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Exam 5: Employer-Sponsored Health-Care Plans

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Question 31

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The network model compensates physicians using a fee schedule.(Prepaid Group Practice Model)

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Question 32

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This consumer-driven health care option allows employees to contribute pre-tax wages annually to pay for qualified medical expenses,but they will lose the balance not used at year's end.(Consumer-Driven Health Care)

A) Flexible spending accounts
B) Health reimbursement arrangements
C) Health savings accounts
D) Flexible savings accounts

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Question 33

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This federal law requires group health plans to provide medical and surgical benefits for mastectomies.(The Employee Retirement Income Security Act of 1974 (ERISA) )

Title XVIII of the Social Security Act established the Medicaid program.(Origins of Health-Care Benefits)

What is coinsurance? (Coinsurance)

Coinsurance rates are generally higher in HMOs than in fee-for-service plans.(Features of Health-Care Plans)

Briefly discuss how insurers determine premiums.(Defining and Exploring Health-Care Plans)

Most plans specify the maximum amount a policyholder must pay per calendar year or plan year,known as the out-of-pocket maximum provision.(Out-of-Pocket Maximum)

Discuss and compare multiple-payer versus single-payer systems.(Defining and Exploring Health-Care Plans)

This type of group insurance plan is an arrangement made for employers with relatively small workforces.A single master trust holds each employer's contributions,and premiums are paid from the trust.(Exhibit 5.1,Types of Group Plans)

Canada,as opposed to the US,has a single-payer health-care system.(Defining and Exploring Health-Care Plans)

Under the employer mandate of the Patient Protection and Affordable Care Act,companies with at least 10 employees are required to offer affordable health insurance to its full-time employees.(Patient Protection and Affordable Care Act of 2010)

The Mental Health Parity Act,which plays a prominent role in establishing parity requirements for mental health plans,was enacted in 2003.(Regulation of Mental Health and Substance Abuse Plans)

There has been much controversy over the Patient Protection and Affordable Care Act with arguments focused on the individual mandate.(Patient Protection and Affordable Care Act of 2010)

Generally,health plans pay expenses according to a schedule of usual,customary and reasonable charges.(Surgical Benefits)

IRC does not allow deductions for providing national health coverage.(Tax Regulations)

Staff model HMOs own the medical facilities and employ the medical and support staffs that work on the premises.(Prepaid Group Practice Model)

This consumer-driven health care option contains contributions made by employers and the balance can be carried-over to the next year.(Consumer-Driven Health Care)

Single employees pay a larger percentage of their health care premium than employees with family coverage pay.(Health-Care Coverage and Costs)

FAS 106 does not do which of the following? (Retiree Health-Care Benefits)