Benefits Plans and Coverage Flashcards
6 cards from real CES practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 6 Benefits Plans and Coverage flashcards as text
What is the actuarial value of a Bronze plan under the ACA?
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%.
A Point of Service (POS) plan combines features of which two plan types?
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).
What is a Health Reimbursement Arrangement (HRA)?
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.
Which plan type has NO deductible but restricts members entirely to in-network providers?
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.
A catastrophic health plan is available primarily to which group?
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.
When a health plan covers preventive services at 100% with no cost-sharing, this requirement comes from:
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.