Question 1

Which of the following is a characteristic of a health maintenance organization (HMO) ?

Accepted Answer

A)   unlimited choice of health-care providers
B)   no premiums until care is provided
C)   narrow, limited, medical services provided
D)   emphasis on cost containmentE) A) and C)
F) All of the above

Question 2

An HMO that contracts with two or more independent group practices to provide medical services to covered members is called a(n)

Accepted Answer

A)   group model HMO.
B)   network model HMO.
C)   staff model HMO.
D)   individual practice association HMO.E) A) and B)
F) None of the above

Question 3

All of the following statements about cost controls in dental insurance plans are true EXCEPT

Accepted Answer

A)   The coinsurance percentage used may vary by type of dental service.
B)   Cosmetic dental work is usually excluded.
C)   The limit on benefits may be expressed as an annual limit or as a lifetime limit for certain types of dental services.
D)   To eliminate small claims, there is no coverage for routine oral examinations, X-rays, or cleaning teeth.E) C) and D)
F) All of the above

Question 4

Reasons for having a minimum participation requirement before a group is eligible for insurance include which of the following?
I.To lower the expense rate per unit of insurance
II.To minimize the possibility of insuring a group which consists largely of unhealthy individuals

Accepted Answer

A)   I only
B)   II only
C)   both I and II
D)   neither I nor IIE) All of the above
F) None of the above

Question 5

Which of the following is a provision of the Affordable Care Act?

Accepted Answer

A)   strengthening the use of pre-existing conditions exclusions
B)   prohibition of harmful practices by insurers.
C)   introduction of annual and lifetime limits to control costs
D)   elimination of flexible spending accountsE) A) and B)
F) C) and D)

Question 6

Marv is covered by a group health insurance plan at work. His employer funds the entire cost of the group health insurance. Because of this characteristic, the group health insurance plan can be described as

Accepted Answer

A)   defined benefit.
B)   contributory.
C)   defined contribution.
D)   noncontributory.E) C) and D)
F) B) and C)

Question 7

Which of the following statements about cafeteria plans is (are)  true?
I.Unspent flexible spending account balances are refunded to the employee, tax-free, at year-end.
II.Cafeteria plans enable employees to select benefits that meet their specific needs.

Accepted Answer

A)   I only
B)   II only
C)   both I and II
D)   neither I nor IIE) B) and C)
F) A) and D)

Question 8

Which of the following statements about the continuation of group health insurance under the COBRA law is true?

Accepted Answer

A)   A continuation of coverage must be made available even if an employee voluntarily terminates employment.
B)   The length of the continuation of coverage is 90 days.
C)   The option to continue coverage applies to minor children only, not to adults.
D)   The employer must pay the entire cost of coverage during the continuation period.E) All of the above
F) B) and C)

Question 9

Under older group medical expense plans, physicians were paid a fee for each covered service and were reimbursed on the basis of reasonable and customary charges, up to a maximum limit. These older group medical expense plans were called

Accepted Answer

A)   service medical plans.
B)   managed care plans.
C)   point-of-service plans.
D)   indemnity plans.E) A) and D)
F) A) and C)

Question 10

The Affordable Care Act requires employers with 100 or more employees to provide health insurance on the employees or pay a penalty if at least one employee receives a tax credit and coverage through the Health Insurance Marketplace. This requirement-providing insurance or paying a fine-is known as the

Accepted Answer

A)   single-payer solution.
B)   employer shared responsibility.
C)   essential benefit requirement.
D)   portability requirement.E) A) and B)
F) A) and C)

Question 11

Connors Company self-funds the medical expense benefits that it provides to its employees. Connors Company has a contract with a commercial health insurance company providing that the health insurance company will pay all claims in excess of $250,000. The arrangement with the health insurance company is called

Accepted Answer

A)   reinsurance.
B)   managed care.
C)   stop-loss insurance.
D)   coinsurance.E) A) and C)
F) A) and D)

Question 12

Which of the following statements regarding recent developments in employer-sponsored health plans is (are)  true?
I.Preferred provider organizations (PPOs)  continue to dominate group health insurance markets.
II.The number of employers offering medical benefits to workers who retire early has increased.

Accepted Answer

A)   I only
B)   II only
C)   both I and II
D)   neither I nor IIE) All of the above
F) A) and B)

Question 13

An employer-funded plan with favorable tax advantages, which repays employees for medical care not covered by the employer's standard medical plan is a(n)

Accepted Answer

A)   401(k)  account.
B)   individual retirement account (IR
A)  .
C)   health reimbursement arrangement (HR
A)  .
D)   flexible spending account (FS
A)  .E) All of the above
F) None of the above

Exam 16: Employee Benefits: Group Life and Health Insurance

An employer-funded plan with favorable tax advantages, which repays employees for medical care not covered by the employer's standard medical plan is a(n)

Correct Answer
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Which of the following statements about cafeteria plans is (are) true? I.Unspent flexible spending account balances are refunded to the employee, tax-free, at year-end. II.Cafeteria plans enable employees to select benefits that meet their specific needs.

Correct Answer
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Correct Answer
verified

Correct Answer
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Which of the following is a provision of the Affordable Care Act?

Correct Answer
verified

Under older group medical expense plans, physicians were paid a fee for each covered service and were reimbursed on the basis of reasonable and customary charges, up to a maximum limit. These older group medical expense plans were called

Correct Answer
verified

An HMO that contracts with two or more independent group practices to provide medical services to covered members is called a(n)

Correct Answer
verified

Marv is covered by a group health insurance plan at work. His employer funds the entire cost of the group health insurance. Because of this characteristic, the group health insurance plan can be described as

Correct Answer
verified

All of the following statements about cost controls in dental insurance plans are true EXCEPT

Correct Answer
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Which of the following statements about the continuation of group health insurance under the COBRA law is true?

Correct Answer
verified

Reasons for having a minimum participation requirement before a group is eligible for insurance include which of the following? I.To lower the expense rate per unit of insurance II.To minimize the possibility of insuring a group which consists largely of unhealthy individuals

Correct Answer
verified

Correct Answer
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Which of the following is a characteristic of a health maintenance organization (HMO) ?

Correct Answer
verified

Exam 16: Employee Benefits: Group Life and Health Insurance

An employer-funded plan with favorable tax advantages, which repays employees for medical care not covered by the employer's standard medical plan is a(n)

Correct AnswerverifiedShow Answer

Which of the following statements about cafeteria plans is (are) true? I.Unspent flexible spending account balances are refunded to the employee, tax-free, at year-end. II.Cafeteria plans enable employees to select benefits that meet their specific needs.

Correct AnswerverifiedShow Answer

Correct AnswerverifiedShow Answer

Correct AnswerverifiedShow Answer

Which of the following is a provision of the Affordable Care Act?

Correct AnswerverifiedShow Answer

Under older group medical expense plans, physicians were paid a fee for each covered service and were reimbursed on the basis of reasonable and customary charges, up to a maximum limit. These older group medical expense plans were called

Correct AnswerverifiedShow Answer

An HMO that contracts with two or more independent group practices to provide medical services to covered members is called a(n)

Correct AnswerverifiedShow Answer

Marv is covered by a group health insurance plan at work. His employer funds the entire cost of the group health insurance. Because of this characteristic, the group health insurance plan can be described as

Correct AnswerverifiedShow Answer

All of the following statements about cost controls in dental insurance plans are true EXCEPT

Correct AnswerverifiedShow Answer

Which of the following statements about the continuation of group health insurance under the COBRA law is true?

Correct AnswerverifiedShow Answer

Reasons for having a minimum participation requirement before a group is eligible for insurance include which of the following? I.To lower the expense rate per unit of insurance II.To minimize the possibility of insuring a group which consists largely of unhealthy individuals

Correct AnswerverifiedShow Answer

Correct AnswerverifiedShow Answer

Which of the following is a characteristic of a health maintenance organization (HMO) ?

Correct AnswerverifiedShow Answer

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