Exam 1

Briefly explain the "Life Stage Protection Approach" to Long-Term Care Insurance:

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Describe why and how the deployment and marketing of long term care insurance years ago was a product gone wrong.

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Which of the following are benefit Triggers to benefit payments of long term car insurance?

Admission to a nursing home Total Disability determination In ability to cannot perform activities of daily living Admission to a hospital

.When Equity was measured� (defined as income and consistent care processes); Compares performance for higher and lower income individuals receiving care, The USA was ranked

Answer 1:About the same as other countries Answer 2:Slightly under the measure of other countries Answer 3:Very much under the measure of other countries Answer 4:Much better than the measure of other countries

When Access was measured by affordability and timeliness of care, the USA was ranked

Answer 1:About the same as other countries Answer 2:Slightly under the measure of other countries Answer 3:Very much under the measure of other countries Answer 4:Much better than the measure of other countries

When Administrative efficiency as measured by Barriers to care; Patient and physician time spent with paperwork; and Documentation requirement disputes between payors and providers, the USA was ranked

Answer 1:About the same as other countries Answer 2:Slightly under the measure of other countries Answer 3:Very much under the measure of other countries Answer 4:Much better than the measure of other countries

When Care Processes were measured by Preventative, safe, coordinated, engagement, and patient centered care, the USA was ranked

Answer 1:About the same as other countries Answer 2:Slightly under the measure of other countries Answer 3:Very much under the measure of other countries Answer 4:Much better than the measure of other countries

When Healthcare Outcomes were measured: Performance outcomes of the healthcare delivery system; includes population health outcomes, mortality amendable to healthcare (i.e. seen as preventable for under 75 years of age populations), and disease specific

Answer 1:About the same as other countries Answer 2:Slightly under the measure of other countries Answer 3:Very much under the measure of other countries Answer 4:Much better than the measure of other countries

For SHBP Eligible students

Answer 1:All Eligible students are automatically enrolled and charged Answer 2:Can provide proof of other insurance timely to aviod paying premiums Answer 3:ID cards issued before the deadline for providing waiver information

Under the Affordable Care Act (ACA) all of the following apply EXCEPT(Multiple Choice)(Single Choice) Answer 1:All employers must offer coverage or pay a penalty

Answer 1:All employers must offer coverage or pay a penalty Answer 2:Employers with (51+) FTEs employees must offer affordable coverage or pay a penalty Answer 3:Employers with (51+) FTEs employees can have employees pay a portion of the premium Answer 4:All �large� employers must offer coverage or pay a penalty

Under the Affordable Care Act (ACA) all of the following apply EXCEPT

Answer 1:All employers must offer coverage or pay a penalty Answer 2:Employers with (51+) FTEs employees must offer affordable coverage or pay a penalty. Answer 3:Employers with (51+) FTEs employees can have employees pay a portion of the premium. Answer 4:All �large� employers must offer coverage or pay a penalty

Companies can choose from which four classes of health insurance programs? (Defining and Exploring Health Insurance Programs)

Answer 1:Fee-for-service, managed care, point-of-service, consumer-driven health care Answer 2:Indemnity, health savings accounts, managed care, fee-for-service Answer 3:Point-of-service, fee-for-service, indemnity, managed care Answer 4:Self-funded, managed care, fee-for-service, point-of-service

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

Answer 1:Flexible spending accounts Answer 2:Health reimbursement arrangements Answer 3:Health savings accounts Answer 4:Flexible savings accounts

Important factors to consider to avoid a "complete nightmare" for covered students if changing/ transitioning to new vendor/administrators, even if even if plan design remains unchanged, are:

Answer 1:Formulary differences Answer 2:Different discounts on medications Answer 3:Provider network change Answer 4:Administrative differences

Student Health Benefit Plan (SHBP)

Answer 1:Full time students can opt out of SHBP to avoid premiums Answer 2:Full time students can not opt out of SHBP to avoid premiums

The factors that determine an individual's health insurance premium in MNSure include all of the following EXCEPT

Answer 1:Household Income Answer 2:Gender Answer 3:Location Answer 4:Tobacco Use Answer 5:Age

The factors which determine the MNsure premium discounts or subsidies include all of the following EXCEPT

Answer 1:Houshold Income Answer 2:Number of people in household Answer 3:Wealth/asset level of household Answer 4:The federal poverty guidelines

Established minimum standards for employer-sponsored pension plans

Answer 1:Is a far-reaching law Answer 2:Has been amended several times Answer 3:Consolidated Omnibus Budget Reconciliation Act (COBRA 1985) Answer 4:Pension Protection Act (2006)

Employee Retirement Income Security Act of 1974 (ERISA) regulates the establishment and implementation of�discretionary (not required by law)�benefits practices including medical insurance, under ACA in mandatory, not discretionary

Answer 1:Life insurance Answer 2:Disability programs Answer 3:Retirement plans

Health insurance premiums at MNsure and other exchanges must be based only on the following, and premiums may only vary due to what factors?

Answer 1:Loss experience, age, family size and smoking status. Answer 2:Loss ratio, geography, age, family size and smoking status. Answer 3:Gender, geography, age, family size and smoking status. Answer 4:Geography, age, family size and smoking status

6.Suppose the entire ACA is held to be unconstitutional by the US Supreme Court. Chect the correct��effect (s) that would have over time on each of the following medical payment systems in USA:

Answer 1:Medicare No effect Answer 2:Medicare Great effect Answer 3:Medicaid including MN Assistance Great effect Answer 4:Medicaid including MN Assistance No effect Answer 5:Private health plans in MNsure Great effect Answer 6:Private health plans in MNsure No effect Answer 7:Workers��Compensation,��No effect Answer 8:Workers��Compensation,��Great effect

COVID has affected SHBP premiums

Answer 1:Not at all Answer 2:May slightly increase Answer 3:May slightly decrease Answer 4:It's too early to tell

Which of the following occurrences in an employer's health benefit plan may lead to increased Claims?

Answer 1:Open enrollment Answer 2:COBRA selections by employees leaving the group Answer 3:Wellness programs Answer 4:Increased deductibles Answer 5:Increased co-pays

UMN students have access to which the following health insurance options

Answer 1:Remain a dependent on parent's health insurance plan to the age of 26; Answer 2:Exchanges/Marketplaces - with premium tax credit, or subsidy, if income requirements are met Answer 3:Catastrophic Plan, offered through the Exchange/Marketplace Answer 4:Medicaid - based on expanded eligibility requirements in some states Answer 5:Individual Health Plan offered outside of the Exchange/Marketplace

Under an employer sponsored health plan the Affordable Care Act measure of affordability is it�s unaffordable if:

Answer 1:The loss ratio is less than 80% Answer 2:The single employee contribution/portion of the premium of lowest cost premium plan is greater than about 9.69% of household income Answer 3:The premium paid by single employees must not be greater than about 9.69% of the total premium. Answer 4:The expense ratio must not be greater than 20%

How much of an added percent mark-up is the tax difference between pre employer plan and the individual plan, post tax options?

Answer 1:Up to somewhere around 20% Answer 2:Up to somewhere around 40% Answer 3:Up to somewhere around 30% Answer 4:There is no difference under the ACA

What is coinsurance? (Features of Fee-For-Service Plans)

Answer 1:When both parents have employer-sponsored insurance coverage for their children Answer 2:Two insurance companies combine to offer a group policy to an employer Answer 3:The amount an employee has to pay out-of-pocket before the insurance kicks in Answer 4:The percentage of covered expenses paid by the insured

SHBP is

Answer 1:a fully insured program Answer 2:a partially insured program Answer 3:an uninsrued self funded program

I during the RFP to obtain bids for the self-insured with stop loss covered, the factors were heavily weighted are: Untitled Question

Answer 1:network discounts including medical and RX claim costs Answer 2:Adequacy and strength of network availability, pharmacy network, including behavioral health network (Disruption) Answer 3:Summary of Benefits & Summary of Plan Descriptions Answer 4:Data Reporting Capabilities

Discretionary benefits can be categorized into programs that (Discretionary Benefits)

Answer 1:protect health and income, provide job security, provide accommodation and enhancement benefits. Answer 2:provide job security, protect health and income, allow for paid time-off. Answer 3:protect health and income, allow for paid time-off, provide accommodation and enhancement benefits. Answer 4:provide job security, allow for paid time-off, provide accommodation and enhancement benefits.

All of the following types of benefits are payable under Long term care insurance policies, except which on is not

Home health care. Respite care. Hospice care. Personal care in the home. Services provided in assisted living facilities. Hospital surgical care. Adult day care centers and other community facilities