CES Benefits Plans and Coverage 2 — Questions and Answers
Question 1: What is the actuarial value of a Bronze plan under the ACA?
- 60% (Correct answer)
- 70%
- 80%
- 90%
Correct answer: 60%
Bronze plans have an actuarial value of 60%, meaning the plan covers 60% of average covered medical costs and the member pays 40%.
Question 2: A Point of Service (POS) plan combines features of which two plan types?
- EPO and PPO
- HMO and PPO (Correct answer)
- HMO and EPO
- HDHP and PPO
Correct answer: HMO and PPO
A POS plan blends HMO features (PCP requirement and referrals) with PPO features (option to use out-of-network providers at higher cost).
Question 3: What is a Health Reimbursement Arrangement (HRA)?
- An employee-funded account for medical expenses
- An employer-funded account that reimburses qualified medical expenses (Correct answer)
- A government subsidy for low-income individuals
- A loan program for healthcare costs
Correct answer: An employer-funded account that reimburses qualified medical expenses
An HRA is an employer-funded account that reimburses employees for qualified out-of-pocket medical expenses and is not portable if the employee leaves.
Question 4: Which plan type has NO deductible but restricts members entirely to in-network providers?
- HDHP
- PPO
- HMO (Correct answer)
- EPO
Correct answer: HMO
Many HMO plans have no deductible and use copayments for services, but members must stay strictly within the HMO network for covered care.
Question 5: A catastrophic health plan is available primarily to which group?
- All ACA Marketplace enrollees
- Adults under age 30 or those with hardship exemptions (Correct answer)
- Medicare-eligible individuals
- Small business employees only
Correct answer: Adults under age 30 or those with hardship exemptions
Catastrophic plans are available to people under 30 or those who qualify for a hardship or affordability exemption, featuring low premiums and very high deductibles.
Question 6: When a health plan covers preventive services at 100% with no cost-sharing, this requirement comes from:
- ERISA regulations
- The Affordable Care Act (ACA) (Correct answer)
- HIPAA portability rules
- COBRA continuation rules
Correct answer: The Affordable Care Act (ACA)
The ACA requires non-grandfathered health plans to cover specified preventive services at no cost-sharing to the member.
CES Benefits Plans and Coverage 2
What is the actuarial value of a Bronze plan under the ACA?