in POS than in PPO; smaller network in a POS than PPO.
Define a Cafeteria Plan (Mod 9.1) - ANS-A plan beneath which all individuals are personnel
(now not proprietors or shareholders) and all individuals may additionally pick out from a
mixture of alternatives- certified benefits or cash.
Benefits can't be provided: Whole Life Insurance and Long-Term Care Insurance.
Define a combination dental plan (Mod five.2) - ANS-Certain techniques on a scheduled
basis at the same time as a few are on a non-scheduled foundation.
Define a Welfare benefit plan (Mod 9.5) - ANS-Any plan, fund or software that is set up or
maintained by way of an agency or employee agency for the purposes of providing
contributors scientific, disability or unemployment advantages. Also might also include
vacation, training packages and criminal offerings.
Define Accumulation-Orientated Benefits (Mod 1.5) - ANS-Consist of Pension Plans,
Profit-Sharing, Savings, 401K, and many others...Which reward an Employee for long carrier
with an Employer. Involve a longer probationary period on account that viewed as a praise -
not a disadvantage for long-time period personnel.
, Define an incentive dental plan (Mod five.2) - ANS-Program that incentivizes sound dental
hygiene thru growing compensation degrees - handiest applies to preventative and
maintenance. When deductibles practice, handiest on lifetime basis.
Define and give an explanation for 3 sorts of health system performance reviews (Mod
12.Three) - ANS-Audit Performance Evaluations (APE):
-compares fitness system with a declaration of what is anticipated; if ER desires to offer
fitness advantages, they could settlement with a health gadget; ER wants to realize whether
or not fitness system provides the offerings wished, so would possibly use evaluator to
specify; some other example is National Committee for Quality Assurance (NCQA)
accreditation of ACO - responsible care organization that is a community of medical doctors
and hospitals that anticipate financial duty coping with the fitness care of a particular
institution of patients - if able to offer lower costs, they acquire economic awards. NCQA
presents accreditation to all ACOs, that's ex of APE
Single-case time fashion performance eval:
-music performance of fitness machine over the years; use mechanically amassed and
suggested records and examine at extraordinary times
Service-assessment overall performance assessment:
-evaluate performance of a set of services at one time, in relation to one or greater
dimensions of carrier performance; most advanced and longest jogging systems record
high-quality and protection records but no longer expenses, so fee evaluation not viable.
Define AWP, WAC and MAC (Mod 6.1) - ANS-AWP = Average Wholesale Price - assigned
with the aid of drug manufacturer, reference charge for all discounts paid to pharmacies and
PBMs.
WAC = Wholesale acquisition cost (average manufacturers price) - charge at which
wholesalers buy prescription drugs from manufacturers.
MAC = Maximum Allowable Cost - of regular places a ceiling on compensation for
widespread medicine. Concept of Medicaid/Medicare with the aid of Centers for
Medicaid/Medicare Services (CMS). PBMs and TPAs advanced their own MAC to cowl all
generics - because of variety, can be average cost of all manufacturers AWPs, lowest AWP,
or a few derived formulation.
Define not unusual styles of Employer Sponsored Health Plans (Mod three.1) - ANS-1: HMO
(Health Maintenance Organization)
2: PPO (Preferred Provider Organization)
three: POS (Point of Service Plan)
four: HDHP (High Deductible Health Plan) - related to Tax-Advantaged Savings Account
Define idea of danger (Mod 2.1) - ANS-Uncertainty with admire to viable losses. Inability to
determine with fact the actual quantity and cost of claims.
Define HSAs in a Cafe Plan (Mod 10.Four) - ANS-Health Savings Accounts;
3 Examples of Tax Advantages of Employee Benefit Plans (Mod 1.2) - ANS-1: Employer
Contributions are Tax Deductible
2: Employer Contributions aren't taken into consideration earnings to Employees
three: Certain Retirement Benefits Accumulate Tax-Free until dispensed.
ACA created "Simple Cafeteria Plans." In what approaches are these extraordinary? (Mod
10.Five) - ANS-For eligible small Employers; must be designed with specific
eligibility/contribution necessities. In exchange, plans are instance from non-discrimination
trying out.
ADA standards for Wellness programs (Mod eight.2) - ANS-(2000) The program is
considered voluntary so long as the business enterprise does now not require participation
and does no longer penalize employees who do not participate. (2014) Employer companies
urge that economic incentives must be approved for wellbeing participation. (2016) EEOC
problems rule permitting using monetary incentive for packages that encompass scientific
inquiries with a most of 30% of the whole cost of worker simplest coverage.
After WWII, why did insurers region limits on outpatient hospital treatment? (Mod 7.1) -
ANS-Treatment persisted for indefinite durations of time, a whole lot subjectivity concerning
remedy.
Broad view of Employee Benefits (Mod 1.1) - ANS-Considers Employee Benefits to be
sincerely any shape of compensation apart from direct wages paid to Employees (Ex: WC,
Unemployment, State DI, SS, Vacation, Holidays, 401K/Retirement, Employer proportion of
Medical, Severance Pay, Child Care, and so on..)
Cafe Plans are difficulty to insurance and nondiscrimination exams. Some observe to plan
as a whole while a few apply to underlying benefits. Provide evaluation of every trying out
shape (Mod 10.5) - ANS-3 Overall Tests:
Eligibility Test: May now not discriminate in prefer of tremendously compensated EEs as the
ability to take part
-classification/period of services/participation test
-no EE required to finish greater than three YOS
-defining pretty comped EE (5% proprietor, or particularly paid character - subjectively)
-Aug 2007 delivered blessings thing determination to make sure advantages similarly to be
had to all EEs
Contributions and Benefits Test: Plan have to contribute and benefits to be had on a
non-discriminatory foundation and plan fails take a look at if relatively comped EEs select
more nontaxable advantages than non extraordinarily comped EEs
-Benefits element to decide if blessings/contributions are similarly to be had to all EEs
,-Utilization element: rather comped EEs are disproportionately using all blessings; uniformed
possibility to choose blessings
-If presenting health benefits, not discriminatory if any contributions made on behalf of the
EE are same to: 100% of price of fitness below the plan of the majority of incredibly comped
are similarly situated; seventy five% of the fee of maximum steeply-priced benefits elected
via any similarly situated participant
Key EE Concentration Test: Plan's Key EE contributions can not exceed 25% of the entire
contributions into the plan.
-Key EE: Officer incomes $175,000+, 5% Owner or 1% Owner Earning $a hundred and
fifty,000+
-Test is based totally on stage of coverage rather than degree of reimbursements
Cafe Plans are problem to what different laws (Mod nine.Five) - ANS--COBRA
-FMLA
-HIPAA
-MHPA
-MHPAEA
-NMHPA
-WHCRA
-MMA
-WFTRA
-HEART
-Michelle's Law
-GINA
-PPACA
Common techniques to govern pharmacy costs (Mod 6.Three) - ANS-1 = Review design of
advantages to peer in the event that they suit basic scientific program (flat copays/no incr)
2 = Analyze revel in to pick out areas that need better management
3 = Reduce pharmacy network to smallest length w/o compromising get admission to
four = Offer mail provider
5 = Promote generics
6 = Use/develop fee effective formulary
7 = Practice utilization control
8 = Physician profiling
nine = Educate and talk to participants the plan
10 = Anticipate monetary impact of recent capsules
Compare Compensation/Service Oriented Benefit Philosophy with the Needs-Oriented (Mod
1.4) - ANS-Compensation/Service: EBP created from typically compensation, carrier or both.
Level of benefits tied to income or pay stages/years of service
Needs Orientated: Focuses on Needs of EE's and their dependents
Compare variations of behavioral health treatments: inpatient, partial (day), outpatient (Mod
7.Five) - ANS--Acute inpatient: maximum severe, not able to care for themselves: suicidal,
homicidal
,-Partial medical institution: offer intensive day remedy however patient returns home
overnight
-Intensive Outpatient: patient needs greater extensive than weekly, but fewer hours every
day than partial facilities
Compare insurance mechanism to gambling (Mod 2.Three) - ANS-Insurance is a
mechanism to handling present chance - playing creates hazard in which one did no longer
previously exist. Risk as a result of gambling is 100% speculative, even as coverage deals
with natural danger. Gambling includes a benefit for one birthday celebration while coverage
is a mutual sharing of any losses. The loser in the playing transaction stays in a bad
scenario whilst the insured is financially restored in whole or part to earlier situation.
Compare rates, contributions and deductibles of HDHP/HRAs vs HDHP/HSAs (Mod 4.2) -
ANS-HDHP/HSAs have a tendency to have lower premiums, lower worker contributions and
higher deductibles than HDHP/HRAs. EE's personal manipulate of HSA, at the same time as
ER controls HRA.
Contrast between an In-Network (Preferred) vs an Out-of-Network (Non-Preferred) Provider
(Mod 3.Three) - ANS-In-Network: Contract with man or woman's medical insurance plan to
offer services to the member at a discount (for extended extent). Some plans may
additionally have a tiered shape with various out of pocket costs.
Out-of-Network: No settlement with insurance plan...When available, costs are substantially
better.
Contrast PPO's vs POS' (Mod three.1) - ANS-Both overlap substantially. Differences do
consist of primary care provider requirement through POS however not PPO; decrease
copay quantities for desired care in POS than in PPO; smaller network in a POS than PPO.
Define a Cafeteria Plan (Mod 9.1) - ANS-A plan beneath which all individuals are personnel
(now not proprietors or shareholders) and all individuals may additionally pick out from a
mixture of alternatives- certified benefits or cash.
Benefits can't be provided: Whole Life Insurance and Long-Term Care Insurance.
Define a combination dental plan (Mod five.2) - ANS-Certain techniques on a scheduled
basis at the same time as a few are on a non-scheduled foundation.
Define a Welfare benefit plan (Mod 9.5) - ANS-Any plan, fund or software that is set up or
maintained by way of an agency or employee agency for the purposes of providing
contributors scientific, disability or unemployment advantages. Also might also include
vacation, training packages and criminal offerings.
Define Accumulation-Orientated Benefits (Mod 1.5) - ANS-Consist of Pension Plans,
Profit-Sharing, Savings, 401K, and many others...Which reward an Employee for long carrier
with an Employer. Involve a longer probationary period on account that viewed as a praise -
not a disadvantage for long-time period personnel.
, Define an incentive dental plan (Mod five.2) - ANS-Program that incentivizes sound dental
hygiene thru growing compensation degrees - handiest applies to preventative and
maintenance. When deductibles practice, handiest on lifetime basis.
Define and give an explanation for 3 sorts of health system performance reviews (Mod
12.Three) - ANS-Audit Performance Evaluations (APE):
-compares fitness system with a declaration of what is anticipated; if ER desires to offer
fitness advantages, they could settlement with a health gadget; ER wants to realize whether
or not fitness system provides the offerings wished, so would possibly use evaluator to
specify; some other example is National Committee for Quality Assurance (NCQA)
accreditation of ACO - responsible care organization that is a community of medical doctors
and hospitals that anticipate financial duty coping with the fitness care of a particular
institution of patients - if able to offer lower costs, they acquire economic awards. NCQA
presents accreditation to all ACOs, that's ex of APE
Single-case time fashion performance eval:
-music performance of fitness machine over the years; use mechanically amassed and
suggested records and examine at extraordinary times
Service-assessment overall performance assessment:
-evaluate performance of a set of services at one time, in relation to one or greater
dimensions of carrier performance; most advanced and longest jogging systems record
high-quality and protection records but no longer expenses, so fee evaluation not viable.
Define AWP, WAC and MAC (Mod 6.1) - ANS-AWP = Average Wholesale Price - assigned
with the aid of drug manufacturer, reference charge for all discounts paid to pharmacies and
PBMs.
WAC = Wholesale acquisition cost (average manufacturers price) - charge at which
wholesalers buy prescription drugs from manufacturers.
MAC = Maximum Allowable Cost - of regular places a ceiling on compensation for
widespread medicine. Concept of Medicaid/Medicare with the aid of Centers for
Medicaid/Medicare Services (CMS). PBMs and TPAs advanced their own MAC to cowl all
generics - because of variety, can be average cost of all manufacturers AWPs, lowest AWP,
or a few derived formulation.
Define not unusual styles of Employer Sponsored Health Plans (Mod three.1) - ANS-1: HMO
(Health Maintenance Organization)
2: PPO (Preferred Provider Organization)
three: POS (Point of Service Plan)
four: HDHP (High Deductible Health Plan) - related to Tax-Advantaged Savings Account
Define idea of danger (Mod 2.1) - ANS-Uncertainty with admire to viable losses. Inability to
determine with fact the actual quantity and cost of claims.
Define HSAs in a Cafe Plan (Mod 10.Four) - ANS-Health Savings Accounts;
