Chapter 9

A healthcare organization develops a benefits package that aligns with its goal to support employee well-being, reduce turnover, and maintain compliance with ERISA and ACA. What best describes this type of plan?
A) A strategically aligned, employee-centered benefits plan
B) A cost-only benefits plan
C) A minimal compliance plan
D) A short-term coverage plan

A) A strategically aligned, employee-centered benefits plan

A hospital adds gym memberships, tuition reimbursement, and financial wellness workshops to its benefits package to improve retention. What kind of benefits are these?
A) Voluntary benefits
B) Mandatory benefits
C) Federal benefits
D) Required coverage

A) Voluntary benefits

A nurse is injured at work and receives medical treatment and wage replacement benefits through her employer. What type of benefit is this?
A) Mandatory – workers’ compensation
B) Voluntary – wellness program
C) Voluntary – paid time off
D) Optional – life insurance

A) Mandatory – workers’ compensation

A healthcare organization tailors its benefits package to include childcare assistance and flexible scheduling for employees with young families. Which factor are they considering?
A) Workforce demographics
B) Cost sharing
C) Policy compliance
D) Tax implications

A) Workforce demographics

A hospital’s HR team is analyzing claims data to find high-cost areas and adjust coverage tiers. Which benefit management concept are they applying?
A) Utilization review
B) Premium cost sharing
C) Open enrollment education
D) Self-insured planning

A) Utilization review

The HR team designs wellness programs and preventive care incentives to lower long-term costs. What benefit design consideration is being addressed?
A) Cost considerations
B) Workforce demographics
C) Compliance oversight
D) Self-insurance options

A) Cost considerations

A hospital that self-insures its health plan wants protection from extremely high claims from a single employee. Which option should it purchase?
A) Stop-loss insurance
B) Health savings account
C) High-deductible health plan
D) Flexible spending account

A) Stop-loss insurance

A healthcare administrator decides to hold webinars during open enrollment to help staff understand new benefit options. What key planning consideration does this address?
A) Communication strategy
B) Workforce demographics
C) Cost containment
D) Policy alignment

A) Communication strategy

A public health department is implementing new reporting practices to make their OPEB (Other Postemployment Benefit) disclosures more transparent. Which standard applies?
A) GASB 74
B) GASB 45
C) GASB 43
D) GASB 75

A) GASB 74

A state hospital system is updating its financial statements to clearly show full liabilities for retiree health benefits. Which GASB standard requires this?
A) GASB 75
B) GASB 43
C) GASB 45
D) GASB 74

A) GASB 75

A patient with diabetes applies for private insurance and is told she’ll pay extra due to her condition. Which ACA rule prevents this?
A) Coverage for pre-existing conditions
B) Essential health benefits
C) Dependent coverage rule
D) Medicaid expansion

A) Coverage for pre-existing conditions

A hospital is penalized because its rate of patient readmissions after surgery is higher than expected. Which ACA program caused this penalty?
A) Hospital Readmissions Reduction Program (HRRP)
B) Medicare Accountability Program
C) Affordable Hospital Care Initiative
D) Health Plan Transparency Act

A) Hospital Readmissions Reduction Program (HRRP)

A low-income patient who doesn’t qualify for Medicare seeks affordable insurance coverage through a state exchange. The healthcare navigator helps her apply for subsidies. Which ACA feature makes this possible?
A) Employer mandate
B) Subsidies and tax credits
C) Essential health benefits
D) Medical loss ratio rule

B) Subsidies and tax credits

A 24-year-old nursing student working part-time still has health insurance through her parents’ plan. Which ACA provision allows this?
A) Dependent coverage up to age 26
B) Medicaid expansion
C) Individual mandate
D) Premium tax credit

A) Dependent coverage up to age 26

A small healthcare facility has 60 full-time employees but hasn’t offered health insurance. What consequence could the organization face under the ACA?
A) Required to expand Medicaid coverage
B) Penalties for violating the employer mandate
C) Higher employee tax credits
D) No penalty if wages are under $50,000

B) Penalties for violating the employer mandate

A benefits manager notices employees don’t understand their postpartum care rights. What problem is this most closely related to?
A) HIPAA noncompliance
B) Limited awareness of the Newborns’ and Mothers’ Health Protection Act
C) ACA transparency requirements
D) ERISA plan reporting

B) Limited awareness of the Newborns’ and Mothers’ Health Protection Act

A clinic owner is frustrated that many insurance companies still apply stricter preauthorization requirements for mental health services than for physical health services. This shows a compliance issue with which rule?
A) Parity standards under the MHPA
B) HIPAA security rule
C) ERISA funding rules
D) FMLA leave rules

A) Parity standards under the MHPA

After 2017, a healthcare employee decides not to carry insurance but notices they no longer owe a penalty when filing taxes. Which law caused this change?
A) Tax Cuts and Jobs Act (TCJA) of 2017
B) ACA
C) HIPAA
D) ERISA

A) Tax Cuts and Jobs Act (TCJA) of 2017

A hospital HR manager must ensure all full-time staff have access to affordable health insurance or risk penalties. Which law established this employer responsibility?
A) ERISA
B) Affordable Care Act (ACA) of 2010
C) HIPAA
D) TCJA

B) Affordable Care Act (ACA) of 2010

A healthcare system wants to allow higher contribution limits for employees’ 401(k) plans to improve retention. Which law made this possible?
A) Economic Growth and Tax Relief Reconciliation Act (EGTRRA) of 2001
B) HIPAA of 1996
C) TCJA of 2017
D) ERISA of 1974

A) Economic Growth and Tax Relief Reconciliation Act (EGTRRA) of 2001

After a mastectomy, a hospital employee requests insurance coverage for breast reconstruction and related treatment. Her insurer denies the claim. Which law requires this coverage?
A) HIPAA

B) Women’s Health and Cancer Rights Act (WHCRA) of 1998
C) ACA
D) ERISA

B) Women’s Health and Cancer Rights Act (WHCRA) of 1998

An HR coordinator receives a request from a nurse who is transferring to another hospital and wants to maintain her health coverage during the transition. Which law ensures she can do this?
A) HIPAA of 1996
B) ACA of 2010
C) ERISA of 1974
D) TCJA of 2017

A) HIPAA of 1996

A nurse delivers her baby via C-section, but her employer’s insurance only covers 48 hours in the hospital. She challenges the policy, stating that the law requires coverage for a longer stay. Which act supports her claim?
A) FMLA
B) Newborns’ and Mothers’ Health Protection Act of 1996
C) ACA
D) ERISA

B) Newborns’ and Mothers’ Health Protection Act of 1996

A healthcare organization’s insurance plan allows $200,000 in coverage for medical treatments but only $50,000 for mental health care. Which law is this company violating?
A) HIPAA
B) Mental Health Parity Act (MHPA) of 1996
C) ERISA
D) WHCRA

B) Mental Health Parity Act (MHPA) of 1996

A hospital’s HR director reviews employee retirement plans to make sure they follow federal standards for vesting and benefit management. Which law are they complying with?
A) HIPAA of 1996
B) ERISA of 1974
C) EGTRRA of 2001
D) ACA of 2010

B) ERISA of 1974

A successful benefits plan should be:
A) Strategically aligned, financially sustainable, and employee-centered
B) Focused only on employer savings
C) Designed for short-term recruitment
D) Identical for all employees

A) Strategically aligned, financially sustainable, and employee-centered

Why should workforce demographics be considered in benefit design?
A) Different age groups and life stages value different benefits
B) It determines how much employees should pay in taxes
C) It replaces federal benefit requirements
D) It helps eliminate voluntary benefits

A) Different age groups and life stages value different benefits

What does stop-loss insurance do for self-insured employers?
A) Protects against very high individual or total claims
B) Reduces payroll taxes
C) Reimburses employees for premiums
D) Covers only dental expenses

A) Protects against very high individual or total claims

What is the goal of a strong communication strategy in benefits planning?
A) To clearly educate employees about options and changes
B) To increase employer tax deductions
C) To reduce HR staffing needs
D) To eliminate employee questions

A) To clearly educate employees about options and changes

Which of the following is a voluntary benefit?
A) Wellness programs
B) Social Security
C) Medicare
D) Family and Medical Leave Act

A) Wellness programs

Which of the following is a mandatory employee benefit?
A) Workers’ compensation
B) Life insurance
C) Paid vacation
D) Tuition reimbursement

A) Workers’ compensation

What major change occurred with GASB 74/75 compared to GASB 43/45?
A) Full recognition of OPEB liabilities on balance sheets
B) Elimination of reporting requirements
C) Reduced employer transparency
D) End of postemployment benefit accounting

A) Full recognition of OPEB liabilities on balance sheets

What is the focus of GASB No. 43?
A) Financial reporting for postemployment benefit plans other than pensions
B) Employer pension liability reporting
C) Annual required contribution funding
D) Tax deductions for OPEB plans

A) Financial reporting for postemployment benefit plans other than pensions

What does GASB stand for?
A) Governmental Accounting Standards Board
B) General Accounting Services Bureau
C) Government Audit Standards Base
D) Government and State Benefits

A) Governmental Accounting Standards Board

Which ACA program penalizes hospitals for excessive readmissions?
A) Hospital Readmissions Reduction Program (HRRP)
B) Medicaid Penalty Plan
C) Readmission Equity Act
D) Hospital Care Initiative

A) Hospital Readmissions Reduction Program (HRRP)

Which ACA rule allowed young adults to stay on their parents’ plans?
A) Dependent coverage up to age 26
B) Family health expansion rule
C) Premium assistance mandate
D) Youth coverage incentive

A) Dependent coverage up to age 26

What are Essential Health Benefits under the ACA?
A) Ten required categories of care like maternity, hospitalization, and mental health
B) Optional coverage employers may add
C) Benefits offered only to government employees
D) Out-of-pocket maximums set by the IRS

A) Ten required categories of care like maternity, hospitalization, and mental health

The ACA expanded Medicaid to cover which group?
A) Low-income adults up to 138% of the federal poverty level
B) Only pregnant women
C) Only individuals over 65
D) All part-time workers

A) Low-income adults up to 138% of the federal poverty level

What is the employer mandate under the ACA?
A) Employers with 50+ full-time employees must offer affordable health coverage
B) Employers must provide free healthcare
C) Employers must match employee insurance payments
D) Small businesses must offer health plans

A) Employers with 50+ full-time employees must offer affordable health coverage

What did the ACA’s individual mandate require?
A) Most Americans to have health insurance or pay a penalty
B) Employers to provide insurance for all workers
C) Medicaid to cover all U.S. citizens
D) Employers to pay a healthcare tax

A) Most Americans to have health insurance or pay a penalty

What was a major problem identified with MHPA parity standards?
A) Insurers often failed to apply equal standards for mental health benefits
B) Employers were fined for overcoverage
C) Employees refused to use mental health benefits
D) It eliminated mental health coverage entirely

A) Insurers often failed to apply equal standards for mental health benefits

Which law faced enforcement issues due to limited awareness among employees?
A) Newborns’ and Mothers’ Health Protection Act
B) HIPAA
C) EGTRRA
D) ACA

A) Newborns’ and Mothers’ Health Protection Act

A key challenge with ERISA (1974) is that:
A) It doesn’t require employers to offer benefits
B) It mandates equal benefits for all workers
C) It limits pension contributions
D) It bans private insurance plans

A) It doesn’t require employers to offer benefits

The Tax Cuts and Jobs Act (TCJA) of 2017 impacted healthcare by:
A) Reducing the individual mandate penalty to $0
B) Expanding Medicaid eligibility
C) Requiring all employers to offer paid sick leave
D) Increasing subsidies for private insurance

A) Reducing the individual mandate penalty to $0

The Affordable Care Act (ACA) of 2010 was designed to:
A) Expand access to insurance, improve care quality, and reduce costs
B) Replace employer-sponsored insurance entirely
C) Create universal healthcare under Medicare
D) Privatize Medicaid

A) Expand access to insurance, improve care quality, and reduce costs

The Economic Growth and Tax Relief Reconciliation Act (EGTRRA) of 2001 focused on:
A) Increasing retirement contribution limits to boost savings
B) Reducing healthcare costs through employer mandates
C) Expanding Medicaid coverage
D) Repealing the ACA individual mandate

A) Increasing retirement contribution limits to boost savings

The Women’s Health and Cancer Rights Act (WHCRA) of 1998 ensures:
A) Coverage for breast reconstruction and related treatments after mastectomy
B) Free annual mammograms for all women
C) Paid maternity leave for new mothers
D) Coverage for prenatal vitamins

A) Coverage for breast reconstruction and related treatments after mastectomy

The Health Insurance Portability and Accountability Act (HIPAA) of 1996 primarily focuses on:
A) Protecting medical privacy and ensuring insurance continuity
B) Reducing healthcare costs for employers
C) Setting retirement contribution limits
D) Requiring all citizens to have insurance

A) Protecting medical privacy and ensuring insurance continuity

The Mental Health Parity Act (MHPA) of 1996 required what?
A) Equal annual or lifetime dollar limits for mental health and medical benefits
B) Free mental health coverage for all employees
C) Coverage only for inpatient mental health services
D) Elimination of mental health copays

A) Equal annual or lifetime dollar limits for mental health and medical benefits