Chapter 14

Consumer-driven health care allows individuals to use a _____-tiered approach to funding the costs of medical services and treatment. A 3 B 2 C 5 D 4

A 3

Under the Patient Protection and Affordable Care Act, the special enrollment period in the Small Business Health Options (SHOP) Marketplace lasts ______ days from the date of the qualifying event. A 30 B 10 C 20 D 15

A 30

Under the Patient Protection and Affordable Care Act, the special enrollment period in the Small Business Health Options (SHOP) Marketplace lasts ______ days from the date of the qualifying event. A 30 B 15 C 10 D 20

A 30

The PPACA requires the medical loss ratio to be ______% for large group plans. A 85 B 80 C 95 D 90

A 85

Premium Tax Credits are available from the ________ government to help lower the cost of health coverage for individuals and small employers who meet certain income requirements and do not have affordable health insurance that meets the minimum essential coverage requirements. A Federal B State C County D City

A Federal

California residents can obtain financial assistance in obtaining healthcare insurance coverage in all of the following ways, except: A Grants and loans B Advanced Premium Tax Credits C Medi-Cal Assistance D Cost-Sharing Reduction

A Grants and loans

All health plans, group and individual, offered through a Health Insurance Exchange must provide, at a minimum, essential health benefits in all of the following categories of care and services, except: A Long-term care B Laboratory services C Hospitalization D Maternity and newborn care (including prenatal and delivery care)

A Long-term care

Covered California must meet all federal requirements established under the: A Patient Protection and Affordable Care Act B PBGC C IRS D ERISA

A Patient Protection and Affordable Care Act

Under the PPACA, all health plans are prohibited from discriminating against or charging higher rates to any individual on the basis of: A Preexisting conditions B Occupations C Avocations D Vocations

A Preexisting conditions

A qualified health plan is any plan which provides coverage for the ______ Essential Health Benefits and provides a minimum actuarial value of 60%. A 4 B 10 C 6 D 8

B 10

The __________ value of a health plan equals the percentage of the total average costs that a plan pays for Essential Health Benefits. A Taxable B Actuarial C Intrinsic D Economic

B Actuarial

Consumers in California must purchase a Qualified Health Plan through __________ in order to obtain Premium Tax Credits. A A private insurer B Covered California C Medi-Cal D A licensed agent

B Covered California

Under the Patient Protection and Affordable Care Act, a(n) _______ enrollment period is the length of time during which a person may enroll in a Qualified Health Plan outside of open enrollment if a qualifying life event, such as marriage, divorce, or the birth of a child, takes place. A Post B Special C Qualifying D Open

B Special

Under the Patient Protection and Affordable Care Act, insurers may no longer rate and charge higher premiums for __________ risks. A Super-preferred B Substandard C Standard D Preferred

B Substandard

Karen, age 50, withdraws $1,000 from her Health Savings Account (HSA) for a purpose other than a qualified medical expense. As a result of this action: A The $1,000 is taxed as ordinary income, with an additional $150 penalty tax applied B The $1,000 is taxed as ordinary income, with an additional $200 penalty tax applied C The $1,000 is taxed as ordinary income, with no penalty tax applied D The $1,000 is taxed as ordinary income, with an additional $100 penalty tax applied

B The $1,000 is taxed as ordinary income, with an additional $200 penalty tax applied

The PPACA extends dependent children's coverage through age _____ based strictly on the parent - child relationship. A 23 B 21 C 25 D 22

C 25

Under the PPACA, the special enrollment period in the Individual Marketplace lasts ______ days from the date of the qualifying event. A 45 B 20 C 60 D 30

C 60

The Patient Protection and Affordable Care Act, referred to as the Affordable Care Act (ACA), consists of all of the following, except: A Subsidized, regulated private insurance B An expansion of coverage through public and private insurance which includes broader Medi-Cal eligibility and Medicare coverage C All employers are required to provide health insurance to their employees D A combination of measures to control healthcare costs

C All employers are required to provide health insurance to their employees

California residents can obtain financial assistance in obtaining healthcare insurance coverage in all of the following ways, except: A Medi-Cal Assistance B Cost-Sharing Reduction C Grants and loans D Advanced Premium Tax Credits

C Grants and loans

What is the Health Insurance Marketplace? A It is like a stock exchange where insurers can make offers to obtain more business from their competitors B It is a clearinghouse where consumers are automatically matched with companies and enrolled in their plans C It is a resource where consumers can learn about their health insurance coverage options and compare plans D It is a physical location in every major city where consumers can go to shop and compare insurance policies and companies

C It is a resource where consumers can learn about their health insurance coverage options and compare plans

Which of the following statements is false regarding the Affordable Care Act? A It consists of a combination of measures to control healthcare costs, and an expansion of coverage through public and private insurance including broader Medicaid eligibility and Medicare coverage, and subsidized, regulated private insurance B Its goals are increasing the quality and affordability of health insurance, lowering the uninsured rate by expanding public and private insurance coverage, and reducing the costs of healthcare for individuals and the government C It requires all employers to provide health insurance to their employees D It established the Health Insurance Marketplace

C It requires all employers to provide health insurance to their employees

An Essential Health Benefits package is required to provide levels of coverage offered through all health exchanges known as: A Qualified Ratings B Diamond Tiers C Metal Tiers D Essential Categories

C Metal Tiers

Nathan is insured under a group disability plan which requires that he pay 1/3 of the premium. Nathan is currently drawing a $6,000 monthly benefit from the plan. How much of the $6,000 is subject to income tax? A Zero B $2,000 C $6,000 D $4,000

D $4,000

Plans that offer Minimum Essential Coverage include all of the following, except: A Medicaid B Medicare C Individual insurance offered through an exchange, and employer-sponsored health insurance D An employer self-funded plan

D An employer self-funded plan

Covered California must meet all federal requirements established under the: A PBGC B ERISA C IRS D Patient Protection and Affordable Care Act

D Patient Protection and Affordable Care Act

Which one of the following regarding individual or employer eligibility to buy insurance through the California Health Benefit Exchange is false? A Households with incomes between 138% and 400% of the federal poverty level in addition may qualify for Advanced Premium Tax Credits or Cost Sharing Reductions B The California Exchange will ensure that federally-authorized tax credits are paid to the insurers C Individuals and small employers must meet federal citizenship or legal residency requirements D Small employers with less than 1000 employees may purchase coverage through the exchange

Small employers with less than 1000 employees may purchase coverage through the exchange