Skip to content

Instantly share code, notes, and snippets.

@mikewadhera

mikewadhera/answers.json

Created July 26, 2023 23:39
Show Gist options
  • Star 0 You must be signed in to star a gist
  • Fork 0 You must be signed in to fork a gist
  • Save mikewadhera/3e9350d926336365d716d424a0a0da0f to your computer and use it in GitHub Desktop.
Save mikewadhera/3e9350d926336365d716d424a0a0da0f to your computer and use it in GitHub Desktop.
Download ZIP
Raw
answers.json
[
{
"question": "There can be great variability in employer spending to sponsor a workplace wellness program. However, the cost of these programs per employee per year typically ranges from:",
"choices": [
"$0- $450",
"$0-$800",
"$50-$1,500",
"$100-$2,000",
"$200-$2,500"
],
"key": 1,
"claude2": " The cost of workplace wellness programs typically ranges from $0 to $450 per employee, per year. Therefore, the correct answer is 0) $0- $450.",
"gpt35": "The correct answer is 2) $50-$1,500.",
"gpt4": "The correct answer is 1) $0-$800."
},
{
"question": "Benefits for so-called lifestyle drugs:",
"choices": [
"Have been typically excluded from employer plans.",
"Have been routinely included in all plans since the enactment of the Health Insurance Portability and Accountability Act.",
"Have been mandated by both federal and state law for all insured plans.",
"Have often been required by courts although recent rulings appear to be reversing the trend.",
"Have been widely debated since conditions treated by these drugs are often subject to actuarial risk analysis."
],
"key": 1,
"claude2": " 0) Have been typically excluded from employer plans.\n\nLifestyle drugs are prescription products that do not necessarily cure illness but can be used to improve daily life by boosting psychological attitudes, energy levels, sexual performance and body image. These drugs are typically excluded from employer-sponsored prescription drug plans.",
"gpt35": "The correct answer is 0) Have been typically excluded from employer plans.",
"gpt4": "The correct answer is 0) Have been typically excluded from employer plans."
},
{
"question": "For a cafeteria plan to be afforded favorable tax treatment, the plan must allow participants to choose between how many benefits consisting of cash (or a taxable benefit that is treated as cash) and qualified benefits?",
"choices": [
"Two or more",
"Three or more",
"Four or more",
"Five or more",
"Six or more"
],
"key": 1,
"claude2": " The correct answer is: \n\n0) Two or more\n\nAccording to the CEBS study material, for a cafeteria plan to be afforded favorable tax treatment, the plan must allow participants to choose between two or more benefits consisting of cash (or a taxable benefit that is treated as cash) and qualified benefits.",
"gpt35": "The correct answer is 1) Three or more.",
"gpt4": "The correct answer is 0) Two or more."
},
{
"question": "The Small Business Health Care Relief Act created the qualified small employer HRA (QSEHRA). \u200b This Act applies to businesses with fewer than how many employees?",
"choices": [
"20",
"30",
"50",
"75",
"100"
],
"key": 3,
"claude2": " The correct answer is 2) 50\n\nThe Small Business Health Care Relief Act created the qualified small employer HRA (QSEHRA) and applies to businesses with fewer than 50 employees.",
"gpt35": "The correct answer is 2) 50. The Small Business Health Care Relief Act applies to businesses with fewer than 50 employees.",
"gpt4": "The correct answer is 2) 50."
},
{
"question": "Which of the following statements regarding the functional approach to employee benefit planning is correct?",
"choices": [
"The functional approach assumes a business firm is interested in providing an industry-wide average level of employee benefits.",
"The functional approach is appropriate only for organizations that are well-established.",
"The functional approach is essentially a planning approach that aligns a total compensation philosophy with strategic business objectives.",
"The functional approach is based primarily on the needs of employees and their dependents, rather than on the compensation and service of employees.",
"The primary goal of the functional approach is to balance short-term benefits with long-term employee benefits."
],
"key": 3,
"claude2": " 2) The functional approach is essentially a planning approach that aligns a total compensation philosophy with strategic business objectives.\n\nThe functional approach to employee benefit planning involves analyzing an employer's employee benefit program as a coordinated whole in terms of meeting employee needs and managing exposures within the employer's overall compensation goals and cost parameters. It is a planning approach aligning total compensation philosophy with strategic business objectives.",
"gpt35": "The correct answer is 2) The functional approach is essentially a planning approach that aligns a total compensation philosophy with strategic business objectives.",
"gpt4": "The correct answer is 2) The functional approach is essentially a planning approach that aligns a total compensation philosophy with strategic business objectives."
},
{
"question": "A dental plan in which certain procedures are reimbursed on a scheduled basis and others are reimbursed on a nonscheduled basis is called a(n):",
"choices": [
"Coordinated plan",
"Balanced plan",
"Combination plan",
"Integrated plan",
"Incentive plan"
],
"key": 3,
"claude2": " 2) Combination plan\n\nA dental plan in which certain procedures are reimbursed on a scheduled basis while others are reimbursed on a nonscheduled basis is called a combination dental plan. This type of plan seeks to provide a balance between the need to emphasize preventive care and cost control.",
"gpt35": "The correct answer is 2) Combination plan.",
"gpt4": "The correct answer is 2) Combination plan."
},
{
"question": "Money forfeited by employees under the use-it-or-lose-it rule in cafeteria plans is called an experience gain. These experience gains may NOT be:",
"choices": [
"Retained by the employer.",
"Used to reduce administrative expenses of the cafeteria plan.",
"Returned to the employees who incurred the forfeitures.",
"Used to reduce employer\u2019s required salary reduction amounts.",
"Given to charity."
],
"key": 3,
"claude2": " 2) Returned to the employees who incurred the forfeitures.\n\nMoney forfeited by employees under the use-it-or-lose-it rule in cafeteria plans is called an experience gain. According to the textbook, these experience gains may be:\n\na) Retained by the employer \nb) Used to reduce administrative expenses of the cafeteria plan\nc) Returned to employees (subject to the stipulation in the preceding paragraph)\nd) Used to reduce employees\u2019 required salary reduction amounts\n\nThe textbook specifically states that the forfeited funds cannot be refunded solely to the employees who incurred the forfeitures. Therefore, the correct answer is 2) Returned to the employees who incurred the forfeitures.",
"gpt35": "The correct answer is 0) Retained by the employer.",
"gpt4": "The correct answer is 2) Returned to the employees who incurred the forfeitures."
},
{
"question": "Which of the following is a correct statement regarding return on investment (ROI) evaluations and calculations?",
"choices": [
"The first step in an ROI calculation is to determine the upper and lower limits of acceptable returns.",
"ROI is the same as a \u201cbusiness case\u201d assessment.",
"The typical ROI evaluation is broader than a \u201ccost-quality return on investment\u201d (CQROI).",
"Most ROI calculations calculate a single rate of return: the return over a 20-year period.",
"ROI evaluations usually only consider the payback for the investor in terms of the money they get back for the money they put in."
],
"key": 5,
"claude2": " 3) Most ROI calculations calculate a single rate of return: the return over a 20-year period.\n\nThis is not correct. ROI evaluations typically look at returns over shorter periods of time, such as 1-3 years. They do not usually calculate a single return over a 20-year timeframe.",
"gpt35": "The correct answer is 2) The typical ROI evaluation is broader than a \u201ccost-quality return on investment\u201d (CQROI).",
"gpt4": "The correct answer is 4) ROI evaluations usually only consider the payback for the investor in terms of the money they get back for the money they put in."
},
{
"question": "A health care plan has no restrictions on a member's choice of provider, there is no \"steerage,\" and there is no basic utilization management. This type of health care coverage is known as:",
"choices": [
"Preferred provider plan",
"High-deductible health plan",
"Indemnity plan",
"Point-of-service plan",
"Health maintenance organization plan"
],
"key": 3,
"claude2": " 2) Indemnity plan\n\nThis is the correct answer. An indemnity plan has no restrictions on a member's choice of provider, no \"steerage,\" and no basic utilization management. It reimburses providers on a fee-for-service basis.",
"gpt35": "The correct answer is 2) Indemnity plan.",
"gpt4": "The correct answer is 2) Indemnity plan."
},
{
"question": "The amount of covered medical expenses that a participant must incur before any medical benefits for non-preventive care services or treatment become payable under a plan is known as the:",
"choices": [
"Coinsurance",
"Copay",
"Assigned benefit",
"Allowable portion",
"Deductible"
],
"key": 5,
"claude2": " The correct answer is 4) Deductible\n\nThe deductible is the amount of covered medical expenses that a participant must incur before any medical benefits for non-preventive care services or treatment become payable under a plan.\n\nCoinsurance refers to the percentage of costs that the plan participant pays after meeting the plan deductible. \n\nA copay is a fixed dollar amount paid by the insured when a medical service is received, regardless of the total charge. \n\nAn assigned benefit is not a standard term used in describing health insurance plans.\n\nThe allowable portion refers to the portion of a medical bill that is covered by the plan after deductible/copays are applied. It does not refer to an amount that must be incurred before benefits are payable.\n\nSo the deductible is the correct term for the amount that must be incurred before regular medical benefits are payable under a typical health insurance plan.",
"gpt35": "The correct answer is 4) Deductible.",
"gpt4": "The correct answer is 4) Deductible."
},
{
"question": "Which risk-handling techniques are being used by a firm that decides to not produce a dangerous chemical, to purchase insurance with a $10,000 deductible on its assets and to install a fire sprinkler system throughout the plant?",
"choices": [
"Insurance and retention",
"Control and transfer",
"Noninsurance transfer and insurance",
"Avoidance, insurance and transfer",
"Avoidance, retention, insurance and control"
],
"key": 5,
"claude2": " 3) Avoidance, insurance and transfer\n\nThe firm is using avoidance by deciding to not produce the dangerous chemical. It is using insurance by purchasing a policy with a deductible. And it is using transfer through the insurance policy. The firm is not using retention in this example. Therefore, the correct answer is 3) Avoidance, insurance and transfer.",
"gpt35": "The correct answer is 3) Avoidance, insurance and transfer.",
"gpt4": "The correct answer is 4) Avoidance, retention, insurance and control."
},
{
"question": "An insured individual has $12,000 of covered medical expenses for in-network nonpreventive treatment. His plan is a high-deductible health policy with a $1,500 deductible and a 20% coinsurance arrangement. Also, the plan reimburses 100% after an individual reaches the plan\u2019s $6,000 out-ofpocket maximum. What will the insured pay out of the total medical expenses if this is the first claim of the plan year?",
"choices": [
"0",
"1000",
"2400",
"3000",
"3600"
],
"key": 5,
"claude2": " Step 1) The individual has $12,000 of covered medical expenses.\nStep 2) The plan has a $1,500 deductible. So the individual must pay the first $1,500. \nStep 3) After meeting the deductible, there is a 20% coinsurance. 20% of ($12,000 - $1,500) = 20% of $10,500 = $2,100\nStep 4) The individual has paid $1,500 (deductible) + $2,100 (coinsurance) = $3,600 so far. \nStep 5) The plan pays 100% after the individual reaches the $6,000 out-of-pocket maximum.\nStep 6) Since the individual has already paid $3,600, they will not have to pay anything more.\n\nTherefore, the total amount the insured will pay is $3,600.\n\nThe correct answer is 4) $3,600.",
"gpt35": "The correct answer is 2) 2400. \n\nThe insured individual has a high-deductible health policy with a $1,500 deductible and a 20% coinsurance arrangement. This means that the insured individual is responsible for paying the first $1,500 of covered medical expenses out of pocket. \n\nAfter the deductible is met, the plan will cover 80% of the remaining expenses, while the insured individual is responsible for the remaining 20%. In this case, the insured individual has $10,500 of remaining expenses after the deductible ($12,000 - $1,500). \n\nThe insured individual will pay 20% of $10,500, which is $2,100. However, the plan has a $6,000 out-of-pocket maximum, which means that once the insured individual reaches this amount, the plan will cover 100% of the remaining expenses. \n\nSince this is the first claim of the plan year, the insured individual has not yet reached the out-of-pocket maximum. Therefore, the insured individual will pay $2,400 out of the total medical expenses ($1,500 deductible + $2,100 coinsurance). \n\nTherefore, the correct answer is 2) 2400.",
"gpt4": "The correct answer is 3) 3000."
},
{
"question": "The landmark \u201cInland Steel Case\u201d had extreme importance because it:",
"choices": [
"Made it clear that insurance is commerce and therefore subject to federal regulation when it is interstate commerce.",
"Stated that the employer had the duty to bargain in good faith over wages which also included insurance and fringe benefits.",
"Established the distinction between retirement benefits and welfare benefits.",
"Established the rights of employees to continue certain employee benefits after termination of their employment.",
"Provided the basis for the federal income tax treatment of employee benefit plans."
],
"key": 2,
"claude2": " The correct answer is 1) Stated that the employer had the duty to bargain in good faith over wages which also included insurance and fringe benefits.\n\nThe Inland Steel Case was a landmark 1948 National Labor Relations Board (NLRB) ruling that stated the employer had the duty to bargain in good faith over wages, which also included insurance and fringe benefits like pension plans. This ruling helped spur the growth of employer-sponsored benefits in the years following World War II.\n\n0) is incorrect. That describes the South-Eastern Underwriters case. \n\n2) is incorrect - that describes the distinction made by the Taft-Hartley Act.\n\n3) is incorrect - that describes the Consolidated Omnibus Budget Reconciliation Act (COBRA).\n\n4) is incorrect - that refers to the favorable tax treatment that was codified and enhanced by legislation in later decades.",
"gpt35": "The correct answer is 2) Established the distinction between retirement benefits and welfare benefits.",
"gpt4": "The correct answer is 1) Stated that the employer had the duty to bargain in good faith over wages which also included insurance and fringe benefits."
},
{
"question": "The legislation that plays a fundamentally important role in protecting sensitive patient information gathered during behavioral treatment is the:",
"choices": [
"Employee Retirement Income Security Act (ERISA)",
"Health Insurance Portability and Accountability Act (HIPAA)",
"Health Maintenance Organizations Act (HMO)",
"Americans with Disabilities Act (ADA)",
"Mental Health Parity and Addiction Equity Act (MHPAEA)"
],
"key": 2,
"claude2": " The Health Insurance Portability and Accountability Act (HIPAA) plays a particularly important part in protecting sensitive patient information gathered during behavioral treatment.\n\nTherefore, the correct answer is 1) Health Insurance Portability and Accountability Act (HIPAA)",
"gpt35": "The correct answer is 1) Health Insurance Portability and Accountability Act (HIPAA). HIPAA includes provisions that protect the privacy and security of sensitive patient information, including information gathered during behavioral treatment.",
"gpt4": "The correct answer is 1) Health Insurance Portability and Accountability Act (HIPAA)."
},
{
"question": "The Affordable Care Act (ACA) aimed to make health insurance more affordable by providing tax credits to individuals ineligible for other affordable coverage and with income between which of the following limits:",
"choices": [
"25% and 50% of the federal poverty line.",
"50% and 100% of the federal poverty line.",
"75% and 200% of the federal poverty line.",
"100% and 400% of the federal poverty line.",
"200% and 600% of the federal poverty line."
],
"key": 4,
"claude2": " 3) 100% and 400% of the federal poverty line.\n\nThe Affordable Care Act (ACA) aimed to make health insurance more affordable by providing tax credits to people with income between 100% and 400% of the poverty line who are not eligible for other affordable coverage. The tax credit is advanceable, so it can lower premium payments each month rather than making the individual wait for tax time. It\u2019s also refundable, so even moderate-income families can receive the full benefit of the credit. These individuals may also qualify for reduced cost sharing which covers copayments, coinsurance and deductibles.\n\nTherefore, the correct answer is 3) 100% and 400% of the federal poverty line.",
"gpt35": "The correct answer is 3) 100% and 400% of the federal poverty line.",
"gpt4": "The correct answer is 3) 100% and 400% of the federal poverty line."
},
{
"question": "Which of the following statements regarding prescription drug rebates is correct?",
"choices": [
"A rebate occurs when there is an agreement between a pharmacy benefit manager and a drug manufacturer.",
"The purpose of such rebates is to secure significant reductions in the cost of prescription drugs.",
"The growth of rebates has paralleled the rise of a single-tier copay prescription plan design.",
"Some of the savings from rebates are passed along to independent pharmacy owners.",
"Rebates are based solely on utilization\u2014not increases in market share."
],
"key": 1,
"claude2": " The correct answer is 1. \n\nA rebate is an agreement between a pharmacy benefit manager (PBM) and a drug manufacturer to secure significant reductions in the cost of prescription drugs. Some of these savings are passed along to employers. The growth of rebates has paralleled the rise of pharmacy benefit inflation and the advent of multitiered copay designs (not single-tier copay designs). Rebates reward PBMs that are able to encourage a significant percentage of enrollees to switch to the company's key products, not solely based on utilization. Rebates are not passed along to independent pharmacy owners.",
"gpt35": "The correct answer is 0) A rebate occurs when there is an agreement between a pharmacy benefit manager and a drug manufacturer.",
"gpt4": "The correct answer is 1) The purpose of such rebates is to secure significant reductions in the cost of prescription drugs."
},
{
"question": "The design of any employee benefit plan should start with deciding which of the following?",
"choices": [
"Which benefits should be provided",
"Who should be covered by the plan",
"What are the overall objectives of the plan",
"How should the benefits be provided",
"How should the plan be administered"
],
"key": 3,
"claude2": " The correct answer is 2) What are the overall objectives of the plan\n\nThe design of any employee benefit plan should start with setting overall objectives from the standpoints of both the employer and the employees. Thus there should be a meaningful and well-reasoned rationale for any and every employee benefit plan. The rationale and sustainability of an employee benefit plan should take into account the present time as well as look strategically toward the future.",
"gpt35": "The correct answer is 2) What are the overall objectives of the plan.",
"gpt4": "The correct answer is 2) What are the overall objectives of the plan."
},
{
"question": "Which of the following statements regarding managed behavioral health care organizations (MBHOs) and administrative services only (ASO) arrangements is correct?",
"choices": [
"ASOs are especially effective for small employers.",
"ASOs are sometimes referred to as \u201cfully insured\u201d plans.",
"An ASO transfers the financial risk of health care costs to an insurance company.",
"A key advantage of ASOs is that employers can offer the same benefit to employees working in different states because ERISA exempts ASO plans from compliance with state laws and regulations.",
"Employers who purchase an ASO contract agree to assume the financial risk for claims payments up to a certain (rather large) amount but claims in excess of the stipulated amount are paid by the MBHO."
],
"key": 4,
"claude2": " 3) A key advantage of ASOs is that employers can offer the same benefit to employees working in different states because ERISA exempts ASO plans from compliance with state laws and regulations.\n\nAn ASO or administrative services only arrangement transfers the financial risk of health care costs to the employer, not an insurance company. Under an ASO, the employer assumes the financial risk of the health care costs for its members. A key advantage of an ASO is that employers can offer the same benefit to employees working in different states because ERISA exempts self-funded health plans, including ASO plans, from compliance with state laws and regulations. \n\nThe other statements are incorrect:\n- ASOs are not especially effective for small employers since small employers typically cannot absorb the financial risk as well as larger employers. \n- ASOs are not \"fully insured\" plans. Fully insured plans transfer risk to an insurance company.\n- Under an ASO, the employer assumes all the risk. The MBHO does not assume risk for claims exceeding a certain amount.\n\nTherefore, the correct answer is 3.",
"gpt35": "The correct answer is 0) ASOs are especially effective for small employers.",
"gpt4": "The correct answer is 4) Employers who purchase an ASO contract agree to assume the financial risk for claims payments up to a certain (rather large) amount but claims in excess of the stipulated amount are paid by the MBHO."
},
{
"question": "Which of the following statements regarding the functional approach to employee benefit planning is correct?",
"choices": [
"The functional approach assumes a business firm is interested in providing a level of employee benefits that is average for the industry.",
"The functional approach is appropriate only for organizations that are well-established.",
"The functional approach is based primarily on the needs of employees and their dependents, rather than on the compensation and service of employees.",
"The primary goal of the functional approach is to balance short-term benefits with long-term employee benefits.",
"The functional approach is compatible with both the compensation/service oriented benefit philosophy and the needs-oriented benefit philosophy."
],
"key": 5,
"claude2": " 4) The functional approach is compatible with both the compensation/service oriented benefit philosophy and the needs-oriented benefit philosophy.\n\nThe functional approach to employee benefit planning involves analyzing an employer's employee benefit program to determine if it meets the needs and goals of both the employer and the employees. It can be used with either a compensation/service oriented philosophy or a needs-oriented philosophy. The functional approach does not assume an average industry benefit level, it can be used by any type of employer, and it considers both short-term and long-term needs and goals.",
"gpt35": "The correct answer is 2) The functional approach is based primarily on the needs of employees and their dependents, rather than on the compensation and service of employees.",
"gpt4": "The correct answer is 2) The functional approach is based primarily on the needs of employees and their dependents, rather than on the compensation and service of employees."
},
{
"question": "A behavioral health care carve-out program usually operates under a separate contract and from a separate company known as a(n):",
"choices": [
"Managed behavioral modification program (MBMP)",
"Administrative services only (ASO) organization",
"Employee assistance program (EAP)",
"Managed behavioral health care organization (MBHO)",
"Managed mental health care company (MMHCC)"
],
"key": 4,
"claude2": " 3) Managed behavioral health care organization (MBHO)\n\nA behavioral health care carve-out program is one that separates, or carves out, mental health and chemical dependency services from a medical plan and provides them separately, usually under a separate contract and from a separate company known as a managed behavioral health care organization (MBHO).",
"gpt35": "The correct answer is 3) Managed behavioral health care organization (MBHO).",
"gpt4": "The correct answer is 3) Managed behavioral health care organization (MBHO)."
},
{
"question": "Which of the following statements regarding primary care physicians (PCPs) is correct?",
"choices": [
"PCPs are not used in preferred provider organizations.",
"Pediatricians cannot be a PCP.",
"PCPs are not necessary in health maintenance organizations.",
"PCPs are usually a general, family or internal medicine doctor (internist).",
"OB/GYN (gynecologist) doctors cannot be PCPs."
],
"key": 4,
"claude2": " 3) PCPs are usually a general, family or internal medicine doctor (internist).\n\nThis is the correct answer. A primary care physician (PCP) is usually a general practitioner, family physician, internist, or pediatrician who provides basic medical services and coordinates more specialized care as needed. PCPs are a key component of preferred provider organizations and health maintenance organizations, helping to manage costs and coordinate patient care. OB/GYNs and pediatricians can serve as PCPs.",
"gpt35": "The correct answer is 3) PCPs are usually a general, family or internal medicine doctor (internist).",
"gpt4": "The correct answer is 3) PCPs are usually a general, family or internal medicine doctor (internist)."
},
{
"question": "The \u201cmanaged care backlash\u201d of the late 1990s created significant growth in which of the following types of health care organizations?",
"choices": [
"Health maintenance organizations (HMOs)",
"Preferred provider organizations (PPOs)",
"Health savings accounts (HSAs)",
"Health reimbursement arrangements (HRAs)",
"High-deductible health plans (HDHPs)"
],
"key": 2,
"claude2": " The correct answer is 1) Preferred provider organizations (PPOs).\n\nThe explanation is:\n\nThe \"managed care backlash\" of the late 1990s resulted in significant growth in preferred provider organization (PPO) plans. PPO plans are highly valued by a significant number of plan participants. PPO plans allow limited benefits for care received outside of the PPO's preferred network and require no permission\u2014that is, no referral\u2014to see a specialist. PPO plans were designed specifically in response to HMO criticism.\n\nThe other answer options are incorrect:\n- HMOs were the target of the \"managed care backlash\", not the result of it. \n- HSAs and HRAs did not exist yet in the late 1990s.\n- HDHPs also came later, as consumer-driven health plans emerged in the early 2000s.\n\nSo the correct answer is 1) Preferred provider organizations (PPOs).",
"gpt35": "The correct answer is 1) Preferred provider organizations (PPOs).",
"gpt4": "The correct answer is 1) Preferred provider organizations (PPOs)."
},
{
"question": "Which of the following statements regarding dental care and the Affordable Care Act (ACA) is correct?",
"choices": [
"Dental care is not an essential benefit for adults in the ACA.",
"The ACA requires dental coverage for all children.",
"Dental coverage is required by the ADA only if health coverage is provided under a self-insured/self-administered plan.",
"The ACA requires comprehensive dental care for adults and children.",
"The ACA excludes all dental care benefits."
],
"key": 1,
"claude2": " The correct answer is 0. \n\nThe Affordable Care Act (ACA) does not designate dental coverage as an essential health benefit for adults. However, pediatric dental care is included as one of the ten essential health benefits (EHBs) that must be covered by nongrandfathered individual and small group health plans. The ACA does not require that stand-alone dental plans for adults or children be offered. Rather, for children, if a medical plan subject to ACA's EHB provisions is offered, that plan must include pediatric dental as one of the ten essential benefits. Dental coverage was not deemed an essential health benefit for adults under the ACA.",
"gpt35": "The correct answer is 1) The ACA requires dental coverage for all children.",
"gpt4": "The correct answer is 1) The ACA requires dental coverage for all children."
},
{
"question": "The Affordable Care Act (ACA), in general, defined a full-time employee as one employed on average at least how many hours per week?",
"choices": [
"20",
"25",
"30",
"35",
"40"
],
"key": 3,
"claude2": " 2) 30\n\nThe Affordable Care Act (ACA), in general, defined a full-time employee as one employed on average at least 30 hours per week for purposes of the employer shared responsibility provisions.",
"gpt35": "The correct answer is 4) 40. The Affordable Care Act (ACA) defines a full-time employee as one employed on average at least 40 hours per week.",
"gpt4": "The correct answer is 2) 30."
},
{
"question": "A mechanism by which one attempts either to prevent or reduce the probability of a loss taking place or to reduce the severity of the loss if it does take place is referred to as:",
"choices": [
"Avoidance",
"Retention",
"Transfer",
"Insurance",
"Control"
],
"key": 5,
"claude2": " 3) Insurance\n\nThe mechanism that attempts either to prevent or reduce the probability of a loss taking place or to reduce the severity of the loss if it does take place is insurance.",
"gpt35": "The correct answer is 4) Control.",
"gpt4": "The correct answer is 4) Control."
},
{
"question": "Which of the following statements regarding workplace wellness programs is correct?",
"choices": [
"A workplace wellness program should be designed to target the most fitness-conscious employees.",
"Workplace wellness programs are used almost exclusively by large employers.",
"The most significant drivers of cost of workplace wellness programs are incentives, equipment, and outside service providers.",
"Health screenings known as health risk assessments (HRAs) are prohibited if used in conjunction with workplace wellness programs.",
"Biometric testing for workplace wellness programs must be conducted by qualified physicians."
],
"key": 3,
"claude2": " 2) The most significant drivers of cost of workplace wellness programs are incentives, equipment, and outside service providers.\n\nThis is the correct answer. Key points:\n\n- Workplace wellness programs should target all employees, not just the most fitness-conscious. \n\n- They are utilized by employers of all sizes, not just large employers.\n\n- The major costs associated with workplace wellness programs are typically incentives, equipment like on-site gyms, and outside providers such as consultants and counselors. \n\n- Health risk assessments (HRAs) are commonly used in conjunction with workplace wellness programs to gather health data from employees. Their use is not prohibited. \n\n- Biometric testing does not need to be conducted solely by physicians. Other health professionals can perform these screenings for workplace wellness programs.",
"gpt35": "The correct answer is 2) The most significant drivers of cost of workplace wellness programs are incentives, equipment, and outside service providers.",
"gpt4": "The correct answer is 2) The most significant drivers of cost of workplace wellness programs are incentives, equipment, and outside service providers."
},
{
"question": "The maximum annual contribution that can be made to a health savings account (HSA) is:",
"choices": [
"A flat dollar amount for individuals and a different dollar amount for families.",
"A percentage of the participant's compensation",
"The annual deductible under the high-deductible health plan (HDHP)",
"The greater of either 100 % of the annual deductible under the HDHP or a fixed, indexed amount",
"The lesser of either 100 % of the annual deductible under the HDHP or a fixed, indexed amount"
],
"key": 1,
"claude2": " The correct answer is 4) The lesser of either 100 % of the annual deductible under the HDHP or a fixed, indexed amount\n\nEach year the IRS publishes the maximum annual HSA contribution limits. The limit is the lesser of either 100% of the annual deductible under the HDHP or a fixed dollar amount determined by the IRS. For 2022, the maximum HSA contribution limit is $3,650 for individual coverage and $7,300 for family coverage. These limits represent the lesser of 100% of the minimum annual deductible for HDHPs ($1,400 individual/$2,800 family) or the indexed fixed dollar maximums set by the IRS.",
"gpt35": "The correct answer is 4) The lesser of either 100% of the annual deductible under the HDHP or a fixed, indexed amount.",
"gpt4": "The correct answer is 0) A flat dollar amount for individuals and a different dollar amount for families."
},
{
"question": "Numerous studies have examined the effectiveness of workplace wellness programs in promoting health or preventing disease. Which of the following statements best describes the effectiveness of these programs?",
"choices": [
"These programs have been greatly effective for all participating employees.",
"These programs have been greatly effective for older employees, but not for younger employees.",
"These programs have been mildly effective, but only for few employees.",
"These programs have had limited evidence of their effectiveness.",
"These programs have actually been detrimental to the health of many employees."
],
"key": 4,
"claude2": " 3) These programs have had limited evidence of their effectiveness.\n\nAccording to the GBA CEBS study text, numerous studies have found limited evidence on the effectiveness of workplace wellness programs in promoting health or preventing disease. The effectiveness is hard to measure due to challenges such as healthier individuals being more likely to participate in the programs in the first place. Therefore, answer choice 3 is correct.",
"gpt35": "The correct answer is 3) These programs have had limited evidence of their effectiveness.",
"gpt4": "The correct answer is 3) These programs have had limited evidence of their effectiveness."
},
{
"question": "Generally in a premium conversion cafeteria plan:",
"choices": [
"An employer contribution of 10% of pay is required.",
"An employer contribution of 15% of pay is required.",
"An employer contribution of 25% of pay is required.",
"An employer contribution of 30% of pay is required.",
"There are no employer contributions."
],
"key": 5,
"claude2": " 4) There are no employer contributions.\n\nIn a premium conversion cafeteria plan, there are typically no employer contributions. The plan is offered to employees so they may pay for their insurance costs on a tax-favored basis. Because there are no employer contributions or flexible credits, this type of plan is considered a cafeteria plan in its simplest form.",
"gpt35": "The correct answer is 4) There are no employer contributions.",
"gpt4": "The correct answer is 4) There are no employer contributions."
},
{
"question": "The concept designed to make victims of losses whole again reflects the principle of:",
"choices": [
"Insurable interest",
"Insurance",
"Indemnification",
"Transfer",
"Pure risk"
],
"key": 3,
"claude2": " 2) Indemnification\n\nThe principle of indemnification refers to the fact that insurance is used to make victims of losses whole again. An insured is indemnified if a covered loss occurs - that is, they are placed in somewhat the same situation that existed prior to the loss, through reimbursement for damaged property, medical bills, disability income, etc.",
"gpt35": "The correct answer is 2) Indemnification.",
"gpt4": "The correct answer is 2) Indemnification."
},
{
"question": "A peril as the term applies to the insurance mechanism is defined as:",
"choices": [
"A condition that increases the chance of a loss",
"The cause of a loss",
"The relative variation of actual loss from expected loss",
"The uncertainty experienced by some people as a result of mental and personality factors",
"A tendency for accidents to occur to specific individuals or at specific places"
],
"key": 2,
"claude2": " 1) The cause of a loss\n\nThe correct answer is 1) The cause of a loss.\n\nA peril is basically the cause of a loss. Some examples of perils are fire, theft, illness, and death. These perils are the root causes that can lead to losses that are covered by insurance policies.\n\n0) is incorrect because that describes a hazard, which increases the chance of a loss occurring. \n\n2) refers to variability, not the actual cause of a loss.\n\n3) describes moral hazard, which exists due to dishonesty or personality traits that increase loss chances.\n\n4) refers to increased accident frequency for certain people or locations, but does not describe the root cause of losses.\n\nSo the correct answer is 1) The cause of a loss. Perils are the root causes that can lead to insured losses.",
"gpt35": "The correct answer is 1) The cause of a loss.",
"gpt4": "The correct answer is 1) The cause of a loss."
},
{
"question": "Dental treatments are placed into ten professional treatment categories. The repair of a natural tooth is included in which of the following categories?",
"choices": [
"Restorative",
"Endodontics",
"Periodontics",
"Preventive",
"Palliative"
],
"key": 1,
"claude2": " The correct answer is 0) Restorative.\n\nRepairing a natural tooth falls under the restorative category of dental treatments. The ten professional treatment categories of dentistry are:\n\n1) Diagnostic \n2) Preventive\n3) Restorative \n4) Endodontics\n5) Periodontics\n6) Oral surgery \n7) Prosthodontics\n8) Orthodontics\n9) Pedodontics\n10) Implantology\n\nRestorative treatments involve repairing or restoring teeth damaged by decay, fracture, attrition, abrasion or erosion. Examples include fillings, crowns, bridges and denture repair. Repairing a natural tooth would fall under the restorative category.",
"gpt35": "The correct answer is 0) Restorative.",
"gpt4": "The correct answer is 0) Restorative."
},
{
"question": "When a participant of a cafeteria plan makes a one-time election on coverage that stays in force from plan year to plan year unless the participant elects to make a change during the applicable election period, it is referred to as a(n):",
"choices": [
"Evergreen election",
"De minimis election",
"Consistent benefit election",
"Negative election",
"Revocation election"
],
"key": 1,
"claude2": " The correct answer is 0) Evergreen election.\n\nAn evergreen election is similar to a negative election. When a plan uses an evergreen election, a participant makes a one-time election. Once made, the evergreen election stays in force from plan year to plan year unless the participant elects to make a change during the applicable election period (most often, this would be the plan\u2019s annual open enrollment period).",
"gpt35": "The correct answer is 0) Evergreen election.",
"gpt4": "The correct answer is 0) Evergreen election."
},
{
"question": "Which of the following factors affect(s) the cost of an employer-sponsored dental plan? I. Design of the plan II. Characteristics of the covered group III. Employers' approach to plan implementation",
"choices": [
"I only",
"I and II only",
"I and III only",
"II and III only",
"I, II and III"
],
"key": 5,
"claude2": " The correct answer is 4) I, II and III\n\nAccording to the study material, there are three primary factors that affect the cost of an employer-sponsored dental plan:\n\nI. The design of the plan, including features like deductibles, coinsurance, plan maximums, and coverage of procedures like orthodontics.\n\nII. Characteristics of the covered group, such as the ages, gender distribution, location, incomes, and occupations of the participants. These factors can impact dental costs and utilization patterns.\n\nIII. The employer's approach to plan implementation, including how the plan is communicated, enrollment procedures, and whether adverse selection is effectively managed. \n\nSince all three factors - the design of the plan, the characteristics of the covered group, and the employer's implementation approach - can impact the cost of a dental plan, the correct answer is 4) I, II and III.",
"gpt35": "The correct answer is 4) I, II and III. All three factors - the design of the plan, characteristics of the covered group, and the employer's approach to plan implementation - can affect the cost of an employer-sponsored dental plan.",
"gpt4": "The correct answer is 4) I, II and III."
},
{
"question": "Which of the following statements regarding the types of formularies is (are) correct? I. Preferred formularies encourage patients to use the preferred or formulary drugs in return for a reduced copayment. II. Open formularies allow plan enrollees any covered prescription drug prescribed for them. III. Closed formularies allow changes in the list of preferred drugs only once per year; otherwise the list is static.",
"choices": [
"I only",
"II only",
"III only",
"I and II only",
"II and III only"
],
"key": 4,
"claude2": " 3) I and II only\n\nThe statements regarding types of formularies that are correct are:\n\nI. Preferred formularies encourage patients to use the preferred or formulary drugs in return for a reduced copayment. \n\nII. Open formularies allow plan enrollees any covered prescription drug prescribed for them.\n\nStatement III is incorrect. Closed formularies often meet with resistance from plan enrollees. They simply mean that the plan will not cover the nonformulary drug. Closed formularies are typically found in hospital settings and tightly managed HMO programs\u2014employers normally do not use this type of formulary. \n\nSo the correct answer is I and II only.",
"gpt35": "The correct answer is 3) I and II only.",
"gpt4": "The correct answer is 3) I and II only."
},
{
"question": "Which of the following statements concerning maximum allowable cost (MAC) for drug benefits is (are) correct? I. MAC programs reimburse up to a certain threshold on selected, common generics. II. Maximum allowable cost (MAC) is synonymous with average wholesale price (AWP). III. The concept of MAC is used only by Medicaid.",
"choices": [
"I only",
"III only",
"I and II only",
"II and III only",
"I, II and III"
],
"key": 1,
"claude2": " The correct answer is 1). III only.\n\nMaximum allowable cost (MAC) programs reimburse up to a certain threshold on selected, common generics. They do not use the average wholesale price (AWP). MAC programs are used by many payers including Medicaid, Medicare, and private payers/plans.\n\nSo the only correct statement is III. MAC programs are not limited to just Medicaid plans.",
"gpt35": "The correct answer is 0) I only.\n\nExplanation: Statement I is correct. MAC programs do reimburse up to a certain threshold on selected, common generics. Statement II is incorrect. Maximum allowable cost (MAC) is not synonymous with average wholesale price (AWP). Statement III is incorrect. The concept of MAC is not used only by Medicaid, it is also used by other payers such as private insurance plans.",
"gpt4": "The correct answer is 0) I only."
},
{
"question": "Which of the following entities are eligible to participate in a cafeteria plan? I. Sole proprietors II. Partners in a partnership III. 2% or greater shareholders in an S-corporation",
"choices": [
"None",
"I only",
"II only",
"III only",
"II and III only"
],
"key": 1,
"claude2": " The entities that are eligible to participate in a cafeteria plan are partners in a partnership and 2% or greater shareholders in an S-corporation. \n\nSole proprietors are not eligible to participate in a cafeteria plan. According to tax law, a cafeteria plan may only benefit employees, not owners such as sole proprietors.\n\nPartners in a partnership and 2% or greater shareholders in an S-corporation are eligible to participate in a cafeteria plan. Although they are considered owners, tax law makes an exception for them to participate. \n\nTherefore, the correct answer is 4) II and III only. Partners in a partnership and 2% or greater shareholders in an S-corporation are the entities that are eligible to participate in a cafeteria plan.",
"gpt35": "The correct answer is 4) II and III only.",
"gpt4": "The correct answer is 0) None."
},
{
"question": "Which of the following statements regarding self-funding or self-insurance is (are) correct? I. Self-insurance is sometimes used for property exposures but it cannot be used for employee benefit plans. II. Stop loss insurance utilizes the concept of self-insurance. III. An effective self-insurance program requires a large enough number of exposure units to make losses predictable.",
"choices": [
"III only",
"I and II only",
"I and III only",
"II and III only",
"I, II and III"
],
"key": 4,
"claude2": " The correct answer is 3) II and III only\n\nSelf-insurance or self-funding of employee benefit plans means that an organization retains the risks as opposed to transferring them to an insurance company in exchange for a premium. Self-insurance requires a large enough number of exposure units to make losses predictable based on the law of large numbers (III is correct). \n\nStop loss insurance utilizes the concept of self-insurance by having an organization retain some of the risk while transferring the excess risk to an insurer (II is correct).\n\nHowever, self-insurance can be used for employee benefit plans (I is incorrect).",
"gpt35": "The correct answer is 3) II and III only.",
"gpt4": "The correct answer is 3) II and III only."
},
{
"question": "Which of the following is (are) primary factors that have contributed to cafeteria plans becoming a standard benefit offering today? I. The increasing costs of benefits II. Cafeteria plans allow participants to pay for dependent care expenses through the plan and, at the same time, claim personal tax credits on their personal income tax returns. III. The diverse workforce with differing benefit needs",
"choices": [
"I only",
"III only",
"I and III only",
"II and III only",
"I, II and III"
],
"key": 3,
"claude2": " The correct answer is 2) I and III only. \n\nThe primary factors that have contributed to cafeteria plans becoming a standard benefit offering today are:\n\nI. The ever-increasing costs of benefits\nIII. A diverse workforce with vastly differing employee benefit needs.\n\nII is incorrect. Cafeteria plans allow participants to pay for dependent care expenses through the plan on a tax-favored basis. Participants cannot also claim personal tax credits on their personal income tax returns for expenses reimbursed through the cafeteria plan.",
"gpt35": "The correct answer is 4) I, II and III.",
"gpt4": "The correct answer is 2) I and III only."
},
{
"question": "A typical behavioral health specialty network might include which of the following health professionals? I. Individual practitioners and multispecialty group practices II. Medical doctors that specialize in addictionology III. Developmental behavioral pediatricians",
"choices": [
"I only",
"II only",
"III only",
"II and III only",
"I, II and III"
],
"key": 5,
"claude2": " 3) II and III only\n\nA typical behavioral health specialty network might include:\n\nII. Medical doctors that specialize in addictionology \nIII. Developmental behavioral pediatricians\n\nSo the correct answer is 3) II and III only.",
"gpt35": "The correct answer is 4) I, II and III. A typical behavioral health specialty network may include individual practitioners and multispecialty group practices (I), medical doctors that specialize in addictionology (II), and developmental behavioral pediatricians (III).",
"gpt4": "The correct answer is 4) I, II and III."
},
{
"question": "Which of the following statements regarding the market acceptance of consumer directed health plans (CDHPs) is (are) correct? I. Generally, less than 25 percent of employers offer a CDHP as their only health plan, but a more typical scenario is for employers to offer a CDHP as a choice within a menu of plan offerings. II. Among the largest employers it is increasingly rare to find an employer that does not make a CDHP choice available to its employees. III. All health care expenditures are now \u201cshoppable\u201d because of the transparency CDHPs have brought to the healthcare market.",
"choices": [
"I only",
"III only",
"I and II only",
"II and III only",
"I, II and III"
],
"key": 3,
"claude2": " 2) I and II only\n\nThe correct answers are:\n\nI. Generally, less than 25 percent of employers offer a CDHP as their only health plan, but a more typical scenario is for employers to offer a CDHP as a choice within a menu of plan offerings. \n\nII. Among the largest employers it is increasingly rare to find an employer that does not make a CDHP choice available to its employees.\n\nIII is incorrect because not all health care expenditures are \"shoppable\" - certain services like emergency care cannot be easily compared or anticipated.",
"gpt35": "The correct answer is 2) I and II only.",
"gpt4": "The correct answer is 2) I and II only."
},
{
"question": "An effective behavioral health program should include which of the following? I. An integrated mental health/chemical dependency benefit. II. Inpatient and outpatient services III. An employee assistance program (EAP)",
"choices": [
"II only",
"III only",
"I and II only",
"II and III only",
"I, II and III"
],
"key": 5,
"claude2": " The correct answer is 4) I, II and III\n\nAn effective behavioral health program should include:\n\nI. An integrated mental health/chemical dependency benefit. \n\nII. Inpatient and outpatient services\n\nIII. An employee assistance program (EAP)\n\nAll three elements (I, II, and III) are important components of an effective behavioral health program.",
"gpt35": "The correct answer is 4) I, II and III. An effective behavioral health program should include an integrated mental health/chemical dependency benefit (I), inpatient and outpatient services (II), and an employee assistance program (EAP) (III).",
"gpt4": "The correct answer is 4) I, II and III."
},
{
"question": "Which of the following statements regarding health savings accounts (HSAs) is (are) correct? I. Contributions to these plans cannot be rolled over from year to year; unused amounts must be forfeited. II. There are penalties for money used for nonmedical expenses before age 65. III. HSAs are coupled with high-deductible health plans.",
"choices": [
"II only",
"III only",
"I and II only",
"II and III only",
"I, II and III"
],
"key": 4,
"claude2": " 3) II and III only\n\nThe correct answer is 3) II and III only.\n\nI is incorrect. Unlike health flexible spending accounts (FSAs), unused HSA contributions can be rolled over from year to year. The funds never expire and are available even after employment ends, including for qualified medical expenses in retirement. \n\nII is correct. Withdrawals from an HSA used for nonmedical expenses before age 65 are subject to income tax and a 20% penalty tax. After age 65, nonmedical withdrawals are taxed as ordinary income but exempt from the 20% penalty.\n\nIII is correct. To be eligible to contribute to an HSA, an individual must be enrolled in a qualified high-deductible health plan (HDHP).\n\nSo II and III are correct statements regarding HSAs, while I is incorrect. The answer is 3) II and III only.",
"gpt35": "The correct answer is 3) II and III only.",
"gpt4": "The correct answer is 3) II and III only."
},
{
"question": "Which of the following statements regarding Consolidated Omnibus Budget Reconciliation Act (COBRA) coverage is (are) correct? I. The cost of coverage under COBRA is limited, by law, to no more than 98% of the full cost of coverage for active employees. II. Employers are required to pay a significant portion of the cost of insurance for employees who continue their COBRA coverage. III. COBRA continuation coverage lasts only for a limited period of time.",
"choices": [
"I only",
"III only",
"I and II only",
"II and III only",
"I, II and III"
],
"key": 2,
"claude2": " III only.\n\nThe key points about COBRA coverage are:\n\n- COBRA requires employers to allow eligible employees and their dependents to continue their group health coverage for a limited time after they would otherwise lose coverage due to certain qualifying events like termination of employment. \n\n- Individuals who elect COBRA continuation coverage can be required to pay the full cost of coverage plus a 2% administrative fee. Employers are not required to contribute to the cost. \n\n- COBRA coverage lasts only for a limited period of time - generally 18 months for termination of employment or reduction of hours. The maximum period can extend to 36 months under certain circumstances like death, divorce, or Medicare entitlement.\n\nSo statement III is correct - COBRA continuation coverage lasts only for a limited period of time. Statements I and II are incorrect. The cost of COBRA coverage can be up to 102% of the full cost, not limited to 98%, and employers are not required to subsidize the cost.\n\nThe answer is III only.",
"gpt35": "The correct answer is 2) I and II only.",
"gpt4": "The correct answer is 1) III only."
},
{
"question": "Under which of the following circumstances can an eligible employee take benefits under the Family Medical Leave Act (FMLA)? I. The employee becomes a parent and needs to care for the newborn child. II. The employee is required to take care of his spouse who has a serious health condition. III. The employee has a serious health condition that makes him/her unable to perform the essential functions of the job.",
"choices": [
"I only",
"II only",
"III only",
"II and III only",
"I, II and III"
],
"key": 5,
"claude2": " 3) II and III only\n\nThe Family Medical Leave Act (FMLA) entitles eligible employees of covered employers to take unpaid, job-protected leave for specified family and medical reasons with continuation of group health insurance coverage. An eligible employee may take up to 12 weeks of leave in a 12-month period for the following reasons:\n\n- To care for the employee's spouse, child, or parent who has a serious health condition (II)\n\n- A serious health condition that makes the employee unable to perform the essential functions of their job (III) \n\n- The birth of a child and to care for the newborn child within one year of birth (I) does not apply here as the question asks about an eligible employee taking benefits under FMLA, not about the circumstances under which FMLA leave may be taken in general.\n\nSo the correct answer is 3) II and III only.",
"gpt35": "The correct answer is 4) I, II and III. Under the Family Medical Leave Act (FMLA), eligible employees can take benefits in all three of the mentioned circumstances: when they become a parent and need to care for a newborn child (I), when they need to take care of their spouse who has a serious health condition (II), and when they have a serious health condition that makes them unable to perform the essential functions of their job (III).",
"gpt4": "The correct answer is 4) I, II and III."
},
{
"question": "In addition to medical flexible spending accounts (FSAs), the law permits which of the following other types of FSAs? I. Dependent care FSAs that allow participants to set aside funds on a pretax basis to pay for certain dependent care expenses. II. FSAs to pay for parking and transit reimbursement. III. FSAs to pay for adoption assistance.",
"choices": [
"I only",
"III only",
"I and II only",
"II and III only",
"I, II and III"
],
"key": 5,
"claude2": " The correct answer is 4) I, II and III\n\nAccording to the study material, in addition to medical FSAs, the law permits the following other types of FSAs:\n\nI. Dependent-care FSAs that allow plan participants to set aside funds on a pretax basis to pay for certain expenses in connection with care for dependents while the legal guardian is working. \n\nII. FSAs for non-employer sponsored premium reimbursement, parking and transit expense reimbursement, and adoption assistance.\n\nIII. FSAs to pay for adoption assistance under IRC Section 137.\n\nSo all three statements I, II, and III are correct. The correct answer is 4) I, II and III.",
"gpt35": "The correct answer is 4) I, II and III.",
"gpt4": "The correct answer is 2) I and II only."
},
{
"question": "Which of the following are common ways pharmacy benefit managers (PBMs) typically generate profits? I. Charging payers an administrative fee per transaction based on the number of prescriptions or employees. II. Filling mail-service prescriptions from their wholly owned mail-order pharmacies. III. Requiring pharmacies to remit to them the difference when a plan member pays a copay that exceeds the actual cost of a drug.",
"choices": [
"None",
"I only",
"III only",
"I and II only",
"II and III only"
],
"key": 4,
"claude2": " 3) I and II only\n\nThe common ways PBMs typically generate profits are:\n\nI. Charging payers an administrative fee per transaction based on the number of prescriptions or employees. This is correct. PBMs charge payers like employers an administrative fee to manage the pharmacy benefit. \n\nII. Filling mail-service prescriptions from their wholly owned mail-order pharmacies. This is correct. Many PBMs own their own mail-order pharmacies and generate revenue by filling prescriptions through mail order.\n\nIII. Requiring pharmacies to remit to them the difference when a plan member pays a copay that exceeds the actual cost of a drug. This is incorrect. This practice is called zero-balance billing and while some PBMs may engage in it, it is not a universal source of PBM profit.\n\nTherefore, the correct answers are I and II only.",
"gpt35": "The correct answer is 4) II and III only. Pharmacy benefit managers (PBMs) typically generate profits by filling mail-service prescriptions from their wholly owned mail-order pharmacies (II) and by requiring pharmacies to remit to them the difference when a plan member pays a copay that exceeds the actual cost of a drug (III). They do not typically generate profits by charging payers an administrative fee per transaction based on the number of prescriptions or employees (I).",
"gpt4": "The correct answer is 3) I and II only."
},
{
"question": "Which of the following statements regarding the distinctions between health reimbursement accounts (HRAs) and health savings accounts (HSAs) is (are) correct? I. There is no federal limit on contributions to HSAs, but HRAs are subject to a rather low federal limit. II. An HRA must be funded solely by the employee, but HSAs are funded only by employers. III. Nonmedical use is not allowed with HRAs, but such withdrawals are permitted with HSAs, subject to income tax and penalties if the participant is under age 65.",
"choices": [
"II only",
"III only",
"I and II only",
"II and III only",
"II and III only"
],
"key": 2,
"claude2": " 3) II and III only\n\nThe correct answer is 3) II and III only. \n\nStatement I is incorrect because there is a federal limit on contributions to HSAs, not HRAs. HSAs have a maximum allowable annual contribution limit for individuals and families, while HRAs have no federal limit on contributions.\n\nStatement II is incorrect because HRAs are funded solely by the employer, while HSAs may be funded by the employee, employer or both. \n\nStatement III is correct. Nonmedical use is not allowed with HRAs, but withdrawals from HSAs for nonmedical use are allowed if the participant is age 65 or over. If under age 65, such withdrawals are subject to income tax and penalties.\n\nSo statements II and III are correct.",
"gpt35": "The correct answer is 3) II and III only.",
"gpt4": "The correct answer is 1) III only."
},
{
"question": "Which of the following policy provisions have historically been used by insurers to control adverse selection? I. Preexisting conditions clauses II. Suicide clauses III. Open enrollment period restrictions",
"choices": [
"II only",
"III only",
"I and II only",
"II and III only",
"I, II and III"
],
"key": 5,
"claude2": " The correct answer is 4) I, II and III.\n\nInsurers attempt to control adverse selection by using sophisticated underwriting methods and supportive policy provisions. Examples of the types of policy provisions historically used to control adverse selection include:\n\nI. Preexisting conditions clauses in medical expense policies\nII. Suicide clauses\nIII. Maximum coverage amounts \nIV. Open enrollment period restrictions\n\nSo preexisting conditions clauses, suicide clauses, and open enrollment period restrictions have all been used by insurers to control adverse selection.",
"gpt35": "The correct answer is 4) I, II and III. All three policy provisions have historically been used by insurers to control adverse selection. Preexisting conditions clauses help insurers avoid covering individuals with existing health conditions. Suicide clauses limit coverage for death by suicide within a certain period after the policy is issued. Open enrollment period restrictions limit the time period during which individuals can enroll in or change their insurance coverage.",
"gpt4": "The correct answer is 4) I, II and III."
},
{
"question": "Maximum limits in dental plans typically are expressed in which of the following ways? I. A separate inside maximum for orthodontics II. A separate maximum per person per calendar year III. A separate lifetime maximum for each procedure",
"choices": [
"II only",
"III only",
"I and II only",
"I and III only",
"I, II and III"
],
"key": 3,
"claude2": " 2) I and II only\n\nThe maximum limits in dental plans are typically expressed in the following ways:\n\nI. A separate inside maximum for orthodontics \n\nII. A separate maximum per person per calendar year\n\nIII. A separate lifetime maximum for each procedure\n\nOptions I and II are correct. Orthodontics often have a separate lifetime maximum since orthodontic treatment takes place over several years. Most dental plans also have a calendar year maximum that applies on a per person basis. \n\nOption III is incorrect. Dental plans do not typically have separate lifetime maximums for each procedure. Rather, the calendar year and orthodontic lifetime maximums apply broadly across multiple procedures.\n\nTherefore, the correct answer is 2) I and II only.",
"gpt35": "The correct answer is 4) I, II and III. Maximum limits in dental plans typically include a separate inside maximum for orthodontics (I), a separate maximum per person per calendar year (II), and a separate lifetime maximum for each procedure (III).",
"gpt4": "The correct answer is 2) I and II only."
},
{
"question": "Which of the following is (are) characteristics of modern prescription drug plans? I. Plan members pay the full cost at the pharmacy and then file a claim for reimbursement. II. These plans are usually carved out from the medical benefit and are typically administered by a pharmacy benefit manager (PBM) or third party administrator (TPA). III. These plans have not yet used mail service and the Internet but are expected to do so after regulatory permission is obtained.",
"choices": [
"I only",
"II only",
"I and II only",
"II and III only",
"I, II and III"
],
"key": 2,
"claude2": " II only is the correct answer.\n\nModern prescription drug plans usually are \u201ccarved out\u201d from the medical benefit and are typically administered by a pharmacy benefit manager (PBM) or third-party administrator (TPA). The plan offers payers discounts on normal pharmacy charges, electronic claims administration according to benefit requirements, and utilization reports. It also offers programs to reduce costs through mail service and the internet and rebates from manufacturers for volume purchasing.\n\nIn contrast, under older plans that directly reimbursed drug expenditures, there was typically no discounts for prescription drug coverage. Plan participants paid the full cost at the pharmacy and then filed a claim for reimbursement. Also, limited data was available in report format for reviewing drug trends because of a lack of detailed information from the claims processing systems.",
"gpt35": "The correct answer is 1) II only.",
"gpt4": "The correct answer is 1) II only."
},
{
"question": "Which of the following is (are) major requirements of the Affordable Care Act (ACA) for employers who sponsor group health plans? I. The Act eliminated the use of the \u201cessential health benefits\u201d list. II. The Act eliminated lifetime maximum limitations. III. The Act expanded coverage for preventive services.",
"choices": [
"II only",
"III only",
"I and II only",
"II and III only",
"I, II and III"
],
"key": 4,
"claude2": " 3) II and III only\n\nThe Affordable Care Act (ACA) imposed several major requirements on employers who sponsor group health plans, including:\n\nII. The Act eliminated lifetime maximum limitations on essential health benefits. This prohibits group health plans from placing lifetime dollar limits on coverage of essential health benefits, such as hospital stays, physician visits, prescription drugs, etc. \n\nIII. The Act expanded coverage for preventive services without cost sharing. This requires nongrandfathered group health plans to provide coverage for certain preventive services without charging deductibles, copayments or coinsurance when the services are delivered by an in-network provider.\n\nI is incorrect. The ACA established the essential health benefits requirement for health plans. It did not eliminate the use of the essential health benefits list. \n\nThe correct answer is II and III only.",
"gpt35": "The correct answer is 3) II and III only. The Affordable Care Act (ACA) did not eliminate the use of the \"essential health benefits\" list (I), but it did eliminate lifetime maximum limitations (II) and expanded coverage for preventive services (III).",
"gpt4": "The correct answer is 3) II and III only."
},
{
"question": "Which of the following statements regarding flexible spending accounts (FSAs) is (are) correct? I. FSAs allow individuals, before the start of the plan year, to elect a certain amount to be deducted on a pretax basis from their paycheck to pay for IRS-qualified medical expenses. II. Individuals cannot enroll in FSAs if they are covered by any other health plan. III. Employers are not allowed to contribute to FSAs.",
"choices": [
"I only",
"II only",
"III only",
"I and II only",
"II and III only"
],
"key": 1,
"claude2": " The correct answer is 1) I only.\n\nI is correct. FSAs allow individuals, before the start of the plan year, to elect a certain amount to be deducted on a pretax basis from their paycheck (deductions may not exceed the IRS limit) to pay for IRS-qualified medical expenses. \n\nII is incorrect. Individuals can enroll in FSAs regardless of their health plan insurance status. \n\nIII is incorrect. Employers are permitted to make contributions to FSAs if they choose to do so.\n\nTherefore, the only statement that is correct is I. The correct answer is 1) I only.",
"gpt35": "The correct answer is 3) I and II only.",
"gpt4": "The correct answer is 0) I only."
},
{
"question": "Which of the following is (are) taxable benefits in a cafeteria plan? I. Whole life insurance premiums II. Group term life insurance premiums for coverage greater than $50,000 III. Long-term care insurance premiums",
"choices": [
"I only",
"II only",
"III only",
"II and III only",
"I, II and III"
],
"key": 2,
"claude2": " 3) II and III only\n\nGroup term life insurance premiums for coverage greater than $50,000 and long-term care insurance premiums are taxable benefits that can be paid through a cafeteria plan. Whole life insurance premiums cannot be offered through a cafeteria plan.\n\nTherefore, the correct answer is 3) II and III only.",
"gpt35": "The correct answer is 3) II and III only. Group term life insurance premiums for coverage greater than $50,000 and long-term care insurance premiums are taxable benefits in a cafeteria plan. Whole life insurance premiums are not taxable benefits in a cafeteria plan.",
"gpt4": "The correct answer is 3) II and III only."
},
{
"question": "Under the Genetic Information Nondiscrimination Act (GINA), which of the following statements is (are) correct? I. Group health plans are permitted to establish premium contribution differentials on the basis of genetic information as long as they do not exceed 30%. II. GINA prohibits employment discrimination based on genetic information. III. GINA forbids employers from asking about individuals\u2019 genetic information but there is an exception for inquires through voluntary wellness programs.",
"choices": [
"I only",
"III only",
"I and II only",
"II and III only",
"I, II and III"
],
"key": 4,
"claude2": " 3) II and III only\n\nGINA prohibits employment discrimination based on genetic information and forbids employers from asking about individuals' genetic information, with an exception for inquiries through voluntary wellness programs. \n\nOptions I and II are incorrect. GINA does not permit group health plans to establish premium contribution differentials based on genetic information.",
"gpt35": "The correct answer is 3) II and III only.",
"gpt4": "The correct answer is 3) II and III only."
},
{
"question": "Which of the following is (are) basic differences between medicine and dentistry? I. Medical care is rarely cosmetic; dental care often is. II. Dental expenses generally are lower, more predictable and budgetable, with the average medical claim being much higher than the average dental claim. III. There is a greater emphasis on prevention in medicine than in dentistry.",
"choices": [
"None",
"I only",
"II only",
"III only",
"I and II only"
],
"key": 5,
"claude2": " The correct answer is 4) I and II only.\n\nThe relevant differences between medicine and dentistry are: \n\nI. While medical care is rarely cosmetic, dental care often is. \n\nII. Dental expenses generally are lower, more predictable and budgetable, with the average medical claim being much higher than the average dental claim.\n\nIII. There is a greater emphasis on prevention in dentistry than in medicine.\n\nSo statements I and II are true differences between medicine and dentistry, while statement III is false. Therefore, the correct answer is 4) I and II only.",
"gpt35": "The correct answer is 4) I and II only.",
"gpt4": "The correct answer is 4) I and II only."
},
{
"question": "Which of the following statements describe(s) reforms enacted by the Affordable Care Act (ACA)? I. The Act precluded insurance companies from denying coverage due to a preexisting condition. II. In general, the Act prohibited group health plans from offering coverage with any lifetime or annual limits on the dollar value of essential health benefits III. Imposing coverage requirements on applicable large employers (ALEs) defined as those with more than 20 full-time employees (including full-time equivalent employees)",
"choices": [
"III only",
"I and II only",
"I and III only",
"II and III only",
"I, II and III"
],
"key": 2,
"claude2": " 1) I and II only\n\nThe correct options are:\n\nI. The Act precluded insurance companies from denying coverage due to a preexisting condition. \n\nII. In general, the Act prohibited group health plans from offering coverage with any lifetime or annual limits on the dollar value of essential health benefits\n\nIII is incorrect. The ACA defined applicable large employers (ALEs) as those with at least 50 full-time employees (including full-time equivalent employees) on average, not more than 20.\n\nSo the correct answer is 1) I and II only.",
"gpt35": "The correct answer is 4) I, II and III.",
"gpt4": "The correct answer is 1) I and II only."
},
{
"question": "Which of the following statements is (are) descriptive of the functional approach to employee benefit plan design? I. It involves the evaluation of each benefit plan on a product-oriented basis. II. Using Social Security integration concepts is inconsistent with this approach. III. It is an organized system for classifying and analyzing the risks and needs of various categories of persons into logical categories of exposure to loss and employee needs.",
"choices": [
"I only",
"III only",
"I and II only",
"I and III only",
"I, II and III"
],
"key": 2,
"claude2": " The correct answer is 1) III only.\n\nThe functional approach to employee benefit plan design involves classifying and analyzing risks and needs into logical categories, so statement III is correct. \n\nStatement I is incorrect because the functional approach evaluates benefits in terms of how well they address risks and needs, not as standalone products. \n\nStatement II is incorrect because integrating benefits with Social Security is consistent with the functional approach to ensure adequate income replacement.\n\nSo the only statement that is descriptive of the functional approach is III. The correct answer is 1) III only.",
"gpt35": "The correct answer is 3) I and III only.",
"gpt4": "The correct answer is 1) III only."
},
{
"question": "Which of the following statements regarding the effectiveness of workplace wellness programs is (are) correct? I. Health risk assessments, conducted at the conclusion of the program, can provide a complete diagnosis of a worker\u2019s health. II. Incentives, such as cash, movie tickets, discounts on medical care, have been shown to be very effective in increasing worker participation in wellness programs. III. Biometric testing for wellness programs is prohibited by the Genetic Information Nondiscrimination Act (GINA).",
"choices": [
"I only",
"II only",
"I and II only",
"I and III only",
"II and III only"
],
"key": 2,
"claude2": " The correct answer is 2) II only.\n\nA health risk assessment (HRA) does not provide a complete diagnosis of a worker's health. Rather, an HRA consists of questions about lifestyle, family history, and other factors that can identify potential health risks. It does not involve diagnostic medical tests or a clinician's examination. \n\nThe use of incentives has been shown to increase participation in workplace wellness programs. However, the extent to which substantial incentives induce participation in programs that involve disclosure of health information has raised concerns.\n\nBiometric testing is not prohibited by GINA as long as individually identifiable results are not shared with the employer. The employer may receive aggregate data to design programs but not individual results.\n\nSo the statement in II, that incentives can effectively increase participation in workplace wellness programs, is correct. Statements I and III are incorrect.",
"gpt35": "The correct answer is 1) II only.",
"gpt4": "The correct answer is 1) II only."
},
{
"question": "Insurance can be distinguished from gambling by which of the following factors? I. Insurance handles existing risk while gambling creates a new risk. II. Insurance is a speculative risk and gambling is pure risk. III. Insurance is based on a mutual sharing of losses that occur while gambling involves a gain for one party at the expense of another.",
"choices": [
"I only",
"II only",
"I and III only",
"II and III only",
"I, II and III"
],
"key": 3,
"claude2": " 2) I and III only\n\nInsurance can be distinguished from gambling based on two factors:\n\nI. Insurance handles existing risk while gambling creates a new risk. This statement is correct. Insurance deals with existing risks like illness, disability, death etc. Gambling creates a new financial risk that did not exist before gambling.\n\nII. Insurance is a speculative risk and gambling is pure risk. This statement is incorrect. Insurance deals with pure risks that have only two potential outcomes - a financial loss or no loss. Gambling involves speculative risks that have the potential for loss, no loss or gain. \n\nIII. Insurance is based on a mutual sharing of losses that occur while gambling involves a gain for one party at the expense of another. This statement is correct. Insurance pools risks and members share in the losses. Gambling involves a direct transfer of money from the loser to the winner.\n\nTherefore, statements I and III are correct while statement II is incorrect. The answer is 2) I and III only.",
"gpt35": "The correct answer is 2) I and III only.",
"gpt4": "The correct answer is 2) I and III only."
},
{
"question": "Which of the following accurately reflect(s) major federal tax advantages associated with employee benefit plans? I. Most contributions to employee benefit plans result in tax credits for the employer. II. Most contributions to employee benefit plans are only deductible by the employer when considered income for the employee. III. In certain types of capital accumulation plans, benefits accumulate tax-free to the employee until distributed.",
"choices": [
"II only",
"III only",
"I and III only",
"II and III only",
"I, II and III"
],
"key": 2,
"claude2": " 3) I and III only\n\nThe major federal tax advantages associated with employee benefit plans are:\n\nI. Most contributions to employee benefit plans by employers are deductible as long as they are reasonable business expenses. This statement is true.\n\nII. Within certain limits, these employer contributions are generally not considered income to employees. This statement is false. Employer contributions are not considered taxable income to employees. \n\nIII. In certain types of retirement and capital accumulation plans, benefits accumulate tax-free to the employee until distributed. This statement is true.\n\nTherefore, statements I and III are accurate reflections of the major federal tax advantages associated with employee benefit plans. The correct answer is 2) I and III only.",
"gpt35": "The correct answer is 1) III only.",
"gpt4": "The correct answer is 1) III only."
},
{
"question": "When planning retirement income, the replacement ratio includes which of the following sources of income? I. Social security II. Capital accumulation plans III. Pension benefits",
"choices": [
"I only",
"II only",
"III only",
"I and II only",
"I, II and III"
],
"key": 5,
"claude2": " The correct answer is 4) I, II and III\n\nWhen planning retirement income, the replacement ratio includes all three of the listed sources of income:\n\nI. Social security \nII. Capital accumulation plans\nIII. Pension benefits\n\nTherefore, the correct answer is that the replacement ratio includes I, II and III - all three sources of income.",
"gpt35": "The correct answer is 4) I, II and III. The replacement ratio includes all three sources of income: Social security, capital accumulation plans, and pension benefits.",
"gpt4": "The correct answer is 4) I, II and III."
},
{
"question": "Which of the following is (are) features that are generally associated with consumer-directed health plans (CDHPs)? I. Relatively low deductible II. A personal spending account III. Availability of information tools for enrollees",
"choices": [
"I only",
"II only",
"III only",
"I and II only",
"II and III only"
],
"key": 5,
"claude2": " 4) II and III only\n\nThe key features generally associated with consumer-directed health plans (CDHPs) are:\n\nII. A relatively high deductible, not a low deductible. This exposes enrollees to more costs upfront and is intended to encourage them to be wise consumers of health care services. \n\nIII. A personal spending account, such as a health savings account (HSA) or health reimbursement arrangement (HRA), to help enrollees pay for out-of-pocket costs below the deductible.\n\nIII. Availability of information tools for enrollees to support informed decision making about treatment options and provider choices.\n\nSo the correct answer is 4) II and III only. A relatively high deductible and personal spending account, along with information tools for enrollees, are defining features of CDHPs.",
"gpt35": "The correct answer is 4) II and III only.",
"gpt4": "The correct answer is 4) II and III only."
},
{
"question": "Managed behavioral healthcare organizations have the potential to offer significant savings because of which of the following? I. They allow large, self-funded employers to offer the same behavioral health benefits across all health plans offered. II. They are usually managed by firms that specialize in behavioral health treatment. III. The Affordable Care Act (ACA) strongly encourages the practice of carving out behavioral health benefits rather than covering them in more comprehensive health plans.",
"choices": [
"None",
"II only",
"I and II only",
"I and III only",
"II and III only"
],
"key": 3,
"claude2": " The correct answer is 2) I and II only.\n\nManaged behavioral healthcare organizations (MBHOs) have the potential to offer significant savings because:\n\nII. They are usually managed by firms that specialize in behavioral health treatment. MBHOs are managed by firms that focus specifically on managing behavioral health treatment and costs, allowing for specialized expertise.\n\nI. They allow large, self-funded employers to offer the same behavioral health benefits across all health plans offered. A major advantage of carving out behavioral health benefits into an MBHO is that it allows large, self-funded employers to have consistent behavioral health benefits across multiple health plan offerings. \n\nIII. The Affordable Care Act (ACA) does not encourage the practice of carving out behavioral health benefits. In fact, the ACA's emphasis on integrated, coordinated care implicitly discourages carving out behavioral health into a separate MBHO.\n\nSo the correct answer is 2) I and II only.",
"gpt35": "The correct answer is 3) I and III only.",
"gpt4": "The correct answer is 2) I and II only."
},
{
"question": "Which of the following statements regarding workplace wellness programs is (are) correct? I. Many large employers that sponsor workplace wellness programs ask employees to disclose personal health information via a questionnaire, known as a health risk assessment (HRA). II. Most large employers who sponsor workplace wellness programs say that financial incentives to participate in the plan are extremely effective. III. Most employers require employees to submit to biometric testing (such as a physical examination or lab test) as a requirement for participation in the employer\u2019s workplace wellness program.",
"choices": [
"I only",
"II only",
"III only",
"I and II only",
"II and III only"
],
"key": 1,
"claude2": " The correct answer is 1. \n\nOnly statement II is correct. Research indicates that most large employers say financial incentives are either not very effective or only somewhat effective at encouraging employees to participate in workplace wellness programs. \n\nStatement I is incorrect because while many large employers do ask employees to complete health risk assessments, this practice is not universal. \n\nStatement III is incorrect because most employers do not require biometric testing as a requirement to participate in workplace wellness programs. Rather, biometric testing is typically offered on a voluntary basis, often with financial incentives to encourage participation.\n\nSo the correct answer is II only.",
"gpt35": "The correct answer is 3) I and II only.",
"gpt4": "The correct answer is 3) I and II only."
},
{
"question": "Which of the following statements regarding the impact of the Genetic Information Nondiscrimination Act (GINA) on wellness programs and health risk assessments is (are) correct? I. Wellness programs that avoid implementing a health risk assessment which solicits genetic information are in general GINA-compliant. II. GINA allows exceptions for inquiries through voluntary wellness programs. III. GINA imposes limits on participatory wellness programs only if such programs are offered outside a group health plan.",
"choices": [
"None",
"I only",
"II only",
"III only",
"I and II only"
],
"key": 5,
"claude2": " 4) I and II only are correct statements regarding the impact of GINA on wellness programs and health risk assessments.\n\nExplanation: \n\nI. Correct. Wellness programs that avoid soliciting genetic information, such as family medical history, through health risk assessments are generally GINA-compliant. \n\nII. Correct. GINA allows an exception for employers to make inquiries about genetic information, such as family medical history, through voluntary workplace wellness programs.\n\nIII. Incorrect. GINA rules apply to both participatory wellness programs offered inside or outside of group health plans, unlike ERISA rules that distinguish between the two. GINA prohibits employers from offering incentives for employees' spouses or children to provide genetic information.\n\nTherefore, the correct answer is 4) I and II only. GINA allows an exception for voluntary wellness programs to gather genetic information but also imposes limits regardless of whether the program is inside or outside a group health plan.",
"gpt35": "The correct answer is 4) I and II only.",
"gpt4": "The correct answer is 4) I and II only."
},
{
"question": "Which of the following is (are) potential disadvantages for employers in sponsoring a cafeteria plan? I. The plan involves ongoing costs of administration and operation. II. Cafeteria plans are subject to complex coverage and nondiscrimination testing, which can be expensive for the employer. III. The plan will cause a significant increase in the employer\u2019s payroll taxes.",
"choices": [
"II only",
"I and II only",
"I and III only",
"II and III only",
"I, II and III"
],
"key": 2,
"claude2": " 1) I and II only\n\nThe potential disadvantages for employers in sponsoring a cafeteria plan are:\n\nI. The plan involves ongoing costs of administration and operation. This is correct. Administering a cafeteria plan does involve additional administrative complexity and costs for the employer. \n\nII. Cafeteria plans are subject to complex coverage and nondiscrimination testing, which can be expensive for the employer. This is correct. Depending on the employer's workforce demographics, some of the required tests may be difficult to pass, limiting tax benefits for certain employees.\n\nIII. The plan will cause a significant increase in the employer's payroll taxes. This is incorrect. In fact, cafeteria plans generally reduce payroll taxes for employers since employee benefit plan contributions are exempt from payroll taxes.\n\nTherefore, the correct answers are I and II only.",
"gpt35": "The correct answer is 4) I, II and III. All three options listed are potential disadvantages for employers in sponsoring a cafeteria plan.",
"gpt4": "The correct answer is 1) I and II only."
},
{
"question": "The Affordable Care Act (ACA) designated all the following as essential health benefits (EHBs) to be included in covered individual and group health plans EXCEPT:",
"choices": [
"Emergency services",
"Hospitalization",
"Mental health and substance use disorder services",
"Adult oral and vision care",
"Pregnancy, maternity and newborn child care"
],
"key": 4,
"claude2": " 3) Adult oral and vision care\n\nThe Affordable Care Act (ACA) designated the following categories of benefits as essential health benefits (EHBs) that must be included in covered individual and group health plans:\n\n1) Ambulatory patient services (outpatient care)\n2) Emergency services \n3) Hospitalization\n4) Pregnancy, maternity and newborn care\n5) Mental health and substance use disorder services\n6) Prescription drugs\n7) Rehabilitative and habilitative services and devices\n8) Laboratory services\n9) Preventive and wellness services and chronic disease management\n10) Pediatric services, including oral and vision care\n\nACA does not require adult oral and vision care to be included as essential health benefits. Therefore, the correct answer is 3) Adult oral and vision care.",
"gpt35": "The correct answer is 3) Adult oral and vision care.",
"gpt4": "The correct answer is 3) Adult oral and vision care."
},
{
"question": "To offer employees an individual medical insurance-health reimbursement account (IMC-HRA), all the following rules apply EXCEPT:",
"choices": [
"The employer must require participants to enroll in individual medical insurance coverage complying with the Public Health Service Act (PHSA).",
"The plan must require balances in an IMC-HRA account to be forfeited if the employee loses his/her individual coverage.",
"Participants in the plan must specifically reject any Consolidated Omnibus Budget Reconciliation Act (COBRA) protection.",
"An employer cannot offer both an IMC-HRA and a traditional general health plan to the same class of employees.",
"The same terms of coverage must apply for all employees within the covered class or classes."
],
"key": 3,
"claude2": " 2) Participants in the plan must specifically reject any Consolidated Omnibus Budget Reconciliation Act (COBRA) protection.\n\nThis is not a requirement to offer employees an individual medical insurance-health reimbursement account (IMC-HRA). The other statements listed are accurate requirements. IMC-HRAs are subject to COBRA continuation if an individual experiences a qualifying triggering event.",
"gpt35": "The correct answer is 2) Participants in the plan must specifically reject any Consolidated Omnibus Budget Reconciliation Act (COBRA) protection.",
"gpt4": "The correct answer is 2) Participants in the plan must specifically reject any Consolidated Omnibus Budget Reconciliation Act (COBRA) protection."
},
{
"question": "All the following are advantages to employers and employees of cafeteria plans EXCEPT:",
"choices": [
"Contributions to cafeteria plans are exempt from federal income tax.",
"Contributions to cafeteria plans are exempt from Social Security (FICA-Federal Insurance Contributions Act) taxes.",
"Contributions to cafeteria plans are exempt from unemployment Federal Unemployment Tax Act (FUTA) taxes.",
"Deferral amounts usually has the effect of increasing a worker\u2019s social security benefits.",
"Deferral amounts are not considered wages for purposes of determining workers\u2019 compensation premiums and other payroll-related expenses."
],
"key": 4,
"claude2": " 3) Deferral amounts usually has the effect of increasing a worker\u2019s social security benefits.\n\nThis is the exception. Contributions to cafeteria plans are exempt from federal income tax, FICA taxes, and FUTA taxes. They are also not considered wages for purposes of determining workers' compensation premiums and other payroll expenses. However, the deferral amounts have the effect of decreasing a worker's social security benefits, since there is less taxable income subject to FICA taxes.",
"gpt35": "The correct answer is 3) Deferral amounts usually have the effect of increasing a worker's social security benefits.",
"gpt4": "The correct answer is 3) Deferral amounts usually has the effect of increasing a worker\u2019s social security benefits."
},
{
"question": "Cafeteria plan regulations allow participants, under certain circumstances, to revoke an election and make a new election for benefits. Changes related to all the following events are accepted as acceptable change-in-status events EXCEPT:",
"choices": [
"Legal marital status",
"Number of dependents",
"Employment status",
"Place of work or residence",
"Income"
],
"key": 5,
"claude2": " 3) Place of work or residence\n\nThe cafeteria plan regulations allow participants, under certain circumstances, to revoke an election and make a new election for benefits related to changes in their legal marital status, number of dependents, employment status, or cases where a dependent satisfies or ceases to satisfy eligibility requirements. However, a change in place of work or residence is not listed as an acceptable change-in-status event that permits a participant to revoke an election and make a new election. \n\nTherefore, the correct answer is 3) Place of work or residence.",
"gpt35": "The correct answer is 4) Income. Changes related to income are not accepted as acceptable change-in-status events under cafeteria plan regulations.",
"gpt4": "The correct answer is 4) Income."
},
{
"question": "The Employee Retirement Income Security Act (ERISA) regulates health plans by requiring all health plans to meet certain minimum standards with respect to all of the following EXCEPT:",
"choices": [
"Provisions that provide participants with plan information about plan features and funding.",
"Provisions requiring group health plan contributions to a federal fund guaranteeing limited benefits for participants of terminated health plans.",
"Provisions for exercising fiduciary responsibilities while administering a plan and managing plan assets.",
"Provisions that establish a grievance and appeal process for participants.",
"Provisions that allow participants the right to sue for benefits."
],
"key": 2,
"claude2": " The correct answer is 1) Provisions requiring group health plan contributions to a federal fund guaranteeing limited benefits for participants of terminated health plans.\n\nERISA regulates health plans by requiring them to meet certain minimum standards with respect to providing plan information (0), exercising fiduciary responsibilities (2), establishing a grievance and appeal process (3), and allowing participants to sue for benefits (4). However, ERISA does not require health plans to contribute to a federal fund guaranteeing limited benefits for terminated plans (1). This incorrect answer choice refers to the Pension Benefit Guaranty Corporation (PBGC), which provides limited guarantees for certain terminated pension plans, not health plans.",
"gpt35": "The correct answer is 1) Provisions requiring group health plan contributions to a federal fund guaranteeing limited benefits for participants of terminated health plans.",
"gpt4": "The correct answer is 1) Provisions requiring group health plan contributions to a federal fund guaranteeing limited benefits for participants of terminated health plans."
},
{
"question": "All of the following types of health benefits are subject to the Consolidated Omnibus Budget Reconciliation Act (COBRA) EXCEPT:",
"choices": [
"Inpatient and outpatient hospital care",
"Physician care",
"Prescription drugs",
"Dental and vision care",
"Disability benefits"
],
"key": 5,
"claude2": " 4) Disability benefits\n\nThe explanation is:\n\nCOBRA requires most group health plans to provide a temporary continuation of group health coverage that otherwise might be terminated. COBRA requires continuation coverage to be offered to covered employees, their spouses, their former spouses and their dependent children when group health coverage would otherwise be lost because of certain specific events.\n\nCOBRA applies to group health plans, which are arrangements that an employer establishes or maintains to provide employees and their families with medical care, whether provided through insurance, an HMO, or otherwise. Medical care typically covered includes inpatient and outpatient hospital care, physician care, surgery, prescription drugs, and dental and vision care.\n\nLife insurance and disability benefits are not considered \"medical care\" and thus are not subject to COBRA continuation requirements. Therefore, the correct answer is 4) Disability benefits.",
"gpt35": "The correct answer is 4) Disability benefits.",
"gpt4": "The correct answer is 4) Disability benefits."
},
{
"question": "All of the following are common basic features of a health maintenance organization (HMO) EXCEPT:",
"choices": [
"An HMO plan requires an individual to select a primary care physician (PCP) from a network of providers.",
"Reduced benefits are available for care received outside of the HMO network of providers.",
"An individual\u2019s out-of-pocket expense is routinely a flat dollar amount called a copay.",
"The PCP is empowered to authorize, via referrals, access to additional or specialty care.",
"With rare exceptions, individuals have no need to file claims for reimbursement."
],
"key": 2,
"claude2": " The correct answer is 2.\n\nAn HMO plan typically does not provide reduced benefits for out-of-network care. Instead, except for emergency care, no benefits are available for care received outside of the HMO network of providers.\n\nThe other options describe common features of HMO plans:\n- An HMO plan requires selection of a PCP to coordinate care (option 0) \n- Out-of-pocket expenses for in-network care are typically copays (option 2)\n- PCPs provide referrals for specialty care (option 3)\n- In-network care does not require filing claims (option 4)\n\nSo the exception is option 2 - HMO plans do not provide reduced benefits for out-of-network care, they provide no benefits.",
"gpt35": "The correct answer is 1) Reduced benefits are available for care received outside of the HMO network of providers.",
"gpt4": "The correct answer is 1) Reduced benefits are available for care received outside of the HMO network of providers. This is not a common basic feature of a health maintenance organization (HMO). In most cases, HMOs do not provide any coverage for care received outside of their network, except in emergency situations."
},
{
"question": "All of the following are characteristics of typical dental plan designs EXCEPT:",
"choices": [
"Most plans have a calendar-year maximum for nonorthodontic expenses, and sometimes a separate lifetime maximum.",
"Orthodontic and implantology expenses generally are subject to separate lifetime maximums.",
"Restorations, and in some cases replacements, often are fully reimbursed.",
"Most plans are being designed either through construction of a schedule or the use of coinsurance so that the patient pays a portion of the cost for all but preventative and diagnostic services.",
"Preventative and diagnostic expenses generally are reimbursed at 80% to 100% of the usual and customary charges, and full reimbursement is quite common."
],
"key": 3,
"claude2": " 3) Most plans are being designed either through construction of a schedule or the use of coinsurance so that the patient pays a portion of the cost for all but preventative and diagnostic services.\n\nThis is the incorrect statement. Restorations and replacements are typically reimbursed at lower levels (such as 70-85%) compared to preventive and diagnostic services, which are often fully reimbursed.",
"gpt35": "The correct answer is 2) Restorations, and in some cases replacements, often are fully reimbursed.",
"gpt4": "The correct answer is 2) Restorations, and in some cases replacements, often are fully reimbursed."
},
{
"question": "All the following are requirements an employer must meet to offer an Excepted Benefits \u2013 Health Reimbursement Account (EB-HRA) EXCEPT:",
"choices": [
"Employees must be covered in the employer\u2019s general health plan (GHP) in order to be eligible for the EB-HRA.",
"The amount made available through the EB-HRA cannot exceed a legally set level.",
"An EB-HRA must be made available to all \u201csimilarly situated individuals\u201d under the same terms regardless of any adverse health factors.",
"Employers with more than 100 participants must file a Form 5500 if such information is not provided in another fashion.",
"There is no specific exception from the nondiscrimination rules for an EB-HRA."
],
"key": 1,
"claude2": " The correct answer is 4) There is no specific exception from the nondiscrimination rules for an EB-HRA.\n\nThe key points about EB-HRAs are:\n\n- Employees must be covered in the employer's general health plan (GHP) to be eligible for the EB-HRA (1 is incorrect). \n\n- There is a legally set limit on the amount made available through the EB-HRA (2 is incorrect).\n\n- An EB-HRA must be offered on the same terms to all similarly situated individuals regardless of health factors (3 is incorrect). \n\n- Form 5500 filing requirements apply for employers with over 100 participants (4 is incorrect).\n\n- Unlike IMC-HRAs, there is no specific exception from nondiscrimination rules for EB-HRAs. So 4) is the correct answer.",
"gpt35": "The correct answer is 0) Employees must be covered in the employer\u2019s general health plan (GHP) in order to be eligible for the EB-HRA.",
"gpt4": "The correct answer is 0) Employees must be covered in the employer\u2019s general health plan (GHP) in order to be eligible for the EB-HRA."
},
{
"question": "All of the following benefits are considered protection-oriented EXCEPT:",
"choices": [
"Life insurance",
"Profit-sharing",
"Long-term disability",
"Medical expense",
"Short-term disability"
],
"key": 2,
"claude2": " The correct answer is 1) Profit-sharing.\n\nProtection-oriented benefits consist of medical expense benefits, life insurance benefits, and short- and long-term disability income benefits that protect employees and their dependents against serious loss exposures that could spell immediate financial disaster.\n\nProfit-sharing is considered an accumulation-oriented benefit, which rewards employees for relatively long service with an employer.\n\nSo profit-sharing is not a protection-oriented benefit like the other options listed. It is an accumulation-oriented benefit instead.",
"gpt35": "The correct answer is 1) Profit-sharing. Profit-sharing is not considered a protection-oriented benefit. It is a type of retirement benefit that allows employees to share in the profits of the company. Protection-oriented benefits, on the other hand, are designed to protect employees from financial loss due to illness, injury, or death. Examples of protection-oriented benefits include life insurance, long-term disability, short-term disability, and medical expense coverage.",
"gpt4": "The correct answer is 1) Profit-sharing."
},
{
"question": "All the following statements regarding vision care plans are correct EXCEPT:",
"choices": [
"Generally these plans use frequency limits on the number of times a participant can receive benefits during a period.",
"A schedule-of-benefits plan sets maximum dollar limits on the amount that will be paid toward a specific benefit.",
"Preferred provider networks for vision benefits are similar to those for medical care.",
"Vision benefits cannot be included in a flexible benefit health plan.",
"Adult vision benefits are not covered under the Affordable Care Act."
],
"key": 4,
"claude2": " 4) Adult vision benefits are not covered under the Affordable Care Act.\n\nThis is the correct answer. The other statements are all true regarding vision care plans. \n\nUnder the Affordable Care Act, pediatric vision care is considered an essential health benefit that must be covered by individual and small group health plans. However, adult vision care is not considered an essential health benefit, and so is not required to be covered under the ACA.",
"gpt35": "The correct answer is 3) Vision benefits cannot be included in a flexible benefit health plan.",
"gpt4": "The correct answer is 3) Vision benefits cannot be included in a flexible benefit health plan."
},
{
"question": "All of the following statements are seen as potential concerns regarding consumer directed health plans (CDHPs) EXCEPT:",
"choices": [
"Doubts exist as to the extent that CDHPs reduce health care spending.",
"CDHPs reduce the potential for greater risk segmentation in health insurance markets.",
"CDHPs can disproportionately attract favorable risks.",
"CDHPs shift health care risks from insurers to consumers.",
"Consumers may not effectively differentiate between more and less valuable care."
],
"key": 2,
"claude2": " 1) CDHPs reduce the potential for greater risk segmentation in health insurance markets.\n\nThe other statements listed are potential concerns regarding consumer directed health plans (CDHPs):\n\n0) Doubts exist as to the extent that CDHPs reduce health care spending.\n\n2) CDHPs can disproportionately attract favorable risks. \n\n3) CDHPs shift health care risks from insurers to consumers.\n\n4) Consumers may not effectively differentiate between more and less valuable care.\n\nHowever, CDHPs do not reduce the potential for greater risk segmentation in health insurance markets. In fact, the concern is that CDHPs may increase risk segmentation because their lower premiums and higher cost sharing could disproportionately attract favorable (i.e. healthier) risks. \n\nTherefore, the correct answer is 1) CDHPs reduce the potential for greater risk segmentation in health insurance markets.",
"gpt35": "The correct answer is 1) CDHPs reduce the potential for greater risk segmentation in health insurance markets.",
"gpt4": "The correct answer is 1) CDHPs reduce the potential for greater risk segmentation in health insurance markets."
},
{
"question": "All of the following are factors contributing to high prescription drug costs EXCEPT:",
"choices": [
"Rigorous standards for pharmacy and therapeutics (P&T) committees' deliberations",
"Not all prescription discount, rebates and other savings are passed along to plan sponsors",
"Direct-to-consumer marketing",
"Aging of the population",
"Growth of biotechnology drugs"
],
"key": 1,
"claude2": " The correct answer is 0) Rigorous standards for pharmacy and therapeutics (P&T) committees' deliberations\n\nAll of the other answer choices are factors contributing to high prescription drug costs:\n\n1) Not all prescription discount, rebates and other savings are passed along to plan sponsors. Some PBM revenue streams come from retaining a portion of the rebates and other savings.\n\n2) Direct-to-consumer marketing has increased demand for prescription medications.\n\n3) The aging population has increased the prevalence of chronic conditions requiring maintenance medications. \n\n4) Biotechnology drugs, used to treat complex conditions like cancer, account for an increasing share of prescription drug spending.\n\nIn contrast, rigorous standards for P&T committees aim to promote rational, evidence-based selection of cost-effective medications. So rigorous P&T committee standards do not contribute to high prescription costs - rather they help contain costs.",
"gpt35": "The correct answer is 0) Rigorous standards for pharmacy and therapeutics (P&T) committees' deliberations.",
"gpt4": "The correct answer is 0) Rigorous standards for pharmacy and therapeutics (P&T) committees' deliberations."
},
{
"question": "All of the following are advantages to using insurance to fund an employee benefit plan EXCEPT:",
"choices": [
"The presence of a known premium is set in advance by the insurance company.",
"The use of an outside administrator distances the employer from disputes with employees involving plan coverage.",
"The use of an insurance company provides the financial backing of the Federal Surety Insurance Corporation (FSIC).",
"Insurance companies often are leaders in the area of loss control and can implement systems established to limit employee benefit costs for an employer.",
"It may be more economical for an employer to use insurance than other funding alternatives."
],
"key": 3,
"claude2": " 3) The use of an insurance company provides the financial backing of the Federal Surety Insurance Corporation (FSIC).\n\nThere is no such thing as the Federal Surety Insurance Corporation (FSIC). Insurance companies are regulated by state insurance departments, not a federal agency. The other options are valid advantages of using insurance to fund an employee benefit plan.",
"gpt35": "The correct answer is 2) The use of an insurance company provides the financial backing of the Federal Surety Insurance Corporation (FSIC).",
"gpt4": "The correct answer is 2) The use of an insurance company provides the financial backing of the Federal Surety Insurance Corporation (FSIC)."
},
{
"question": "All of the following statements concerning formularies are correct EXCEPT:",
"choices": [
"A formulary is a list of drugs preferred by a health plan or pharmacy benefit manager (PBM).",
"Formulary development typically centers on generic drugs rather than brand products.",
"A pharmacy and therapeutics committee involved in the development of a formulary may be composed of physicians, pharmacists, nurses, and others.",
"A formulary selects drugs within the category that are most cost-effective.",
"The use of formularies is common because they are very effective at moving patients to lower cost drugs."
],
"key": 2,
"claude2": " 3) A formulary selects drugs within the category that are most cost-effective.\n\nThe correct answer is 3). \n\nFormularies typically select drugs that are preferred by the health plan or PBM, not necessarily the most cost-effective options. Formularies focus on brand name drugs, not generics. Pharmacy and therapeutics committees are involved in formulary development. And formularies are common because they effectively move patients to lower cost drugs. But the statement that a formulary selects the most cost-effective drugs within a category is incorrect. Formularies select drugs preferred by the plan or PBM, which are often based on factors like rebates from manufacturers in addition to cost-effectiveness.",
"gpt35": "The correct answer is 1) Formulary development typically centers on generic drugs rather than brand products.",
"gpt4": "The correct answer is 1) Formulary development typically centers on generic drugs rather than brand products."
},
{
"question": "All the following statements regarding behavioral health care benefits are correct EXCEPT:",
"choices": [
"The majority of behavioral health care benefits sold in the United States today are purchased by large groups that buy comprehensive health care benefits.",
"Behavioral benefits are sold through multiple channels, including large brokerage and consulting firms, large managed behavioral health care organization (MBHO) sales forces and health carrier sales forces.",
"Under the Affordable Care Act (ACA) MBHOs can only be funded through fully insured arrangements.",
"The vast majority of employer-sponsored plans cover inpatient and outpatient mental health treatment services.",
"Coverage for behavioral benefits include intermediate mental health treatment services such as residential treatment and partial (or day) hospitalization as well as intensive outpatient services."
],
"key": 3,
"claude2": " Option 2 is the incorrect statement. MBHOs can be funded through fully insured, shared risk, and administrative services only (ASO) arrangements.\n\nThe other statements are correct:\n\n1) The majority of behavioral health care benefits are purchased by large groups that buy comprehensive health care benefits. \n\n3) The vast majority of employer-sponsored plans cover inpatient and outpatient mental health treatment services.\n\n4) Coverage for behavioral benefits include intermediate mental health treatment services such as residential treatment and partial (or day) hospitalization as well as intensive outpatient services. \n\n5) Behavioral benefits are sold through multiple channels, including brokers, MBHO sales forces, and health carrier sales forces.\n\nSo the correct answer is option 2.",
"gpt35": "The correct answer is 2) Under the Affordable Care Act (ACA) MBHOs can only be funded through fully insured arrangements.",
"gpt4": "The correct answer is 2) Under the Affordable Care Act (ACA) MBHOs can only be funded through fully insured arrangements."
},
{
"question": "All the following statements regarding the interaction of the Affordable Care Act (ACA) and the Mental Health Parity and Addiction Act (MHPAEA) are correct EXCEPT:",
"choices": [
"Plans may not impose financial requirements or treatment limitations on mental health and substance use disorder (MH/SUD) benefits that are more restrictive than the \u201cpredominant\u201d financial requirements that are applied to substantially all medical/surgical benefits.",
"Under the ACA, mental health and substance use disorder benefits are considered essential benefits.",
"Deductibles that apply to MH/SUD benefits may be different from the deductibles that apply to medical/surgical benefits.",
"Annual limits may not be imposed on MH/SUD benefits.",
"The ACA requires non-grandfathered group health plans to provide certain preventive services, without cost-sharing, including alcohol misuse screening and counseling, depression counseling and tobacco use screening."
],
"key": 3,
"claude2": " 2) Deductibles that apply to MH/SUD benefits may be different from the deductibles that apply to medical/surgical benefits.\n\nDeductibles and out-of-pocket maximums for MH/SUD benefits cannot accumulate separately from those for medical/surgical benefits, as this would be an impermissible financial constraint under MHPAEA. The other statements are correct:\n\n1) Under the ACA, mental health and substance use disorder benefits are considered essential benefits. \n\n3) Annual limits may not be imposed on MH/SUD benefits. \n\n4) The ACA requires non-grandfathered group health plans to provide certain preventive services, without cost-sharing, including alcohol misuse screening and counseling, depression counseling and tobacco use screening.\n\nSo the correct answer is option 2.",
"gpt35": "The correct answer is 2) Deductibles that apply to MH/SUD benefits may be different from the deductibles that apply to medical/surgical benefits.",
"gpt4": "The correct answer is 2) Deductibles that apply to MH/SUD benefits may be different from the deductibles that apply to medical/surgical benefits. This statement is incorrect because under the MHPAEA, financial requirements such as deductibles for mental health or substance use disorder benefits cannot be more restrictive than those for medical/surgical benefits."
},
{
"question": "A broad view of employee benefits includes all of the following types of benefits EXCEPT:",
"choices": [
"Employer\u2019s payment for direct wages.",
"Employer\u2019s payment for vacation pay",
"Employer\u2019s share of Social Security taxes",
"Employer\u2019s share of medical-related payments",
"Employer\u2019s share of retirement and savings plan payments"
],
"key": 1,
"claude2": " The correct answer is 0) Employer's payment for direct wages.\n\nA broad view of employee benefits includes the employer's share of Social Security taxes, vacation pay, medical-related payments, and retirement and savings plan payments. Direct wages paid to employees are not considered employee benefits under the broad view. They are considered part of the employee's regular compensation.",
"gpt35": "The correct answer is 0) Employer's payment for direct wages.",
"gpt4": "The correct answer is 0) Employer\u2019s payment for direct wages."
},
{
"question": "All of the following are correct statements concerning the Taft-Hartley Act EXCEPT:",
"choices": [
"It is also called the Labor Management Relations Act (LMRA).",
"It sets forth the framework for good-faith collective bargaining over wages, hours, conditions and terms of employment.",
"The Act includes rules for the collective bargaining for employee benefits.",
"It relies on the Fair Labor Standards Act (FLSA) to establish the distinction between retirement and welfare benefits.",
"It is the legislative basis on which jointly trusteed benefit plans are founded."
],
"key": 4,
"claude2": " The correct answer is 3) It relies on the Fair Labor Standards Act (FLSA) to establish the distinction between retirement and welfare benefits.\n\nThe Taft-Hartley Act (also known as the Labor Management Relations Act or LMRA) does the following:\n\n- Sets forth the framework for good-faith collective bargaining over wages, hours, conditions, and terms of employment and employee benefits (1 is correct). \n\n- Provides the regulatory framework for the administration of employee benefits in a collective bargaining agreement (4 is correct).\n\nHowever, it does not rely on the Fair Labor Standards Act (FLSA) to establish the distinction between retirement and welfare benefits. The Taft-Hartley Act itself establishes this distinction (3 is incorrect).\n\nSo the correct answer is 3).",
"gpt35": "The correct answer is 3) It relies on the Fair Labor Standards Act (FLSA) to establish the distinction between retirement and welfare benefits.",
"gpt4": "The correct answer is 3) It relies on the Fair Labor Standards Act (FLSA) to establish the distinction between retirement and welfare benefits."
},
{
"question": "All the following questions concerning dependent-care assistance plans are correct EXCEPT:",
"choices": [
"Dependent care assistance plans can be offered either on a standalone basis or as part of a cafeteria plan.",
"The benefits provided by these plans are taxable income to those who receive the benefits.",
"A dependent care assistance plan must be in writing.",
"To obtain benefits under these plans, the participant\u2019s spouse also must be employed, a full-time student, or physically or mentally incapable of self-care.",
"Benefits cannot be provided for care provided by a person for whom a personal tax exemption is taken on the participant\u2019s tax return."
],
"key": 2,
"claude2": " 3) To obtain benefits under these plans, the participant\u2019s spouse also must be employed, a full-time student, or physically or mentally incapable of self-care.\n\nThis is not a requirement to obtain benefits under a dependent care assistance plan. The other statements about dependent care assistance plans are correct.\n\nTherefore, the correct answer is 3.",
"gpt35": "The correct answer is 1) The benefits provided by these plans are taxable income to those who receive the benefits.",
"gpt4": "The correct answer is 1) The benefits provided by these plans are taxable income to those who receive the benefits."
},
{
"question": "All the following statements regarding Health Insurance Portability and Accountability Act (HIPAA) and possible applications to wellness programs are correct EXCEPT:",
"choices": [
"Federal privacy protections under HIPAA apply to some workplace wellness programs.",
"HIPAA privacy rules do not apply to wellness programs that are offered directly by employers outside of a group health plan.",
"A group health plan is permitted to disclose protected health information to the employer without authorization under certain circumstances.",
"In case of a suspected violation of HIPAA privacy rules, the U.S. Department of Health and Human Services (HHS) would pursue legal remedies under HIPAA and sue the employer on behalf of the employee.",
"Covered entities under HIPAA include most health care providers, health care clearinghouses and health plans, including group health plans sponsored by employers, but employers are not covered entities under HIPAA."
],
"key": 4,
"claude2": " The correct answer is 3.\n\nIn case of a suspected violation of HIPAA privacy rules, the U.S. Department of Health and Human Services (HHS) would not pursue legal remedies under HIPAA against the employer on behalf of the employee. \n\nThe key points are:\n\n- HIPAA privacy rules apply to covered entities like health care providers, health plans, and health care clearinghouses, but not to employers directly. \n\n- For workplace wellness programs offered through a group health plan, the plan must comply with HIPAA and not disclose protected health information to the employer without authorization, except in limited circumstances.\n\n- If there is a suspected HIPAA violation by a covered entity like a health plan, individuals can file a complaint with HHS, but HHS does not have jurisdiction to take direct legal action against employers under HIPAA. HHS could investigate a health plan that improperly disclosed protected health information to an employer, but HHS could not sue the employer under HIPAA on behalf of the employee.\n\nSo answer choice 3 is incorrect and the exception to the other statements, which are correct.",
"gpt35": "The correct answer is 3) In case of a suspected violation of HIPAA privacy rules, the U.S. Department of Health and Human Services (HHS) would pursue legal remedies under HIPAA and sue the employer on behalf of the employee.",
"gpt4": "The correct answer is 3) In case of a suspected violation of HIPAA privacy rules, the U.S. Department of Health and Human Services (HHS) would pursue legal remedies under HIPAA and sue the employer on behalf of the employee."
},
{
"question": "All the following types of benefits may be included in a cafeteria plan EXCEPT:",
"choices": [
"Individually-owned health insurance.",
"401(k) plan",
"Contributions to a health savings account (HSA)",
"Employer-provided dependent-care assistance",
"Employer-provided adoption assistance"
],
"key": 1,
"claude2": " 1) 401(k) plan\n\nThe question asks to identify which type of benefit may NOT be included in a cafeteria plan. \n\nIndividually-owned health insurance, contributions to a health savings account (HSA), employer-provided dependent-care assistance, and employer-provided adoption assistance are all qualified benefits that may be offered in a cafeteria plan.\n\nA 401(k) plan is not considered a qualified benefit under IRC Section 125 and therefore is prohibited from being funded through a cafeteria plan. \n\nTherefore, the correct answer is 1) 401(k) plan.",
"gpt35": "The correct answer is 0) Individually-owned health insurance.",
"gpt4": "The correct answer is 1) 401(k) plan."
},
{
"question": "A sound employee benefit plan generally includes all of the following factors EXCEPT:",
"choices": [
"An appropriate funding mechanism",
"A means of effectively communicating plan provisions",
"An acceptable administrative system",
"An appropriate level of social adequacy of benefits",
"A clearly defined description of participant eligibility"
],
"key": 4,
"claude2": " 3) An appropriate level of social adequacy of benefits\n\nThe correct answer is 3) An appropriate level of social adequacy of benefits.\n\nA sound employee benefit plan generally includes the following factors EXCEPT an appropriate level of social adequacy of benefits:\n\n0) An appropriate funding mechanism \n1) A means of effectively communicating plan provisions\n2) An acceptable administrative system\n\nWhile the level of benefits should be adequate, the social adequacy of benefits is not a factor in the soundness of an employee benefit plan design. The other factors listed are important components of a properly designed employee benefit plan.",
"gpt35": "The correct answer is 3) An appropriate level of social adequacy of benefits.",
"gpt4": "The correct answer is 3) An appropriate level of social adequacy of benefits."
},
{
"question": "All of the following statements regarding the Americans with Disabilities Act are true EXCEPT:",
"choices": [
"The act in general forbids workers from inquiring about another worker\u2019s health status.",
"The act makes exceptions for certain medical inquiries.",
"A wellness program is deemed a voluntary one under the act as long as an employer neither requires participation nor penalizes employees who do not participate.",
"In case of violations of the act\u2019s privacy rules, employees\u2019 recourse is to file a complaint with their state\u2019s enforcement authority.",
"The act is applicable to employers with 15 or more workers."
],
"key": 4,
"claude2": " 3) In case of violations of the act\u2019s privacy rules, employees\u2019 recourse is to file a complaint with their state\u2019s enforcement authority.\n\nThis statement is false. The Americans with Disabilities Act is a federal law. In case of suspected violations of the ADA's privacy rules, individuals may file a complaint with the Equal Employment Opportunity Commission (EEOC) and/or initiate a private lawsuit. The other statements are true based on the CEBS study guide content.",
"gpt35": "The correct answer is 3) In case of violations of the act\u2019s privacy rules, employees\u2019 recourse is to file a complaint with their state\u2019s enforcement authority.",
"gpt4": "The correct answer is 3) In case of violations of the act\u2019s privacy rules, employees\u2019 recourse is to file a complaint with their state\u2019s enforcement authority."
},
{
"question": "All of the following are key factors of the covered group that are usually considered in the cost of a dental plan EXCEPT:",
"choices": [
"Gender distribution",
"Length of service",
"Geographic location and presence of fluoridation",
"Income levels",
"Occupations"
],
"key": 2,
"claude2": " 3) Income levels\n\nThe key factors of the covered group that are usually considered in the cost of a dental plan include:\n\na) Ages of the participants \nb) The distribution by gender of the group\nc) The location of the group, because dental charges, practice patterns and the availability of dentists vary by locale. Differences exist in the frequency of use for certain procedures as well. Also, the presence of fluoride in the water supply substantially reduces dental costs.\nd) The occupations of the group members, because blue-collar workers have decidedly lower dental costs than white-collar employees.\n\nIncome levels are not listed as one of the key factors that are usually considered in the cost of a dental plan. Therefore, the correct answer is 3) Income levels.",
"gpt35": "The correct answer is 0) Gender distribution.",
"gpt4": "The correct answer is 3) Income levels."
},
{
"question": "All of the following are requirements for an ideal insurable risk EXCEPT:",
"choices": [
"There must be a large number of heterogeneous exposure units that have different loss characteristics being insured against.",
"The insurer must be able to determine if the loss is covered under the policy and, if it is, how much the insurer will pay.",
"The premium must be subject to calculation.",
"The premium must be reasonable or economically feasible.",
"The loss should be accidental and unintentional from the standpoint of the insured."
],
"key": 1,
"claude2": " 4) The loss should be accidental and unintentional from the standpoint of the insured.\n\nThis is the exception, as an ideal insurable risk does not require the loss to be accidental or unintentional on the part of the insured. The other answer choices are requirements for an ideal insurable risk:\n\n0) There must be a large number of heterogeneous exposure units that have different loss characteristics being insured against. This allows the law of large numbers to operate.\n\n1) The insurer must be able to determine if the loss is covered under the policy and, if it is, how much the insurer will pay. The loss must be measurable and verifiable. \n\n2) The premium must be subject to calculation. The chance of loss should be predictable based on statistical analysis.\n\n3) The premium must be reasonable or economically feasible. The premium should not be cost prohibitive.\n\nTherefore, the correct answer is 4.",
"gpt35": "The correct answer is 0) There must be a large number of heterogeneous exposure units that have different loss characteristics being insured against.",
"gpt4": "The correct answer is 0) There must be a large number of heterogeneous exposure units that have different loss characteristics being insured against."
},
{
"question": "All of the following statements describe common characteristics of a pharmacy benefit manager (PBM) EXCEPT:",
"choices": [
"It is considered a licensed insurance carrier.",
"It is designed to control costs associated with the delivery of pharmaceutical care.",
"It aims to streamline and improve the prescribing and dispensing process through online and real-time claims adjudication.",
"It may maintain a retail network of pharmacies.",
"It offers limited drug utilization review at the point of sale or dispensing."
],
"key": 1,
"claude2": " The correct answer is 0. \n\nA pharmacy benefit manager (PBM) is not considered a licensed insurance carrier. PBMs are third party administrators that are contracted by plan sponsors to process prescription drug claims and provide other administrative services related to managing pharmacy benefits on behalf of health plans.\n\nThe other statements do accurately describe common characteristics of PBMs:\n\n1) PBMs are designed to control costs associated with pharmaceutical care through various utilization management and cost containment techniques. \n\n2) PBMs streamline the prescribing and dispensing process through real-time online claims adjudication at the point of sale. \n\n3) PBMs typically contract with retail pharmacy networks to fill prescriptions at discounted rates.\n\n4) PBMs offer limited drug utilization review, such as checking for duplicative therapy and drug interactions, at the point of sale when prescriptions are filled.\n\nSo the correct answer is that a PBM is not considered a licensed insurance carrier. The other statements accurately reflect features of PBMs.",
"gpt35": "The correct answer is 0) It is considered a licensed insurance carrier.",
"gpt4": "The correct answer is 0) It is considered a licensed insurance carrier."
},
{
"question": "All of the following statements regarding orthodontic benefits are correct EXCEPT:",
"choices": [
"Orthodontic benefits are almost never written without other dental coverage.",
"Maximum benefits typically are expressed on a lifetime basis.",
"Many of these plans limit coverage to persons under a specified age.",
"These plans normally have a high deductible.",
"A common coinsurance level for orthodontia expenses is 50 percent, but this varies widely among plans."
],
"key": 4,
"claude2": " 4) A common coinsurance level for orthodontia expenses is 50 percent, but this varies widely among plans.\n\nThe other statements about orthodontic benefits are correct:\n\n0) Orthodontic benefits are almost never written without other dental coverage. This is true, orthodontic coverage is typically offered along with other dental benefits.\n\n1) Maximum benefits typically are expressed on a lifetime basis. This is correct, orthodontic maximums are often lifetime maximums since orthodontic treatment is generally a one-time event. \n\n2) Many of these plans limit coverage to persons under a specified age. This is true, many dental plans restrict orthodontic coverage to dependent children under age 19. \n\n3) These plans normally have a high deductible. This is incorrect. Orthodontic benefits often have no deductible at all since the purpose of a deductible is to discourage small claims. Orthodontic treatment involves significant expense over an extended timeframe, so a deductible serves little purpose.\n\nTherefore, the incorrect statement is 3) These plans normally have a high deductible.",
"gpt35": "The correct answer is: 3) These plans normally have a high deductible.",
"gpt4": "The correct answer is 3) These plans normally have a high deductible."
},
{
"question": "All the following are characteristics of mail service programs (MSPs) for prescription drug programs EXCEPT:",
"choices": [
"These programs typically allow a more generous quantity amount to be filled, e.g. a 90-day supply compared to a 30-day supply.",
"MSPs are typically used for chronic conditions that require maintenance medications for long periods of time.",
"These programs essentially eliminate the possibility of waste.",
"MSPs are typically underused because enrollees are not familiar with a plan\u2019s mail service benefit or are not sure how to access the service.",
"MSPs offer a lower cost of dispensing and allow quality control through automation that is uncommon in retail pharmacy."
],
"key": 3,
"claude2": " 3) These programs essentially eliminate the possibility of waste.\n\nThe other statements all describe true characteristics of mail service programs (MSPs) for prescription drug programs. However, MSPs do not essentially eliminate the possibility of waste. There is still the possibility of waste if individuals obtain excessive dosage sizes prior to a change in their treatment regimens. Therefore, the correct answer is 3.",
"gpt35": "The correct answer is 3) MSPs are typically underused because enrollees are not familiar with a plan\u2019s mail service benefit or are not sure how to access the service.",
"gpt4": "The correct answer is 2) These programs essentially eliminate the possibility of waste. While MSPs can reduce waste, they do not eliminate the possibility entirely."
},
{
"question": "All of the following are care management and cost-containment practices of managed behavioral healthcare organizations (MBHOs) EXCEPT:",
"choices": [
"Predictive modeling and risk assessment",
"Minimum coverage for high-risk, potentially high-cost members.",
"Preauthorization to access treatment",
"Performance measurement",
"Outcomes management"
],
"key": 2,
"claude2": " The correct answer is 1) Minimum coverage for high-risk, potentially high-cost members.\n\nThe other options listed are all common care management and cost-containment practices of MBHOs:\n\n0) Predictive modeling and risk assessment - MBHOs use data analytics to identify high-risk members likely to have high costs so they can target them for care management.\n\n2) Preauthorization to access treatment - Requiring preapproval from the MBHO before accessing certain higher levels of care manages utilization. \n\n3) Performance measurement - MBHOs measure performance on clinical and cost metrics.\n\n4) Outcomes management - MBHOs aim to improve clinical outcomes through their care management practices.\n\nHowever, MBHOs do not provide minimum coverage for high-risk members. In fact, high-risk members may be subjected to more stringent utilization management to control costs. The correct answer is 1) Minimum coverage for high-risk, potentially high-cost members.",
"gpt35": "The correct answer is 1) Minimum coverage for high-risk, potentially high-cost members.",
"gpt4": "The correct answer is 1) Minimum coverage for high-risk, potentially high-cost members."
},
{
"question": "All of the following are common key characteristics of the group insurance technique used in employee benefit plans EXCEPT:",
"choices": [
"A minimum number of individuals eligible",
"A waiting period applied before benefits commence",
"A steady flow of new entrants",
"A disallowance of any commission payments",
"An automatic determination of benefits"
],
"key": 4,
"claude2": " 3) A disallowance of any commission payments\n\nThe key characteristics of the group insurance technique used in employee benefit plans include:\n\n- A minimum number of individuals eligible (to spread risk and expenses) \n- A steady flow of new entrants (to maintain a stable risk pool)\n- An automatic determination of benefits (to prevent adverse selection)\n\nThe disallowance of any commission payments is not a common characteristic of group insurance plans. Agents and brokers commonly receive some form of commission compensation for selling and servicing group insurance policies. \n\nTherefore, the correct answer is 3) A disallowance of any commission payments",
"gpt35": "The correct answer is 3) A disallowance of any commission payments.",
"gpt4": "The correct answer is 3) A disallowance of any commission payments."
},
{
"question": "All of the following statements regarding information tools used in the consumer-directed health plan (CDHP) movement are correct EXCEPT:",
"choices": [
"POS plans offer members the choice of network or out-of-network providers.",
"These plans typically do not have co-pays for in-network providers, but normally have sizeable deductibles.",
"The individual may need to select a primary care physician to obtain referrals for in-network specialty care.",
"There is no need to file a claim for reimbursement of in-network services.",
"The out-of-pocket expenses for out-of-network providers is not a flat dollar amount but rather a percentage of the insurer\u2019s designated prevailing fees."
],
"key": 2,
"claude2": " 3) There is no need to file a claim for reimbursement of in-network services.\n\nThis statement is false. POS plans typically require members to file claims and pay coinsurance for services received from out-of-network providers. The other statements about POS plans are true:\n\n0) POS plans offer members the choice of network or out-of-network providers.\n\n1) These plans typically do not have co-pays for in-network providers, but normally have sizeable deductibles. \n\n2) The individual may need to select a primary care physician to obtain referrals for in-network specialty care.\n\n4) The out-of-pocket expenses for out-of-network providers is not a flat dollar amount but rather a percentage of the insurer\u2019s designated prevailing fees.\n\nSo the correct answer is 3) There is no need to file a claim for reimbursement of in-network services.",
"gpt35": "The correct answer is 0) POS plans offer members the choice of network or out-of-network providers.",
"gpt4": "The correct answer is 2) The individual may need to select a primary care physician to obtain referrals for in-network specialty care. This statement is not correct because in a CDHP, individuals typically do not need to select a primary care physician for referrals."
},
{
"question": "All of the following statements regarding the basic features of indemnity health plans are correct EXCEPT:",
"choices": [
"These plans are also known as \u201ctraditional\u201d and \u201cfee for service.\u201d",
"Originally these plans primarily covered only inpatient hospital expenses but later added outpatient, diagnostic and physician services coverage.",
"They pay a percentage of the cost of treatment (as much as 100% for emergency/preventive care and 80% for most other services).",
"They almost always require insureds to obtain permission from their physician to access specialty or diagnostic services.",
"Managed care models have all but replaced traditional indemnity plans."
],
"key": 4,
"claude2": " 4) Managed care models have all but replaced traditional indemnity plans.\n\nIndemnity plans, also known as traditional, fee-for-service or conventional plans, do not require insureds to obtain permission from their physician to access specialty or diagnostic services. Therefore, statement 4 is the incorrect statement.",
"gpt35": "The correct answer is 4) Managed care models have all but replaced traditional indemnity plans.",
"gpt4": "The correct answer is 3) They almost always require insureds to obtain permission from their physician to access specialty or diagnostic services."
}
]
Sign up for free to join this conversation on GitHub. Already have an account? Sign in to comment