Question 1

Which of the following statements is true of health care costs? (Health-Care Coverage and Costs)

Accepted Answer

A) Many private-sector companies require employees to contribute a portion of health-care premiums because of their considerable cost. 
B) The premiums for fully insured plans is likely to decrease. 
C) The highest paid workers contribute the most towards the cost of their health insurance. 
D) Employees contributed 42% of the cost for single coverage and 62% for family coverage. 
A) Many private-sector companies require employees to contribute a portion of health-care premiums because of their considerable cost. 
B) The premiums for fully insured plans is likely to decrease. 
C) The highest paid workers contribute the most towards the cost of their health insurance. 
D) Employees contributed 42% of the cost for single coverage and 62% for family coverage.

Question 2

In consumer-driven health care plans,the first tier is a pretax account that allows employees to pay for services using pretax dollars.(Consumer-Driven Health Care)

Accepted Answer

A) True 
 B)False

Question 3

Formularies are lists of drugs proven to be clinically appropriate and cost effective.(Prescription Drug Benefits)

Accepted Answer

A) True 
 B)False

Question 4

These types of insurance plans are set up to cover things like dental care,vision care and prescription drugs (Other Health-Care-Related Benefits)

Accepted Answer

A) Flexible savings plans 
B) Flexible services accounts 
C) Carve-out plans 
D) Health services accounts 
A) Flexible savings plans 
B) Flexible services accounts 
C) Carve-out plans 
D) Health services accounts

Question 5

Employers can offer health-care plans using fully insured or self-funded plans.(Defining and Exploring Health-Care Plans)

Accepted Answer

A) True 
 B)False

Question 6

This prescription drug plan is usually associated with indemnity plans,pays benefits after the employee has met the deductible and tends to charge the most for filling the prescriptions.(Prescription Drug Benefits)

Accepted Answer

A) Drug prescription plan 
B) Mail order prescription drug program 
C) Medical reimbursement plan 
D) Prescription card program 
A) Drug prescription plan 
B) Mail order prescription drug program 
C) Medical reimbursement plan 
D) Prescription card program

Question 7

Network model HMOs primarily use contracts with established practices of physicians that cover multiple specialties,but do not directly employ physicians.(Prepaid Group Practice Model)

Accepted Answer

A) True 
 B)False

Question 8

State health instructor laws address all BUT which of the following (State Regulations)

Accepted Answer

A) Extending coverage to particular services,treatments or health conditions 
B) Reimbursing recognized health-care providers for health care services 
C) Employer's self-funded plans 
D) Length of time coverage must be available to employees who terminate employment 
A) Extending coverage to particular services,treatments or health conditions 
B) Reimbursing recognized health-care providers for health care services 
C) Employer's self-funded plans 
D) Length of time coverage must be available to employees who terminate employment

Question 9

Which of the following does not fall within the scope of the role of a primary care physician? (Exhibit 5.4,Role of Primary Care Physicians)

Accepted Answer

A) Making initial diagnosis and evaluation of patient's condition 
B) Identifying applicable treatment protocols and practice guidelines 
C) Providing specialist diagnosis 
D) Deciding what treatment is warranted 
A) Making initial diagnosis and evaluation of patient's condition 
B) Identifying applicable treatment protocols and practice guidelines 
C) Providing specialist diagnosis 
D) Deciding what treatment is warranted

Question 10

What are the three specific forms of prepaid group practices? (Prepaid Group Practice Model)

Accepted Answer

A) Universal model HMOs,group model HMOs,staff model HMOs 
B) Group model HMOs,network model HMOs,universal model HMOs 
C) Staff model HMOs,group model HMOs,network model HMOs 
D) Network model HMOs universal model HMOs,staff model HMOs 
A) Universal model HMOs,group model HMOs,staff model HMOs 
B) Group model HMOs,network model HMOs,universal model HMOs 
C) Staff model HMOs,group model HMOs,network model HMOs 
D) Network model HMOs universal model HMOs,staff model HMOs

Question 11

A premium is the amount an employer pays to establish and maintain a health-care plans.(Defining and Exploring Health-Care Plans)
29.Company-sponsored care benefits appeared in the late 1800s for mining and railroad workers when companies hired doctors to provide medical services to employees.(Origins of Health-Care Benefits)

Accepted Answer

A) True 
 B)False

Question 12

The Patient Protection and Affordable Care Act distinguishes between health plans that existed prior to the enactment date (grandfathered plans)and those that come into existence afterward (non-grandfathered plans).(Patient Protection and Affordable Care Act of 2010)

Accepted Answer

A) True 
 B)False

Question 13

Fee-for-service plans pay benefits on a reimbursement basis and they generally do not rely on networks of health-care providers.(Fee-For-Service Plans)

Accepted Answer

A) True 
 B)False

Question 14

What are the three common forms of managed care plans? (Managed Care Plans)

Accepted Answer

A) Individual practice organizations,point-of-service plans,health maintenance organizations 
B) Health maintenance organizations,preferred provider organizations,point-of-service plans 
C) Preferred provider organizations,point-of-service plans,individual practice organizations 
D) Preferred provider organizations,health maintenance organizations,individual practice organizations 
A) Individual practice organizations,point-of-service plans,health maintenance organizations 
B) Health maintenance organizations,preferred provider organizations,point-of-service plans 
C) Preferred provider organizations,point-of-service plans,individual practice organizations 
D) Preferred provider organizations,health maintenance organizations,individual practice organizations

Question 15

Morbidity tables express annual probabilities of the occurrence of health problems.(Defining and Exploring Health-Care Plans)

Accepted Answer

A) True 
 B)False

Question 16

Discuss consumer-driven health-care plans briefly.(Consumer-Driven Health Care)

Accepted Answer

Main Points 
● Refers to the objective o

Question 17

In 2015,half of the private-sector workers in opposite-sex partnerships had access to health-care benefits.(Health-Care Coverage and Costs)

Accepted Answer

A) True 
 B)False

Question 18

The National Association of Insurance Commissioners deals with state level issues relating to supervision of insurance.(State Regulations)

Accepted Answer

A) True 
 B)False

Question 19

_____ pay medical service providers a fixed amount based on the number of people enrolled,regardless of services received.(Health Plan Design Alternatives)

Accepted Answer

A) Indemnity plans 
B) Fee-for-service plans 
C) Self-funded plans 
D) Prepaid plans 
A) Indemnity plans 
B) Fee-for-service plans 
C) Self-funded plans 
D) Prepaid plans

Question 20

A point-of-service plan requires the selection of a primary care physician,similar to HMOs.(Point-of-Service Plans)

Accepted Answer

A) True 
 B)False

Which of the following statements is true of health care costs? (Health-Care Coverage and Costs)

In consumer-driven health care plans,the first tier is a pretax account that allows employees to pay for services using pretax dollars.(Consumer-Driven Health Care)

Formularies are lists of drugs proven to be clinically appropriate and cost effective.(Prescription Drug Benefits)

These types of insurance plans are set up to cover things like dental care,vision care and prescription drugs (Other Health-Care-Related Benefits)

Employers can offer health-care plans using fully insured or self-funded plans.(Defining and Exploring Health-Care Plans)

This prescription drug plan is usually associated with indemnity plans,pays benefits after the employee has met the deductible and tends to charge the most for filling the prescriptions.(Prescription Drug Benefits)

Network model HMOs primarily use contracts with established practices of physicians that cover multiple specialties,but do not directly employ physicians.(Prepaid Group Practice Model)

State health instructor laws address all BUT which of the following (State Regulations)

Which of the following does not fall within the scope of the role of a primary care physician? (Exhibit 5.4,Role of Primary Care Physicians)

What are the three specific forms of prepaid group practices? (Prepaid Group Practice Model)

The Patient Protection and Affordable Care Act distinguishes between health plans that existed prior to the enactment date (grandfathered plans)and those that come into existence afterward (non-grandfathered plans).(Patient Protection and Affordable Care Act of 2010)

Fee-for-service plans pay benefits on a reimbursement basis and they generally do not rely on networks of health-care providers.(Fee-For-Service Plans)

What are the three common forms of managed care plans? (Managed Care Plans)

Morbidity tables express annual probabilities of the occurrence of health problems.(Defining and Exploring Health-Care Plans)

Discuss consumer-driven health-care plans briefly.(Consumer-Driven Health Care)

In 2015,half of the private-sector workers in opposite-sex partnerships had access to health-care benefits.(Health-Care Coverage and Costs)

The National Association of Insurance Commissioners deals with state level issues relating to supervision of insurance.(State Regulations)

_____ pay medical service providers a fixed amount based on the number of people enrolled,regardless of services received.(Health Plan Design Alternatives)

A point-of-service plan requires the selection of a primary care physician,similar to HMOs.(Point-of-Service Plans)

Introducing Employee Benefits

The Psychology and Economics of Employee Benefits

Regulating Employee Benefits

Employer-Sponsored Retirement Plans

Employer-Sponsored Disability Insurance, life Insurance, and Workers Compensation

Government-Mandated Social Security Programs

Paid Time-Off and Flexible Work Schedule Benefits

Accommodation and Enhancement Benefits

Managing the Employee-Benefits System

Nonqualified Deferred Compensation Plans for Executives

Global Employee Benefits at a Glance

Filters

Exam 5: Employer-Sponsored Health-Care Plans

Which of the following statements is true of health care costs? (Health-Care Coverage and Costs)

In consumer-driven health care plans,the first tier is a pretax account that allows employees to pay for services using pretax dollars.(Consumer-Driven Health Care)

Formularies are lists of drugs proven to be clinically appropriate and cost effective.(Prescription Drug Benefits)

These types of insurance plans are set up to cover things like dental care,vision care and prescription drugs (Other Health-Care-Related Benefits)

Employers can offer health-care plans using fully insured or self-funded plans.(Defining and Exploring Health-Care Plans)

This prescription drug plan is usually associated with indemnity plans,pays benefits after the employee has met the deductible and tends to charge the most for filling the prescriptions.(Prescription Drug Benefits)

Network model HMOs primarily use contracts with established practices of physicians that cover multiple specialties,but do not directly employ physicians.(Prepaid Group Practice Model)

State health instructor laws address all BUT which of the following (State Regulations)

Which of the following does not fall within the scope of the role of a primary care physician? (Exhibit 5.4,Role of Primary Care Physicians)

What are the three specific forms of prepaid group practices? (Prepaid Group Practice Model)

The Patient Protection and Affordable Care Act distinguishes between health plans that existed prior to the enactment date (grandfathered plans)and those that come into existence afterward (non-grandfathered plans).(Patient Protection and Affordable Care Act of 2010)

Fee-for-service plans pay benefits on a reimbursement basis and they generally do not rely on networks of health-care providers.(Fee-For-Service Plans)

What are the three common forms of managed care plans? (Managed Care Plans)

Morbidity tables express annual probabilities of the occurrence of health problems.(Defining and Exploring Health-Care Plans)

Discuss consumer-driven health-care plans briefly.(Consumer-Driven Health Care)

In 2015,half of the private-sector workers in opposite-sex partnerships had access to health-care benefits.(Health-Care Coverage and Costs)

The National Association of Insurance Commissioners deals with state level issues relating to supervision of insurance.(State Regulations)

_____ pay medical service providers a fixed amount based on the number of people enrolled,regardless of services received.(Health Plan Design Alternatives)

A point-of-service plan requires the selection of a primary care physician,similar to HMOs.(Point-of-Service Plans)

Introducing Employee Benefits

The Psychology and Economics of Employee Benefits

Regulating Employee Benefits

Employer-Sponsored Retirement Plans

Employer-Sponsored Disability Insurance, life Insurance, and Workers Compensation

Government-Mandated Social Security Programs

Paid Time-Off and Flexible Work Schedule Benefits

Accommodation and Enhancement Benefits

Managing the Employee-Benefits System

Nonqualified Deferred Compensation Plans for Executives

Global Employee Benefits at a Glance

Filters