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>---------- End of the Test ----------<
1 2 3 4 5 6
B C C C A C
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Assignment 5: Fully Funded and Self-Funded Health Plans
Reading 5A: Health Plan Funding Distinguish between fully funded and self-funded health plans Identify and describe the two main types of self-funded health plans
Instructions:
1.
2.
Select or enter the best answer for each of the 3 questions. Answer all the questions. Remember to scroll down if necessary.
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1. The Poplar Company and a Blue Cross/Blue Shield organization have contracted to provide a typical fully funded health plan for Poplar's employees. One true statement about this health plan for Poplar's employees is that Poplar bears the entire financial risk if, during a given period, the dollar amount of services rendered to Poplar plan members exceeds the dollar amount of premiums collected for this health plan Poplar and the Blue Cross/Blue Shield organization share the financial risk of paying for claims under Poplar's health plan the Blue Cross/Blue Shield organization, upon acceptance of a premium, becomes the group plan sponsor for Poplar's health plan the Blue Cross/Blue Shield organization, upon acceptance of a premium, bears the entire financial risk of paying for the administrative expenses associated with health plan operations 2. The Kayak Company self funds the health plan for its employees. This plan is an example of a type of self-funded plan known as a general asset plan. The fact that this is a completely self-funded plan indicates that the plan has no funding vehicle Kayak passes to its employees the financial risk of providing healthcare coverage the plan most likely is exempt from ERISA requirements concerning the limits on benefit discrimination for classes of employees the plan is exempt from the state laws and regulations that apply to health insurance policies 3. The Kayak Company self funds the health plan for its employees. This plan is an example of a type of self-funded plan known as a general asset plan. Because Kayak's plan is a general asset plan, the funds that Kayak sets aside for the health plan are subject to the claims of Kayak's creditors
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available to Kayak solely for the purpose of paying for the healthcare expenses of Kayak's covered employees placed in a trust fund established by Kayak to pay for the health plan considered separate from Kayak's current operating funds
>---------- End of the Test ----------<
1 2 3
D D A
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Reading 5B: Alternative Funding Methods Distinguish between a contributory plan and a noncontributory plan
Describe the individual components of a premium, including the interest charge, the risk charge, and the retention charge List the key characteristics of premium-delay arrangements, reserve-reduction arrangements, minimum-premium plans, retrospective-rating arrangements, and administrative-services-only contracts
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2.
Select or enter the best answer for each of the 6 questions. Answer all the questions. Remember to scroll down if necessary.
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1. The methods of alternative funding for health coverage can be divided into the following general categories:
Category AThose methods that primarily modify traditional fully insured group insurance contracts Category BThose methods that have either partial or total selffunding
Go to question 2.
Typically, small employers are able to use some of the alternative funding methods in both Category A and Category B Category A only Category B only neither Category A nor Category B 2. Under the alternative funding method used by the Flair Company, Flair assumes financial responsibility for paying claims up to a specified level and deposits the funds necessary to pay these claims into a bank account that belongs to Flair. However, an insurer, which acts as an agent of Flair, makes the actual payment of claims from this account. When claims exceed the specified level, the insurer pays the balance from its own funds. No state premium tax is levied on the amounts that Flair deposits into this bank account. From the following answer choices, choose the name of the alternative funding method described. Retrospective-rating arrangement Premium-delay arrangement Reserve-reduction arrangement Minimum-premium plan
Go to question 3.
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3. Under the alternative funding method used by the Trilogy Company, the insurer charges Trilogy an initial premium that is based on the assumption that claims will be 93% of the expected claims for the year. If claims exceed 93% of expected claims, then Trilogy must reimburse the insurer for any additional claims paid, up to 112% of expected claims. The insurer bears the responsibility for paying claims in excess of 112% of expected claims. From the following answer choices, choose the name of the alternative funding method described. Retrospective-rating arrangement Premium-delay arrangement Reserve-reduction arrangement Minimum-premium plan 4. The purest form of a self-funded benefit plan is one in which the employer pays benefits from current revenue, administers all aspects of the plan, and bears the risk that actual benefit payments will exceed the expected amount of payments. A decision to use this kind of self-funding is generally considered most desirable when certain conditions are present. These conditions most likely include that the benefit plan is a contributory plan is subject to collective bargaining is unable to secure discounts from the physicians who provide medical services to the plan members has a relatively high frequency of low severity claims 5. The Harp Company self-funds the health plan for its employees. The plan is administered under a typical administrative-services-only (ASO) arrangement. One true statement about this ASO arrangement is that this arrangement prevents Harp from purchasing stop-loss coverage for its health plan the amount that Harp pays the administrator to provide the ASO services is not subject to state premium taxes the administrator is responsible for paying claims from its own assets if Harp's account is insufficient the charges for the ASO services must be stated as a percentage of the amount of claims paid for medical expenses incurred by Harp's covered employees and their dependents 6. The Jasmine Company, which self funds the health plan for its 200 employees, has established a 501(c)(9) trust as a means of addressing possible claims fluctuations under the health plan. This plan is not a part of a collective bargaining process. A potential disadvantage to Jasmine of using a 501(c)(9) trust is that the cost of maintaining the trust may be prohibitive to Jasmine
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the trust must always maintain enough assets to pay the health plan's claims that have been incurred but not yet paid Jasmine is prohibited from earning any return on the trust assets the contributions to this trust are not deductible for federal income tax purposes
>---------- End of the Test ----------<
1 2 3 4 5 6
C D A D B A
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>---------- End of the Test ----------<

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Assignment 5: Fully Funded and Self-Funded Health Plans

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