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Certified Benefits Professional - Health And Welfare Plans And Types > Module 1 > Flashcards

Module 1 Flashcards

1
Q

Total Rewards includes: compensation, well-being, benefits, development, recognition.

what do employee benefits consist of? of?

A

Health and welfare plans

Retirement plans

Paid time away from work

Perks

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2
Q

In regard to health and welfare plans what are 5 types of discretionary benefits?

A

Disability plans
Life insurance
Retirement plans
Paid time off
Perks

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3
Q

Why do employers have a vested interest in employee well-being?

A

Healthy engaged, Workforce drives, productivity, retention, and innovation

An employment package centered on well-being is a top demand of today’s workforce

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4
Q

List eight types of healthcare benefits

A

Medical

Behavioral health

Well-being

Prescription drugs

Dental

Vision

Tax advantage accounts

Long-term care

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5
Q

List three types of welfare benefits

A

Short term disability

Long-term disability

Life insurance

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6
Q

What year did most medical benefits originate in the United States?

A

1930

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7
Q

In the 1930s when most medical benefits originated, who are the two front runners

A

Blue Cross and Blue Shield

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8
Q

Name 6 indemnity, or managed indemnity medical plan types

A

HMO - health maintenance organization

POS - point of service

PPO- preferred provider organization

CDHP - Consumer driven to health plan

Supplement plans, by condition

On-site healthcare clinics

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9
Q

What US healthcare coverage is delivered outside of employer relationships and why is it important

A

ACA exchange center, formerly called PPACA 2012

Medicare / Medigap 1965

Important because the employer is often required to coordinate benefits and comply with provisions of these non-employer health plan offerings 

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10
Q

What is the difference between indemnity and managed indemnity plans?

A

Indemnity - participants have a choice in providers and have full access to care without pre-certification being required

Managed indemnity - participants have a choice in providers and may require some pre-certification or pre-authorization

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11
Q

What were the original Medial Plans?

A

HMO - Organized systems of healthcare that provide prepaid group medical services.

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12
Q

What are the five main attributes of an HMO?

A
  • Encourages preventive care
  • Restricts the plan, participant choice and providers
  • introduced the gate keeper roll
  • Utilizes copayments
  • Negotiated discounts
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13
Q

What type of health plan followed the original HMO plans?

A

POS

  • these plans came about as a response to HMOs not providing out of network access the address concerns employees have about being locked into narrow net work of HMO plans
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14
Q

What are the five primary attributes of POS plans?

A
  • Provides a broader net work for choice of physicians
  • Maintains gatekeepers role
  • Introduces in net work and out of network choices
  • Utilizes, deductibles, and co-pays
  • Negotiates discounts or uses capitated fees
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15
Q

Which medical plans are not considered current medical plans?

A
  • HMO and POS
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16
Q

PPO’s are preferred provider organizations

What are the six primary attributes of a PPO?

A
  • provides a broader net work for a choice of physicians
    -Allows in net work and out of network choices significant incentives for in Network care
  • Has copayments, deductibles, coinsurance, and out-of-pocket maximum’s
  • Requires pre-authorization for procedures
  • Negotiates discounts
  • Most common type of medical plan
17
Q

What are the three key components of a consumer driven health plan CDHP?

A
  • One or more types of medical plan choices
  • Health savings accounts (HSA) offered or health reimbursement accounts (HRA)
  • Online tools, surveys and support
18
Q

What is a common term often used to describe a consumer driven health plan?

A

High deductible, health plan. HDHP

19
Q

Define a consumer driven health plan or high deductible health plan

A

A consumer driven health plan or high deductible health plan requires a producer to pay out-of-pocket to meet deductible before The plan will pay any benefits.

The IRS rules an HDHP deductible is at higher than the rate of a nonqualified HDHP plan

-These plans often offer lower monthly premiums to participants. The plans can be accompanied by a health savings account to help participants, save for unplanned medical expenses.

20
Q

What are the intended goals of CDHPs

A
  • Promotes choice and flexibility
  • Contains cost by empowering consumers (because participants encourage initial costs it drives consumers to make more prudent financial decisions)
  • Plan design (may include HSA)
21
Q

What’s the difference between a qualified high deductible, health plan and a non-qualified high deductible health plan?

A

-In a qualified HDHP the IRS sets, the employee and family level, minimum deductibles and out of pocket maximums - HSA or HRA accounts are permitted with qualified HDHP plans

In an unqualified HDHP the IRS does not permit HSA or HRA accounts and it does not say minimum deductibles

22
Q

In regard to a health savings account, who owns the account?

A
  • Employee
23
Q

In regard to a health savings account, who can make contributions to an employees health savings account?

A

Employee and employer

24
Q

Who sets the contribution amounts for individual and family coverage levels for an HSA

A

The IRS sets the annual calendar for contribution amounts

25
Q

Are HSA employee contributions pretax, or post-tax?

A

Pretax or post-tax contributions are at the discretion of the employee

26
Q

What are the four coverage levels defined by the IRS in regard to HSAs

A

Employee only
employee plus spouse
employee plus children
employee plus family for

27
Q

Funds in an HSA can be used at any time for qualified healthcare expenses.

Who determines what are qualified health care expenses ?

A

The IRS

28
Q

In regard to health savings accounts, is there a time limit to use the funds?

A

There is no time limit to use the funds and the funds remain with the employee, even if employment ends

29
Q

In regard to the health reimbursement account, HRA, who owns the account?

A

The account is owned by the employer, the employee cannot make any contributions to it

30
Q

In regard to an HRA, who determines how much will be funded, and when the funds are available?

A

The employer determines how much will be funded, and when the funds are available?

31
Q

In regard to HRAs, what happens if there are unused funds at the end of the plan year.

A

The employer maintains discretion over unused funds, could roll over all or in part

32
Q

In regard to an HRA, what happens to funds if an employee is terminated?

A

Funds only exist as long as the employer remains employed

33
Q

Which of the following is a healthcare benefit?

Long-term care
Life insurance
401(k) plan
Short-term disability

A
  • Long-term care
34
Q

Which of the following is a welfare benefit?

Dental
Behavioral health
Survivor benefits
Prescription drug benefits

A

Survivor benefits

35
Q

What type of plan offers choice of providers and full access to care?

A

Indemnity

36
Q

Which of the following best describes a PPO plan?

No deductibles or co-pays

Provides in network and out of network choices

Pre-authorization not required

Discounts not negotiated

A

Provides in network and out of network choice

37
Q

What type of plan is designed to promote choice and flexibility, and contain costs by empowering consumers

HMO
POS
PPO
CDHP

A

CDHP

38
Q

Which treatment is typically covered in a medical plan

X-rays
Cosmetic surgery
Custodial care
Experimental procedures

A

X-rays

39
Q

In order to stabilize costs, how might accompany manage the utilization of the medical plan?

Shift more of the cost to the employer

Reduce employee co-pays

Incorporate a disease prevention program

Reduce out of pocket limits 

A

Incorporate a disease prevention program

Certified Benefits Professional - Health And Welfare Plans And Types (4 decks)

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