CEBS - GBA 1 & 2 PRACTICE
CERTIFICATION SCRIPT 2026 QUESTIONS
WITH SOLUTIONS GRADED A+
◍ Which of the following entities have participated in the risk adjustment
program of the Affordable Care Act?
I. All qualified health plans offered outside the exchangeI
I. Self-insured health plans offered on private exchangesII
I. Medicare Part D plans.
Answer: A.) None
◍ The definition of disability for Social Security Disability Insurance benefits
requires the impairment to be expected to result in death or to last for a
continuous period of at least how many months?
A. ) Three B.) Four C.) Five D.) Six E.) Twelve.
Answer: E.) Twelve
◍ Which of the following statements regarding the loading percentage for
health insurance rates is (are) correct?
I. The loading percentage is lower for group health insurance rates than it is
for individual health insurance rates.I
I. The loading percentage is lower for small groups than for large groups.II
I. The Affordable Care Act imposes penalties on insurers if their loading
fees are too high..
Answer: D.) I and III only
◍ Outline the administrative claims audit process (Mod 7.4).
Answer: An audit typically will begin with a kickoff meeting or call where
an overview of the process will be presented, to ensure that the plan
sponsor's objectives are fully understood and defined. The auditor will then
collect information from both the plan sponsor and its administrator. After
, receiving the data and information from both the plan sponsor and
administrator, most auditors will complete acomprehensive data analysis
and scrubbing process. The auditor will typically need to verify key plan
information or enrollment data to ensure an accurate audit. The auditor then
determines whether suspect claims were processed correctly. The next step
would normally be the on-site portion of the audit. The auditors will have
direct access to the administrator's system in order to validate potential
overpayments and underpayments and possible systemic errors/issues. Once
the on-site portion of the audit is complete, along with input from the
carrier/TPA, a draft audit report typically will be issued. After the carrier
provides feedback to the initial draft auditreport, any outstanding
discrepancies will be addressed, and a final audit report will be issued.
When the final audit report has been reviewed, common practice is to
schedule a conference call with all parties to discuss the audit process,
results, outstanding issues, recommendations for improvements and the
recovery process.
◍ List the types of plans that are exempt from ERISA (Mod 9.3).
Answer: (a) Government plans sponsored by a federal, state or local
government(b) Certain church plans(c) Plans subject to state law, including
workers' compensation, disability and unemployment programs(d) Foreign
plans established primarily for nonresident aliens(e) Unfunded excess
benefit plans(f) Unfunded payroll practices providing benefits such as
vacation, sick leave orother types of paid time off(g) Voluntary insurance
products if certain criteria are met
◍ Summarize the accounting and reporting requirements of ASC Topic 960
(Mod 5.1).
Answer: (a) The plan financial statements should be prepared on the accrual
basis of accounting and should include a statement of net assets available for
benefits as of the end of the plan year and a statement of changes in net
assets available for benefits for the plan year then ended.(b) Plan
investments should be presented at their fair value, except for insurance
contracts, which should be presented in the same manner as required for
, filing under ERISA (i.e., fair value or contract value).(c) Information should
be included about:• The actuarial present value of accumulated plan
benefits• Significant changes therein.(d) Accumulated plan benefit
information may be disclosed in one of three places:on the face of the
statements of net assets available for benefits and on changes in net assets
available for benefits, in separate statements or in the notes to the financial
statements.(e) The actuarial present value of accumulated plan benefits
should be based on employees' earnings and service rendered before the
measurement date. Plan actuaries should not consider future salary increases
or benefit improvements unless they have been specified (e.g., automatic
cost-of-living adjustments)
◍ Comment on the rate of inflation that should be used for retiree medical care
costs (Mod 11.5).
Answer: There is no consensus for the rate of inflation that should be used
for retiree medical care costs. The Medicare trustees project that per person
costs will increase at a 4.3% average annual rate. Other organizations use
different rates of inflation. Planners might want to choose two or three rates
in order to project different scenarios.
◍ Describe the general types of information that must be maintained for an
ERISA welfare benefit plan and the record retention requirement for these
documents (Mod 1.4).
Answer: Employers are required to keep sufficiently detailed information
and data necessary to verify, explain, clarify or check on documents for
accuracy and completeness, including vouchers, worksheets, receipts and
applicable resolutions. Records must be maintained for six years for ERISA
purposes, but other laws may require record retention for longer
periods.ERISA stipulates that records be maintained for at least six years
from the date the plan's associated Form 5500 is filed; however, because of
filing extensions, practitioners recommend retaining records for eight years
after the end of the applicable plan year.
◍ The Affordable Care Act defines a Patient Centered Medical Home (PCMH)
, as a model of care that has six core features. All of the following are
included in this list of core features EXCEPT:
A. ) The safe and high-quality care through evidence-informed medicine.
B.) The rare use of personal physicians. C.) A whole person orientation. D.)
The appropriate use of health information technology. E.) A payment that
recognizes added value from additional components of patient-centered
care..
Answer: B.) The rare use of personal physicians.
◍ The vast majority of long-term care needs are met by:
A. ) Medicare B.) Medicaid C.) Individual health insurance policies D.)
Long-term care insurance policies E.) Family members on an unpaid basis.
Answer: E.) Family members on an unpaid basis
◍ For global companies that sponsor DC retirement plans in different
countries, developing and applying a consistent investment philosophy
across many markets can be extremely challenging. What are the benefits
that might be achieved by such an approach? (Mod 12.4).
Answer: (a) Mobile employees(b) Simplified, streamlined governance(c)
Cleaner communication among plan decision makers around the world(d)
Application of best practices across borders(e) A logical framework to
explain plan decisions(f) A consistent approach to regional diversification
◍ Describe the 2013 US Supreme Court decision in Heimeshoff v Hartford
Life & Accident Insurance Company and explain the impact of this decision
(Mod 9.1).
Answer: In the Heimeshoff v. Hartford Life & Accident Insurance Company
decision, the Supreme Court gave its blessing to a contractual limitations
period, provided that it is reasonable in length and not subject to a
controlling statute to the contrary. This decision had a major impact because
in virtually all cases prior to this ruling, a court would consider a three-year
period, and perhaps even a two-year period, commencing with a benefit
claim denial or other definitive action of a plan administrator, to be
reasonable. Furthermore, with this decision it is now hard to argue that an
CERTIFICATION SCRIPT 2026 QUESTIONS
WITH SOLUTIONS GRADED A+
◍ Which of the following entities have participated in the risk adjustment
program of the Affordable Care Act?
I. All qualified health plans offered outside the exchangeI
I. Self-insured health plans offered on private exchangesII
I. Medicare Part D plans.
Answer: A.) None
◍ The definition of disability for Social Security Disability Insurance benefits
requires the impairment to be expected to result in death or to last for a
continuous period of at least how many months?
A. ) Three B.) Four C.) Five D.) Six E.) Twelve.
Answer: E.) Twelve
◍ Which of the following statements regarding the loading percentage for
health insurance rates is (are) correct?
I. The loading percentage is lower for group health insurance rates than it is
for individual health insurance rates.I
I. The loading percentage is lower for small groups than for large groups.II
I. The Affordable Care Act imposes penalties on insurers if their loading
fees are too high..
Answer: D.) I and III only
◍ Outline the administrative claims audit process (Mod 7.4).
Answer: An audit typically will begin with a kickoff meeting or call where
an overview of the process will be presented, to ensure that the plan
sponsor's objectives are fully understood and defined. The auditor will then
collect information from both the plan sponsor and its administrator. After
, receiving the data and information from both the plan sponsor and
administrator, most auditors will complete acomprehensive data analysis
and scrubbing process. The auditor will typically need to verify key plan
information or enrollment data to ensure an accurate audit. The auditor then
determines whether suspect claims were processed correctly. The next step
would normally be the on-site portion of the audit. The auditors will have
direct access to the administrator's system in order to validate potential
overpayments and underpayments and possible systemic errors/issues. Once
the on-site portion of the audit is complete, along with input from the
carrier/TPA, a draft audit report typically will be issued. After the carrier
provides feedback to the initial draft auditreport, any outstanding
discrepancies will be addressed, and a final audit report will be issued.
When the final audit report has been reviewed, common practice is to
schedule a conference call with all parties to discuss the audit process,
results, outstanding issues, recommendations for improvements and the
recovery process.
◍ List the types of plans that are exempt from ERISA (Mod 9.3).
Answer: (a) Government plans sponsored by a federal, state or local
government(b) Certain church plans(c) Plans subject to state law, including
workers' compensation, disability and unemployment programs(d) Foreign
plans established primarily for nonresident aliens(e) Unfunded excess
benefit plans(f) Unfunded payroll practices providing benefits such as
vacation, sick leave orother types of paid time off(g) Voluntary insurance
products if certain criteria are met
◍ Summarize the accounting and reporting requirements of ASC Topic 960
(Mod 5.1).
Answer: (a) The plan financial statements should be prepared on the accrual
basis of accounting and should include a statement of net assets available for
benefits as of the end of the plan year and a statement of changes in net
assets available for benefits for the plan year then ended.(b) Plan
investments should be presented at their fair value, except for insurance
contracts, which should be presented in the same manner as required for
, filing under ERISA (i.e., fair value or contract value).(c) Information should
be included about:• The actuarial present value of accumulated plan
benefits• Significant changes therein.(d) Accumulated plan benefit
information may be disclosed in one of three places:on the face of the
statements of net assets available for benefits and on changes in net assets
available for benefits, in separate statements or in the notes to the financial
statements.(e) The actuarial present value of accumulated plan benefits
should be based on employees' earnings and service rendered before the
measurement date. Plan actuaries should not consider future salary increases
or benefit improvements unless they have been specified (e.g., automatic
cost-of-living adjustments)
◍ Comment on the rate of inflation that should be used for retiree medical care
costs (Mod 11.5).
Answer: There is no consensus for the rate of inflation that should be used
for retiree medical care costs. The Medicare trustees project that per person
costs will increase at a 4.3% average annual rate. Other organizations use
different rates of inflation. Planners might want to choose two or three rates
in order to project different scenarios.
◍ Describe the general types of information that must be maintained for an
ERISA welfare benefit plan and the record retention requirement for these
documents (Mod 1.4).
Answer: Employers are required to keep sufficiently detailed information
and data necessary to verify, explain, clarify or check on documents for
accuracy and completeness, including vouchers, worksheets, receipts and
applicable resolutions. Records must be maintained for six years for ERISA
purposes, but other laws may require record retention for longer
periods.ERISA stipulates that records be maintained for at least six years
from the date the plan's associated Form 5500 is filed; however, because of
filing extensions, practitioners recommend retaining records for eight years
after the end of the applicable plan year.
◍ The Affordable Care Act defines a Patient Centered Medical Home (PCMH)
, as a model of care that has six core features. All of the following are
included in this list of core features EXCEPT:
A. ) The safe and high-quality care through evidence-informed medicine.
B.) The rare use of personal physicians. C.) A whole person orientation. D.)
The appropriate use of health information technology. E.) A payment that
recognizes added value from additional components of patient-centered
care..
Answer: B.) The rare use of personal physicians.
◍ The vast majority of long-term care needs are met by:
A. ) Medicare B.) Medicaid C.) Individual health insurance policies D.)
Long-term care insurance policies E.) Family members on an unpaid basis.
Answer: E.) Family members on an unpaid basis
◍ For global companies that sponsor DC retirement plans in different
countries, developing and applying a consistent investment philosophy
across many markets can be extremely challenging. What are the benefits
that might be achieved by such an approach? (Mod 12.4).
Answer: (a) Mobile employees(b) Simplified, streamlined governance(c)
Cleaner communication among plan decision makers around the world(d)
Application of best practices across borders(e) A logical framework to
explain plan decisions(f) A consistent approach to regional diversification
◍ Describe the 2013 US Supreme Court decision in Heimeshoff v Hartford
Life & Accident Insurance Company and explain the impact of this decision
(Mod 9.1).
Answer: In the Heimeshoff v. Hartford Life & Accident Insurance Company
decision, the Supreme Court gave its blessing to a contractual limitations
period, provided that it is reasonable in length and not subject to a
controlling statute to the contrary. This decision had a major impact because
in virtually all cases prior to this ruling, a court would consider a three-year
period, and perhaps even a two-year period, commencing with a benefit
claim denial or other definitive action of a plan administrator, to be
reasonable. Furthermore, with this decision it is now hard to argue that an
