Question 1

The U.S.health insurance system is based primarily on group coverage provided by:

Accepted Answer

The U.S. health insurance system is primarily based on group coverage provided by employers. This means that employees receive health insurance coverage through their employer, who negotiates group coverage policies with insurance companies. While the government does provide health insurance coverage through programs like Medicare and Medicaid, these programs are not the primary source of coverage for most Americans. Community-based health insurance programs do exist, but they are not the dominant form of coverage in the U.S.

Question 2

When given a choice,employees are moving toward _____,even though they are more expensive,showing that they are willing to pay more for freedom of choice.

Accepted Answer

PPOs (Preferred Provider Organizations) offer more flexibility and freedom of choice to employees, allowing them to visit any healthcare provider in or out of network without needing a referral. Even though PPOs are generally more expensive than other options, employees are willing to pay the extra cost for the added flexibility. Additionally, POSs (Point of Service) plans offer some flexibility, but usually require employees to get a referral for out-of-network care, making them less desirable. CDHPs (Consumer Directed Health Plans) and HMOs (Health Maintenance Organizations) are typically less expensive, but have more limitations on provider choice and coverage.

Question 3

Which of the following is NOT an area of payment covered by workers' compensation?

Accepted Answer

Workers' compensation typically covers medical expenses, lost wages, and vocational rehabilitation for injured workers. However, it does not cover payments to employers while injured workers are recovering.

Question 4

Currently,_____ percent of states have workers' compensation laws.

Accepted Answer

All 50 states in the United States have some form of workers' compensation laws in place to protect employees in the event of work-related injuries or illnesses.

Question 5

The law requiring companies with at least 20 employees to make medical coverage available at group insurance rates for up to 18 months after an employee leaves the job is:

Accepted Answer

COBRA (Consolidated Omnibus Budget Reconciliation Act) is a federal law that requires employers with 20 or more employees to offer continued group health insurance coverage to employees and their families for a limited period of time (typically 18 months) after leaving the job. This law applies to those who left their job voluntarily or involuntarily (except for gross misconduct). ERISA (Employment Retirement Income Security Act) regulates pension and retirement plans, while HIPAA (Health Insurance Portability and Accountability Act) protects the privacy of personal health information. FMLA (Family and Medical Leave Act) provides unpaid leave to eligible employees for certain family or medical reasons.

Question 6

Which of the following requires that health plans not disclose patient identifiers?

Accepted Answer

Protected health information (PHI) refers to any information related to the health status, provision of healthcare, or payment for healthcare that can be linked to an individual. Health plans are required by law to protect PHI and are not allowed to disclose patient identifiers. Salary information, cost of insurance premiums, and spousal information may contain personal identifiers, but they are not considered PHI.

Question 7

In this type of managed care health insurance plan,in-network care comes from a specified group of physicians and hospitals,patients can pay extra to get care from outside the network,and there generally is no gatekeeper.

Accepted Answer

In a PPO, patients have access to a network of preferred providers, but they also have the option to seek care from providers outside the network, albeit at a higher cost. Unlike HMOs, PPOs generally do not require a gatekeeper or primary care physician to manage care. Flexible spending accounts and health reimbursement accounts are types of healthcare spending accounts and do not fit the description provided.

Question 8

The 2010 plan intended to reform the U.S.healthcare system is called the:

Accepted Answer

The Patient Protection and Affordable Care Act, commonly referred to as Obamacare or the ACA, was a plan introduced in 2010 under the Obama administration to reform the U.S. healthcare system. The other options, Preferred Provider Organization Act and Health Maintenance Organization Act, refer to previous healthcare legislation that do not relate to the 2010 plan. The Equal Pay Act pertains to gender discrimination in wages and is not related to healthcare reform.

Question 9

This law provides that,following a worker's death or divorce,the employee's family has the right to buy group-rate health insurance for as long as three years.

Accepted Answer

The law described in the question is commonly known as COBRA, which stands for Consolidated Omnibus Budget Reconciliation Act. It allows employees and their families to continue their group health insurance coverage for a limited time after certain qualifying events, such as the employee's death or divorce.

Question 10

The "gatekeeper" in a "managed care" health insurance plan is the:

Accepted Answer

The primary care physician is typically the "gatekeeper" in managed care health insurance plans. They serve as the first point of contact for patients seeking medical care and must approve referrals to specialists or other medical services. This helps to manage costs and ensure that care is appropriate and necessary.

Question 11

This type of insurance is usually yearly renewable term insurance and typical coverage is one to two times the employee's annual salary.

Accepted Answer

Group life insurance is typically offered by an employer to its employees as a benefit. It provides a set death benefit if the employee dies while enrolled in the plan. The coverage amount is usually based on a multiple of the employee's salary and the policy is renewable on a yearly basis.

Question 12

Which act was enacted to protect the interests of employee-benefit-plan participants and their beneficiaries by requiring the disclosure to them of financial and other information concerning the plan?

Accepted Answer

The Employee Retirement Income Security Act (ERISA) was enacted in 1974 and requires employers to provide employees with information about their retirement and welfare benefit plans, including financial information and plan rules. ERISA aims to protect the interests of plan participants and their beneficiaries by establishing standards of conduct for plan fiduciaries and providing access to information about plan benefits and funding.

Question 13

In this type of managed care health insurance plan,there is no deductible,and the nominal fees generally range from $5 to $30 per visit depending on the service performed.

Accepted Answer

This describes a Health Maintenance Organization (HMO) plan, which does not have a deductible and typically charges low fees for office visits. With an HMO, patients typically have a primary care physician who coordinates their care and must refer them to specialists.

Question 14

_____ programs typically provide a core of basic life coverage and then permit employees to choose greater coverage.

Accepted Answer

Flexible benefit programs allow employees to choose the amount and type of benefits they receive, including greater life coverage beyond the basic amount provided. Defined-benefit and defined-contribution programs generally do not offer options for choosing life coverage beyond a predetermined amount. Point-of-service programs relate to medical coverage and are not relevant to the question.

Question 15

What is driving the increasing costs of healthcare?

Accepted Answer

The increasing costs of healthcare are mainly due to the aging population and an increase in obesity. The aging population leads to an increased demand for healthcare services, and obesity-related conditions such as diabetes and heart disease require more expensive treatments. Other factors such as advances in technology and prescription drug prices also contribute to rising healthcare costs, but the growing prevalence of obesity and an aging population are considered primary drivers. Choice A (passage of the health care exchanges) and C (increasing numbers of legal immigrants) are not directly related to healthcare costs, and choice D (rising cost of childcare) is not relevant to the healthcare industry.

Question 16

All state workers' compensation laws share all of the following features EXCEPT:

Accepted Answer

State workers' compensation laws do not guarantee full coverage for a worker's loss. Compensation is typically based on a percentage of the worker's wages and may have limits or caps.

Question 17

An individual or group health plan that provides or pays the cost of medical care may not use or disclose:

Accepted Answer

The answer of An individual or group health plan that...

Question 18

Under COBRA,employers with at least how many employees must comply:

Accepted Answer

Under COBRA (Consolidated Omnibus Budget Reconciliation Act), employers with at least 20 employees must comply with the law. This means that they must offer employees and their families the option to continue their group health insurance coverage for a limited time after certain events, such as job loss or reduction of work hours. If an employer has fewer than 20 employees, they may still be subject to state continuation coverage laws.

Question 19

Which of the following allows companies to make medical coverage available at group rates for as long as 18 months after the employee leaves?

Accepted Answer

COBRA (Consolidated Omnibus Budget Reconciliation Act) is a federal law that allows employees to continue their employer-sponsored health coverage for a limited time after leaving their job or experiencing a qualifying event. This continuation of coverage can last for up to 18 months, and sometimes longer in certain situations. HIPAA (Health Insurance Portability and Accountability Act) and ERISA (Employee Retirement Income Security Act) also relate to employee benefits, but do not specifically address continuation of medical coverage after leaving a job. ADA (Americans with Disabilities Act) relates to discrimination against individuals with disabilities in employment and other areas.

Question 20

Money set aside by employers to cover _____ has become the nation's largest source of capital.

Accepted Answer

Pension obligations are long-term financial commitments made by employers to their employees, typically in the form of retirement benefits. Employers are required to set aside funds to cover these obligations, and over time, these funds can grow into significant sums of money. As a result, pension obligations have become the nation's largest source of capital, surpassing even other forms of employee benefits like healthcare and workers' compensation.

Quiz 12: Indirect Compensation: Employee Benefit Plans