Cebs gba 1 stuvia - Study guides, Class notes & Summaries

A prescription drug rebate occurs when: - ANSWERThere is an agreement between a pharmacy benefit manager and a drug manufacturer. The concept designed to make victims of losses whole again reflect the principle of: - ANSWERIndemnification A healthcare plan that has no restrictions on a member's choice of provider, no "steerage," and no basic utilization management is known as: - ANSWERIndemnity plan The legislation that plays a fundamentally important role in protecting sensiti...

Broad view of Employee Benefits (Mod 1.1) - ANSWERConsiders Employee Benefits to be virtually any form of compensation other than direct wages paid to Employees (Ex: WC, Unemployment, State DI, SS, Vacation, Holidays, 401K/Retirement, Employer share of Medical, Severance Pay, Child Care, etc..) Narrow view of Employee Benefits (Mod 1.1) - ANSWERAny type of plan sponsored or initiated by Employees and Employers and engaged in providing benefits that result from the employment relationship and ...

Which of the following statements correctly describes minimum requirements that group benefit plans typically must meet in order to be prospectively rated on contract renewal? - ANSWERThe more unpredictable the event that will trigger a claim, the larger the minimum group size and premium requirements Which of the following statements correctly describes the term graduation as it applies to mortality tables? - ANSWERIt is a mathematical process that removes anomalies that should not appear in t...

3 types of total compensation/benefits policies that an employer could adopt - ANSWER1. follow the company's own prevailing compensation/benefits level in their firms industry or community or both 2. high comp/benefits policies attempt to attract higher levels of managment, technical and general employee talent 3. low compensation/benefits policies are lower than average and more modest in scale Broadview of employee benefits - ANSWERany form of compensation other than dirext wages paid ...

Categorize the broad approaches to health care reimbursement methodologies. - ANSWERA limited number of payment methodologies are used to reimburse providers. Payment methodologies fall into two broad classifications: fee-for-service and capitation. Under fee-for-service, of which many variations exist, the greater the amount of services provided, the higher the amount of reimbursement. Under capitation, a fixed payment is made to providers for each covered life, or enrollee, independent of the ...

Fringe Benefits - ANSWERAddition of benefits as an offset to higher labor Broad View - ANSWER"Virtually any form of compensation other than direct wages" Limited (Narrow) View - ANSWERBenefits that stem from an employment relationship, not underwritten or paid for directly by the government Reasons for growth in Employee Benefit Plans - ANSWERBusiness, tax legislation, collective bargaining, efficiency of the approach Labor Management Relations Act (Taft Hartley Act) - ANSWERAd...

______ View is any type of plan sponsored and engaged in providing benefits that result from employment relationship and that are not underwritten or paid directly by government - ANSWERNarrow View A behavioral health care carve-out program usually operates under a separate contract and from a separate company known as a(n): - ANSWERManaged behavioral health care organization (MBHO) A dental plan in which certain procedures are reimbursed on a scheduled basis and others are reimbursed on a...

attraction of private exchanges for employers - ANSWEROne big attraction of private exchanges for employers is the opportunity to change from a traditional premium contribution model, where the employer typically pays 75-80% of the premium, or premium equivalent rate, to a defined contribution model. Because private exchanges provide a wider array of choices to employees, the employer can more easily change from the traditional contribution model to a defined contribution model where a flat...

3 basic types of funding arrangements of an MBHO - ANSWER1. fully insured -MBHOs assume the financial risk for providing behavioral services paying the claims submitted by providers for behavioral services rendered. Financial risk falls on the MBHO. When overall plan costs exceed expected levels, the MBHO absorbs those increased costs. Purchasers pay MBHOs a predetermined, fixed premium for assuming financial risk for behavioral treatment costs. On average, a monthly premium for a fully ins...

Employee Benefits - ANSWERAll forms of financial returns and tangible services and benefits employees receive as part of an employment relationship Broad View of Employee Benefits - ANSWEREmployee benefits are virtually any form of compensation other than direct wages What benefits are included in the broad view of employee benefits? - ANSWER1. Employers' share of legally required payments (Social Security, Medicare, unemployment insurance, and workers' comp benefits) 2. Payments fo...