Deck 10: Managing the Employee-Benefits System

Question 1

Employers use case management companies to ensure that all of their employees' medical needs are being met adequately. (Case Management)

Answer 1

False

Question 2

Insurers use retrospective utilization reviews to determine that all treatment claims were legitimate. (Utilization Reviews)

Answer 2

True

Question 3

To more effectively communicate a benefits package to employees,more companies are having new employees meet one-on-one with benefits counselors. (The "Good Business Sense" of Benefits Communication)

Answer 3

False

Question 4

Waiting periods specify the maximum length of time an employee must remain employed before becoming eligible for benefits coverage. (Managing the Costs of Employee Benefits)

Question 5

Modular plans extend a pre-established set of benefits such as medical insurance as a program core. (Core-Plus-Option Plans)

Question 6

Benefits are considered "qualified" if the employee may exclude the cost from federal income tax. (Cafeteria Plans under Section 125)

Question 7

Under the modular plan,employees contribute the cost difference between a more extensive benefits package and the lowest-cost package. (Modular Plans)

Question 8

FSLA requires employers to provide employees with written summaries of the benefits plan's description and of material modifications. (Summary Plan Description)

Question 9

Utilization reviews are used to evaluate the quality of specific health care services. (Utilization Reviews)

Question 10

Managed care plans use prospective reviews more often than indemnity plans. (Utilization Reviews)

Question 11

Satisfying nondiscrimination rules permits plan participants to take tax deductions for qualified benefits. (Nondiscrimination Rules)

Question 12

A summary of material modifications might include changes in plan eligibility rules. (Summary of Material Modification)

Question 13

Pretax salary reduction plans allow employees reduced taxes on their salary. (Pretax Salary Reduction Plans)

Question 14

Insurers conduct concurrent utilization reviews shortly after hospital admission,following emergency treatment. (Utilization Reviews)

Question 15

After-tax contributions reduce the amount of annual income subject to income tax. (Managing the Costs of Employee Benefits)

Question 16

Flexible premium accounts usually apply to expenses that exceed regular benefits limits. (Pretax Salary Reduction Plans)

Question 17

Premium-only payment systems refer to payment arrangements between managed care insurers and health care providers. (Pretax Salary Reduction Plans)

Question 18

If employees don't choose the maximum benefits limits in a core-plus-option cafeteria plan they lose the difference. (Core-Plus-Option Plans)

Question 19

Under cafeteria plans,employers grant employees the opportunity to accept or reject benefits such as day care benefits. (Employer Choice to Customize Benefits)

Question 20

Employers must supply employees with updated summary plan descriptions after every 4 years. (Summary Plan Description)

Question 21

These are the 4 most common types of cafeteria plans. (Types of Flexible Benefit Plan Arrangements)

A)Premium-only, mix-and-match, core-plus-option, reduction
B)Reduction, modular, core-plus-option, mix-and-match
C)Material modification, mix-and-match, core-plus-option, modular
D)Mix-and-match, material modification, premium-only, reduction

Question 22

Longer waiting periods is one way companies try to reduce the cost of benefits. (Managing the Costs of Employee Benefits)

Question 23

ERISA sets forth legally required disclosure requirements. (Legal Considerations in Benefits Communication)

Question 24

These are the three types of utilization reviews. (Utilization Reviews)

A)Qualified, modified, nondiscriminatory
B)Prospective, concurrent, retrospective
C)Flexible, core-plus, mix-and-match
D)Precertification, prospective, retrospective

Question 25

Mix-and-match allow employees to purchase any benefit but at only certain levels. (Mix-and-Match Plans)

Question 26

Employees are mandated to participate in lifestyle intervention programs on the discretion of the company. (Lifestyle Interventions)

Question 27

This type of utilization review judges whether additional inpatient hospitalization is medically necessary. (Utilization Reviews)

A)Prospective
B)Certification
C)Concurrent
D)Retrospective

Question 28

Employers have been shifting health related costs to employees partly because of the economic downturn starting 2000. (Employee Education)

Question 29

This cafeteria plan allows a single-mother employee to select a benefits package designed to meet the particular needs of single-mothers. (Modular Plans)

A)Core-plus-option
B)Flexible spending account
C)Mix-and-match
D)Modular

Question 30

Outsourcing may be driven by complexity of benefit plan administration. (Outsourcing the Benefits Function)

Question 31

Case management is conducted by primary care physicians. (Case Management)

Question 32

Under mix-and-match plans each flexible credit awarded to purchase benefits equals $10. (Mix-and-Match Plans)

Question 33

Interactive phone systems are not a tool used by organizations to communicate benefits information. (The "Good Business Sense" of Benefits Communication)

Question 34

Waiting periods specify the number of years and employee must wait after applying for a benefit to become eligible for it. (Managing the Costs of Employee Benefits)

Question 35

Employers are obligated to distribute summary plan descriptions to employees and DOL within 90 days of the plan becoming subject to ERISA's reporting requirements. (Summary Plan Description)

Question 36

Which of the following compares the nontaxable benefits provided to key employees to the nontaxable benefits provided to all employees? (Nondiscrimination Rules)

A)Eligibility
B)Concentration
C)Concurrent reviews
D)Prospective reviews

Question 37

Under this provider payment system,primary care physicians are paid a fixed dollar amount for each patient,not for the number of services rendered in a given amount of time. (Provider Payment Systems)

A)Capped-fee schedule
B)Semi-capitation
C)Full capitation
D)Partial capitation

Question 38

ERISA requires that employees receive a summary plan description within how many days of becoming a plan participant? (Summary Plan Description)

A)120 days
B)60 days
C)90 days
D)30 days

Question 39

If all employees are offered health insurance and retirement benefits,but then get to select the rest of their benefits package,then they're being offered what type of cafeteria plan? (Core-Plus-Option Plans)

A)Core-plus-option
B)Mix-and-match
C)Modular
D)Flexible spending

Question 40

Pretax contributions do not reduce the amount of annual income subject to income tax. (Managing the Costs of Employee Benefits)

Question 41

This Section of the IRC permits an employer to offer employees the choice between taxable income or to allocate some of their income to purchase qualified benefits through a cafeteria plan. (Cafeteria Plans under Section 125)

A)125
B)152
C)127
D)172

Question 42

Flexible spending accounts and premium-only plans are versions of which cafeteria plan? (Pretax Salary Reduction Plans)

A)Modular
B)Pretax salary reduction
C)Core-plus-option
D)Mix-and-match

Question 43

ERISA requires employers to distribute new summary plan descriptions to the Department of Labor within how many days. (Summary of Plan Description)

A)210
B)90
C)180
D)120

Question 44

Discuss the concept of "good business sense" of benefits communication. (The "Good Business Sense" of Benefits Communication)

Question 45

Which of the following is not a feature of prospective reviews or precertification reviews? (Utilization Reviews)

A)Verifying a patient's coverage
B)Determining whether the health plan covers the treatment
C)Judging whether the proposed treatment is medically appropriate
D)Proceeding without a second surgical opinion

Question 46

Changes in benefits plans must be described and distributed to employees using one of these. (Summary of Material Modification)

A)Summary plan modifications
B)Summary plan changes
C)Summary of benefit changes
D)Summary of material modifications

Question 47

ERISA requires that material modification summaries must be sent to the Department of Labor within how many days after the end of the plan year in which the change occurred. (Summary of Material Modification)

A)210
B)180
C)90
D)120

Question 48

This cafeteria plan allows employees to exclude allocated income from federal income tax to pay for the benefits. (Pretax Salary Reduction Plans)

A)Core-plus-option plans
B)Modular plans
C)Pretax salary reduction plans
D)Mix-and-match plans

Question 49

Compare one-size-fits-all benefits with employee choice. (A One-Size-Fits-All Approach,Employer Choice to Customize Benefits)

Question 50

Which of the two factors drive the decision to outsource? (Outsourcing the Benefits Function)

A)Availability of outsourcing companies, reductions in workforce size
B)Reductions in workforce size, complexity of the benefit plan administration
C)Complexity of the benefit plan administration, availability of outsourcing companies
D)Reductions in workforce size, financial considerations of the company

Question 51

Under provider payment systems,agreements may include one or more cost saving features.Which of the following is not one of these cost saving features? (Provider Payment Systems)

A)Percentage discounts
B)Capped fee schedules
C)Partial capitation
D)Whole capitation

Question 52

Briefly discuss the information that summary plan descriptions must provide. (Summary Plan Description)

Question 53

Under this provider payment system,managed care plans hold primary care physicians accountable for the cost of services rendered to each assigned patient. (Provider Payment Systems)

A)Full capitation
B)Full capitation plus
C)Partial capitation
D)Semi capitation