Certified Employee Benefit Specialist (CEBS) Group Benefits Associate (GBA) 1 Practice Exam

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• What tool is commonly associated with encouraging wise consumer choices in CDHPs?
• What is a primary reason standalone prescription drug plans are popular?
• What is a key factor for effective organizational change according to recent evaluations?
• What happens to unused funds in an FSA that exceed $500?
• Which act established minimum hospital stay requirements after childbirth?
• What is a distinguishing feature of an open formulary?
• How often do vision plans typically cover lenses under their benefits?
• What influence does the cost charged by Pharmacy Benefit Managers (PBMs) have on prescription drug benefits?
• Which factor may discourage employees from participating in a contributory benefit plan?
• What does the acronym DUR stand for in the context of drug utilization review?
• What should be included in the communication of changes to employee benefits?
• What does COBRA require of health plans regarding group health coverage?
• When FSA funds are provided through salary deferrals in a Cafeteria Plan, what is the reimbursement process like?
• What were Indemnity Plans primarily designed to cover in the beginning?
• Which enrollment trend is noted between High Deductible Health Plans (HDHPs) linked with HSAs versus HRAs?
• What is one event that entitles an employee to COBRA coverage?
• What are the special enrollment events defined under HIPAA?
• Which law does not directly govern Cafe Plans?
• What benefit is typically included in a Premium Conversion Plan?
• Which type of plan is primarily classified as a Premium Conversion Plan?
• What is the federal contribution limit for HRAs compared to HSAs?
• What is typically evaluated in a performance evaluation?
• Which aspect of evaluation can fundamentally improve future interventions?
• Which method for handling risk involves getting rid of the risk entirely?
• What must employees do to opt-out of employer-paid coverage in a Premium Conversion Plan?
• What is a significant advantage for employers using a Cafeteria Plan?
• How does employer contribution impact healthcare use in relation to HDHPs?
• What is the definition of Health Savings Accounts (HSAs) in the context of a Cafe Plan?
• How does the tax doctrine of constructive receipt relate to cafeteria plans?
• What must happen if an employee takes leave under FMLA regarding their Cafeteria plan?
• What is one of the key benefits of a comprehensive workplace wellness program?
• Which of the following is a key element of the Americans with Disabilities Act (ADA) of 1990?
• Which of the following is NOT a common type of employer-sponsored health plan?
• A formulary is best described as what?
• What distinction is made between "immediate subjects" and "long-term aims" of reforms?
• Under the ACA, can health plans impose lifetime or annual limits on essential health benefits?
• According to the RAND Study, what service was not considered comprehensive in workplace wellness programs?
• What is a disadvantage of a non-scheduled dental plan?
• What impact did the Affordable Care Act (ACA) have on CDHPs concerning minimum actuarial requirements?
• What is a feature of Consumer Driven Health Plans (CDHPs)?
• What type of incentives has been shown to double worker participation in wellness programs?
• What type of compensation policy reflects industry norms?
• What happens if compliance with MHPAEA increases plan costs significantly?
• Which factor is NOT associated with the premiums of CDHPs?
• What is the ACA mandate referred to as the shared responsibility for employers?
• What is a disadvantage of COBRA for individuals?
• How do out-of-network benefits typically compare to in-network benefits?
• What is one reason why CDHPs tend to have lower premiums?
• What is a primary reason employers use credit values in flexible benefit plans instead of actual dollar values?
• What does the Genetic Information Nondiscrimination Act (GINA) prohibit?
• What is the primary purpose of pre-determination of dental benefits?
• What is one key limitation of a generic ROI evaluation?
• What types of legal entities can sponsor Cafeteria plans?
• What is one goal of Consumer Driven Health Plans (CDHPs)?
• Which step is essential in applying the functional approach to employee benefits?
• What is the grace period associated with Flexible Spending Accounts (FSAs)?
• What is the final step in the functional approach to employee benefit planning?
• What does MSP stand for in the context of Medicare?
• What is the maximum amount of unpaid job-protected leave under the Family and Medical Leave Act (FMLA) within a 12-month period?
• How does the compensation/service-oriented philosophy differ from the needs-oriented philosophy?
• In risk terminology, what does 'exposure' refer to?
• Which of the following is a tax advantage of employee benefit plans?
• Accumulation-oriented benefits are designed primarily to reward what type of employees?
• What is one of the common steps in evaluating a reform?
• Which of the following is one of the critical questions for performance evaluations?
• What is the effect of asymmetric information in insurance design related to CDHPs?
• What are post-ACA special events that allow an employee to revoke Cafeteria election midyear?
• Which of the following is NOT an insurance reform introduced by the ACA?
• Which compensation strategy is designed to attract higher talent levels?
• What types of medications are generally excluded from prescription drug plans?
• What is a primary characteristic of managed care insurance models?
• What approach is preferable for strategies in organizational integration?
• What concern is associated with the development of Consumer Directed Health Plans (CDHPs)?
• What is one of the overall tests required for Cafe Plans to meet nondiscrimination regulations?
• What is one of the main provisions of Michelle's Law?
• What has been a notable outcome for healthcare spending reductions in CDHPs?
• What is the primary function of a Pharmacy Benefit Manager (PBM)?
• What allows employers to handle forfeited funds from an FSA?
• What is a noted limitation for enrollees in Consumer Directed Health Plans in understanding their costs?
• Which risk handling technique is considered mutually exclusive to others?
• What does adverse selection refer to in the context of Cafeteria Plans for employers?
• Which characteristic best describes a full-flex plan?
• In the context of drug formularies, what is the purpose of a preferred list?
• Why was the provision of benefits under cafeteria plans restructured since IRC Section 125 was added?
• For a flexible benefits plan to be considered a cafe plan, what condition must it fulfill?
• What does an Audit Performance Evaluation (APE) compare?
• Which statement correctly describes how Health Reimbursement Arrangements (HRAs) differ from Health Savings Accounts (HSAs) regarding funders?
• What does the term "MAC" refer to in the context of pharmacy pricing?
• What is one requirement for participants of an FSA prior to reimbursement?
• What is the primary goal of CDHPs in relation to consumer health decisions?
• What is the role of UCR fees in health insurance?
• What is considered the primary goal of a workplace wellness program?
• What is a key objective of Managed Behavioral Health Organizations (MBHOs)?
• What governs the arrangements of cafeteria plans?
• Flexibility in employee benefit plans can lead to which of the following outcomes?
• What does the ROI study design involve?
• Which essential health benefit addresses the needs of individuals requiring substance abuse treatment?
• What typically characterizes an HDHP regarding financial responsibility?
• In risk management, what does the retention method refer to?
• What requirement must applicable large employers meet under the ACA concerning their full-time employees?
• Which category includes routine oral exams and X-rays?
• How does the size of a firm affect the likelihood of offering CDHPs?
• What limitation did the MPHA enforce regarding mental health benefits?
• Why do employers choose a behavioral health carve-out plan?
• Why is a functional approach suitable for administering employee benefits?
• Which percentage of treatment costs do Indemnity Plans typically cover for emergency and preventive services?
• What is the expected impact of biotechnology drugs on future drug pricing?
• What is a requirement for minimizing adverse selection in group insurance techniques?
• When are orthodontic services likely to significantly affect dental plan costs?
• What is a key requirement for contributions and benefits in a Cafe Plan under nondiscrimination testing?
• What is the general rule for revoking a benefit election during a coverage period?
• Why is it important to evaluate a reform before its implementation?
• What is a requirement for a Cafe Plan to be eligible for favorable tax treatment?
• What is the penalty structure for an employer who does not offer minimum essential coverage?
• Which of the following best describes a feature of a "core benefit" in a flexible benefit plan?
• What is a key reason for conducting an evaluation during the reform process?
• What term describes an employee's ability to choose their benefits within set limitations?
• What is the most notable advantage to employees in a Cafeteria Plan?
• Which act prohibits discrimination in group health plans based on an individual's health status?
• What is the primary function of implementation designs in health reforms?
• What constitutes the minimum essential coverage (MEC) under the ACA?
• How does an HMO manage patient care?
• What do HIPAA non-discrimination prohibitions prevent regarding employee benefits?
• Which of the following actions would result in losing grandfathered status under the ACA?
• Which approach is used by MBHOs to ensure patient referrals?
• Under the Affordable Care Act (ACA), how many hours must a full-time employee work in a week to qualify for benefits?
• What significant change regarding wellness programs did the EEOC rule in 2016?
• What do studies suggest about the effects of CDHP enrollment on physician visits?
• What is commonly included in medical policies regarding hearing care?
• What is a criticism associated with the Disease State Management (DSM) programs?
• Which factor is NOT one of the three that affect the cost of a dental plan?
• How does formative realist case evaluation differ from experimental evaluations?
• Which of the following practices is essential for depression disease management?
• How do higher-paid employees generally view the features of a Cafe Plan?
• What type of risk involves personal factors such as death, illness, disability, and unemployment?
• How does HIPAA protect individuals regarding enrollment in health plans?
• What is a common way for a PBM to generate profits?
• Which of the following is NOT considered when estimating value improvement by local service providers?
• What type of contributions fund Health Savings Accounts (HSAs)?
• What is a critical outcome of having clear questions in performance evaluations?
• Which of the following is an advantage of lifetime deductibles in dental care?
• What does evidence-based medicine (EBM) prioritize in medical decision-making?
• What is a significant distinction between the practice of medicine and dentistry?
• What does the term "Allowed Amount" refer to?
• What happens to the unused funds in a Flexible Spending Account at the end of the plan year?
• Which of the following benefits is typically included in vision care plans?
• What types of benefits can be included in a Cafe Plan?
• What is a potential impact of making a benefit plan contributory on employee participation?
• What is one of the advantages of a mail service program (MSP) for chronic conditions?
• What is a Cafeteria Plan primarily defined as?
• When assessing previous research for predicting value improvement, what should be excluded?
• How does Medicare interact with group health insurance for individuals 65 or older, working for an employer with fewer than 20 employees?
• What option is available for employees under USERRA regarding their Cafeteria plan during military leave?
• What is defined as 'uncertainty with respect to possible losses' in risk management?
• What is a key component in conducting a Return on Investment (ROI) evaluation?
• What are the varying aims of health system performance evaluations?
• How do rollover provisions differ between HRAs and HSAs?
• Which of the following is an example of a physical hazard?
• In Sec 125 Plans, what must be true for cash benefits?
• What describes the functional approach to employee benefit planning?
• What does the Women's Health and Cancer Act require health plans to cover?
• What do flexible benefit plans enable employees to do regarding their contributions?
• How did the Mental Health Parity and Addiction Equity Act of 2008 differ from the MPHA?
• In the context of performance evaluations, what is a crucial type of data required?
• What occurs if an applicable large employer fails to provide affordable benefits according to ACA regulations?
• What is the category of mental disorder identified by continuous and severe behavioral issues during childhood?
• What is the purpose of quantity limits (QLs) in a drug plan?
• What are common features of a behavioral health plan?
• What is the common reimbursement structure for hearing care services?
• Which of the following is a payment structure commonly used for healthcare providers?
• Which of the following is considered a severe mental illness?
• How does the ACA aim to assist those in need of affordable healthcare coverage?
• What is a primary method used by Managed Behavioral Health Organizations (MBHOs) for cost containment?
• Which of the following outcomes may arise from the need for financial counseling within employee benefit plans?
• In evaluating a reform, what is assessed after the intervention?
• What does "MAC" stand for in the realm of pharmacy cost management?
• What does the acronym ERISA stand for in the context of employee benefits?
• What administrative responsibility is mandated by ERISA for health plans?
• Which of the following is NOT a disadvantage for employers regarding Cafeteria Plans?
• What distinguishes a fully insured funding arrangement for MBHOs?
• Which characteristic is crucial for an ideal insurable risk?
• Which method focuses on reducing the likelihood or severity of a loss?
• What challenge do Managed Behavioral Health Organizations (MBHOs) face with psychotropic medications?
• What primarily determines the ideal characteristics of an insurable risk involving the calculation of loss frequency and severity?
• What distinguishes a PPO from an HMO?
• What is the primary purpose of a business case assessment?
• What does the grandfathered status in the ACA refer to?
• How does a Cafeteria Plan create greater employee awareness of benefits?
• What method is used for estimating costs or savings from potential benefits changes?
• Which benefit is included in the 10 essential health benefits that must be offered by ACA-compliant plans?
• In what way do POS plans differ from traditional HMO plans?
• What is the primary purpose of a Flexible Spending Account (FSA)?
• How do Consumer Directed Health Plans (CDHPs) generally impact healthcare spending?
• What is a negative election in the context of Cafeteria plans?
• What should be considered when creating benefit objectives?
• What impact has the ACA had on mental health and substance abuse treatments?
• What trend is being seen with incentives in workplace wellness programs?
• Which statement accurately describes the differences between HDHP/HSAs and HDHP/HRAs?
• What was the outcome of the Supreme Court decision in National Federation of Independent Business vs Sebelius regarding Medicaid expansion?
• Which factor is NOT contributing to the rising cost of prescription drug plans?
• Which of the following is NOT one of the ten professional treatment categories in dental care?
• Which characteristic is NOT commonly found in pharmacy plan design options?
• Which type of employer is more significantly affected by risk selection among employer groups?
• What must be defined to determine if a FSA is compliant with nondiscrimination tests?
• Which type of care is NOT covered under COBRA?
• What is a major challenge with formative realist case evaluations?
• What does GINA stand for in relation to wellness programs?
• What type of increase in drug rebates has been seen over the years?
• What aspect of an insurance policy should be economically feasible for insured individuals?
• What category of benefits is primarily aimed at providing financial protection against severe losses?
• Who are the major insurers that cover dental services?
• What does CQROI stand for?
• What does a cafeteria plan allow employees to do regarding their benefits?
• What does the Taft-Hartley Act of 1947 emphasize?
• Which factor does NOT affect the methodology for determining PBM prices?
• In the context of CDHPs, what does the annual deductible represent?
• A common disadvantage of lifetime deductibles is that they can...
• What is included in the concept of medical expenses under needs covered by Employee Benefit Plans?
• What does a Welfare benefit plan provide?
• What could happen if a company offers too many cash options in a flexible benefits plan?
• Under pre-ACA rules, what is a consistent change in status?
• What provision of the ACA does NOT apply to grandfathered health plans?
• What is one requirement for in-network preventative treatments under the ACA?
• What were the typical mental health benefits of Health Maintenance Organizations (HMOs) in the 1980s?
• Which of the following was a major objective of the Affordable Care Act?
• What is one key component of a good ROI evaluation?
• What is the primary purpose of the Americans with Disabilities Act (ADA) regarding workplace wellness programs?
• How are hidden employer subsidies relevant to the valuation of credits in flexible benefit plans?
• How do drug rebates generally function?
• What benefits are typically not eligible for an evergreen election?
• Which of the following is NOT classified as an essential health benefit (EHB) under the ACA?
• What is a behavioral health carve-out plan?
• What is a common characteristic of a scheduled dental plan?
• What are psychotropic medications?
• What aspect of wellness programs showed limited effectiveness according to the RAND Study?
• How does a Single-case time trend performance evaluation function?
• What is a common coinsurance level for orthodontic benefits?
• What additional measures can states take under HIPAA regarding health plan enrollments?
• Which of the following statements accurately reflects employer's options regarding HRAs?
• What does the acronym PEPY stand for in workplace wellness?
• Which of the following benefits does nondiscrimination testing apply to in a Cafe Plan?
• What is the highest level of accreditation granted by MBHOs by the National Committee for Quality Assurance?
• In a workplace wellness program, who shares the responsibility for costs?
• How has the ACA impacted out-of-pocket maximums for group health plans?
• What role does the American Dental Association (ADA) play in the approval of new dental technology?
• What is a critical component of an effective behavioral health program?
• Under ERISA, what are "other employee benefit plans" that are not retirement plans referred to as?
• Under the ACA, what must large employers provide to their employees regarding health coverage?
• What is the lowest tier in a three-tier drug plan?
• Which of the following is a characteristic unique to dentistry compared to medicine?
• Which of the following is NOT a key ingredient of an effective workplace wellness program?
• How have labor unions influenced employee benefits?
• Which event is considered a permitted change in status for revoking a Cafeteria plan election?
• What payment method change did Medicare implement related to diagnosis related groups (DRGs) in the 1980s?
• Which of the following best describes the replacement ratio in retirement planning?
• What does indemnification ensure for the insured after a covered loss?
• When addressing who evaluations are for, what is the most important user?
• Protection-oriented benefits generally include which types of coverage?
• Which of the following laws are Cafe Plans subject to?
• What is NOT an advantage of using insurance to fund an employee benefit plan?
• How can workplace wellness programs improve worker retention?
• Who qualifies as participants in a Cafeteria plan?
• Which of the following is NOT a primary role of a PBM?
• What must a wellness program under GINA avoid offering incentives for?
• What do performance evaluations need to determine for actionable knowledge?
• What is an FSA?
• In terms of nonmedical use, how do HRAs and HSAs differ?
• Which procedures fall under 'minor restorative' in dental categories?
• What effect do payment methods have on healthcare delivery?
• What are the financial requirements imposed by the Mental Health Parity and Addiction Equity Act (MHPAEA)?
• In what way does gambling differ fundamentally from insurance?
• What demographic factor can influence costs for prescription drug benefits?
• How do realist theories view interventions?
• Which requirement is NOT part of ERISA's regulation of health plans?
• Which of the following best describes a moral hazard?
• What is one result of the ACA's play or pay rules?
• Which type of treatment is characterized by patients being unable to care for themselves?
• Which group is restricted from participating directly in a Cafeteria plan?
• What is the most significant impact on dental care costs when adjusting deductibles?
• Which of the following describes HDHPs?
• What distinguishes an HRA from an HSA?
• What aspect of a good ROI evaluation relates to time?
• What distinguishes "prior generation" prescription drug plans (PDP) from today's "carved-out" plans?
• What is one potential outcome of CDHPs related to preventative healthcare services?
• What benefit does establishing external incentives provide in organizational collaboration?
• What is typically true about in-network providers?
• What is a key feature of PPO plans compared to POS plans?
• What is the primary focus of a realist context-intervention-mechanism theory?
• What differentiates pure risk from speculative risk?
• What change was made to Medicare payment methods for physicians in the early 1990s?
• What type of expenses are classified as legal adoption expenses in a Cafe Plan?
• What is the primary function of the Marketplace established by the ACA?
• What is a characteristic of a Dependent Care Assistance Plan?
• Which type of drug review occurs at the point of service in pharmacy?
• What type of treatment provides intensive care during the day while patients return home overnight?
• Which of the following accurately describes the prior authorization (PA) program in a drug plan?
• Which of the following is an example of total compensation that should NOT be included in Cafe Plans?
• Who typically makes up a behavioral health network?
• What is the basic funding arrangement of a Managed Behavioral Health Organization (MBHO)?
• What is the typical range of discounts offered by retail brand networks managed by PBMs?
• In a realist evaluation, what does 'context' refer to?
• How do perils and hazards relate in risk assessment?
• What are two primary factors contributing to the popularity of cafeteria plans?
• In a Cafe Plan, what distinguishes an Elective Paid Time Off option from a Non-Elective option?
• Which rights does the Uniformed Services Employment and Reemployment Rights Act (USERRA) provide?
• What constitutes a valid salary reduction agreement in a Cafeteria plan?
• Generally speaking, how do CDHP premiums compare to those of other plans?
• What significant change regarding pre-existing conditions was established by the ACA as of January 1, 2014?
• Which act deals with the privacy protections of personal health information?
• What is necessary for a negative election to be valid in a Cafeteria plan?
• What was the primary purpose of the Mental Health Parity Act (MPHA) of 1996?
• What was the initial approach to prescription drug coverage in health plans?
• Which procedure is typically excluded from implantology?
• What are the three basic approaches to dental plans?
• How must employees fill prescriptions under a network system in a pharmacy benefit plan (PDP)?
• Which of the following is NOT a condition to consider when selecting a PBM?
• After WWII, what led insurers to place limitations on outpatient medical care?
• What type of plan encourages sound dental hygiene through increased reimbursements?
• Which regulation sets the requirements for the tax treatment of an FSA?
• Which area is most commonly targeted in emotional well-being programs offered by large employers?
• Realist theory most closely aims to connect which two concepts?
• If a Cafe Plan fails the nondiscrimination testing, what is the tax implication for highly compensated employees?
• What are the limitations on the evergreen election option imposed by the ACA?
• What differentiates a combination dental plan from other types?
• Which of the following best defines 'mechanism' in the context of realist theory?
• What can increase the generalizability of findings in a formative realist case evaluation?
• What is an important consideration when evaluating employee benefit plans over time?
• When does group health insurance pay as the primary payer for individuals under the Medicare Secondary Payer rules?
• What should be the primary goal of an evaluation?
• How does the ACA impact mental health and substance use disorder benefits?
• Which model is described as being staffed by nurses to triage patients to appropriate levels of care?
• What is an evergreen election in a Cafeteria plan?
• Which factor is NOT typically considered when evaluating value improvements?
• What is the final question that should be addressed in a performance evaluation?
• What does the term "AWP" represent in the context of drug pricing?
• What lesson is important for organizations trying to implement effective change?
• What was the original focus of Employee Assistance Programs (EAPs)?
• Who must offer COBRA coverage?
• Which of the following best describes a gap analysis in employee benefit planning?
• How does insurance function as a mechanism for employee benefits programs?
• What is an essential component of the realist evaluation model?
• What is broadly considered an employee benefit?
• What must plans do under MHPAEA regarding disclosure requirements?
• What regulatory change was implemented by the ACA regarding HSAs?
• According to the narrow view, what characterizes employee benefits?
• Which of the following is a common technique to control pharmacy costs?
• What is a primary concern expressed by critics of Consumer-Directed Health Plans (CDHPs)?
• What is a key feature of "Simple Cafeteria Plans" as created by ACA?
• Which employers are exempt from the ACA employer-shared responsibility provisions?
• What provision must a qualified Cafe Plan include regarding benefits?
• Which approach to dental plans is characterized by covering a percentage of usual charges in the community?
• Which of the following is a primary disadvantage for employees participating in a Cafeteria Plan?
• Which of the following is considered a core benefit within a flexible benefits plan?
• How does the ACA affect insurance companies in terms of pre-existing conditions?