America's Benefit Specialist August/September 2023

CPC QUIZ

7. Which is not a consideration when you review health benefits? A. cost-saving techniques B underwriting process C. plan designs D. carrier style guide 8. The two most common types of health plan underwrit ing for level-funded plan designs are medical under writing and _____.

1. Which is not a legislative or compliance issue to watch for on the horizon?

A. gag clause attestation B. Medicaid unwinding C. ruling on preventative care D. Medicare unwinding

2. Both employer groups and insurance carriers must attest that they have not engaged in contracts with providers that have _____. A. indemnity clauses B. gag clauses

A. predictive modeling B. actuarial modeling C. deterministic models D. stochastic models

C. force majeure clauses D. non-compete clauses

3. States had to meet several conditions to receive the _____ as well as “continuous coverage” requirement that prohibited states from terminating most Medicaid enrollees’ coverage until after the public health emer gency ended. A. federal Medicaid funds B. self-funded group

9. _____ is an arrangement that uses fixed pricing for healthcare services, based on a multiple of Medicare and/or provider costs, which is used to calculate claim payment. A. Level-funding

B. Reference-based pricing C. Health reimbursement D. Long-term care

C. maintenance of effort D. Medicaid unwinding

4. The Medicaid unwinding process could take _____ months in each state, with each state determining its own timeframe. A. eight to 10

10. _____ is an approach in which employers can define their employee and dependent contributions and offer employees a choice of medical plan options to fit their specific needs. A. Defined contribution B. Health Reimbursement Arrangement C Premium-only plan D. Predictive modeling 11. MedPAC reported that in 2022 Medicare paid _____ more in a hospital outpatient department than it did for the same care in a freestanding office for the first hour of chemotherapy infusion.

B. 10 to 18 C. 12 to 14 D. 14 to 20

5. For employers with _____ group health plans, the in junction allows employers the option to amend their plans to make changes, such as implementing cost sharing for the preventative-care services impacted by the decision, including screening for cancer, mental health, HIV and diabetes, colonoscopies, pap smears and tobacco-cessation services.

A. 58% B. 89% C. 123% D. 141%

A. self-funded B. fully insured C. reference-based pricing D. level-funded

12. MedPAC noted that the increased reimbursements are not linked to improved quality of care for beneficiaries, but they are directly linked to increased cost for _____. A. carriers B. physicians C. patients D. pharmaceutical companies

6. According to MetLife’s Annual Employee Benefits Trends Study, _____ of employees rated the affordabili ty of employer-provided benefits as an important fac tor in their organizations’ demonstration of employee care. A. 58% B 72% C 20% D. 64%

46 ABS | benefitspecialistmagazine.com