CES Benefits Plans and Coverage 2

Question 1

What is the actuarial value of a Bronze plan under the ACA?

Accepted Answer

60%

Answer

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?

Accepted Answer

HMO and PPO

Answer

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)?

Accepted Answer

An employer-funded account that reimburses qualified medical expenses

Answer

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?

Accepted Answer

HMO

Answer

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?

Accepted Answer

Adults under age 30 or those with hardship exemptions

Answer

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.

CES - Certified Enrollment Specialist Practice Test

CES - Certified Enrollment Specialist Practice Test

CES Benefits Plans and Coverage 2