TREX Health & Welfare Benefit Design 3

Question 1

Under COBRA, what is the maximum premium an employer may charge a qualified beneficiary for continuation coverage?

Accepted Answer

102% of the applicable cost

Answer

COBRA allows employers to charge up to 102% of the cost of coverage (100% premium + 2% administrative fee) to the qualified beneficiary.

Question 2

An Exclusive Provider Organization (EPO) differs from a PPO in that an EPO:

Accepted Answer

Does not cover out-of-network care except emergencies

Answer

EPOs restrict coverage to in-network providers (with limited emergency exceptions) but, unlike HMOs, typically do not require PCP referrals.

Question 3

What is the primary purpose of a wellness program's outcomes-based incentive structure?

Accepted Answer

Tie rewards to achieving specific biometric or health outcome targets

Answer

Outcomes-based wellness programs link incentive rewards (or penalties) to achieving measurable health targets such as BMI, blood pressure, or tobacco-free status.

Question 4

Under the ACA's preventive care mandate, which of the following must be covered at no cost-sharing in non-grandfathered plans?

Accepted Answer

USPSTF grade A and B preventive services

Answer

Non-grandfathered plans must cover USPSTF grade A and B preventive services, ACIP-recommended immunizations, and HRSA guidelines without cost-sharing.

Question 5

Which funding vehicle allows employees to pay their share of group health insurance premiums on a pre-tax basis?

Accepted Answer

Section 125 Cafeteria Plan

Answer

A Section 125 cafeteria plan is the IRS vehicle that permits employees to elect to pay group health premiums with pre-tax dollars.

(TREX) WorldatWork Total Rewards Certification Practice Test

(TREX) WorldatWork Total Rewards Certification Practice Test

TREX Health & Welfare Benefit Design 3