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Question ID 17130

Regulatory and legislative bodies are among the important environmental forces in the
health plan industry. The following statements are about such regulation and legislation.
Select the answer choice that contains the correct statement.

Option A

Federal guidelines exist to direct health plans on compliance issues when a health plan encounters conflicting state laws in a given service area.

Option B

 Administrative rules and regulations do not carry the force of law.

Option C

As stakeholders in the health plan industry, federal and state governments exert tremendous influence over a health plan's formation and operations.

Option D

In recent years, the number of health plan bills in the state and the federal legislatures has decreased.

Correct Answer C
Explanation


Question ID 17131

The following statements are about the Federal Employees Health Benefits Program
(FEHBP), which is administered by the Office of Personnel Management (OPM). Three of
the statements are true and one statement is false. Select the answer choice that contains
the FALSE statement.

Option A

For every plan in the FEHBP, OPM annually determines the lowest premium that is actuarially sound and then negotiates with each plan to establish that premium rate.

Option B

Once a health plan has submitted its rate proposals for a contract year to the OPM, it cannot adjust its premium rate for any reason.

Option C

To cover its administrative costs, OPM sets aside 1% of all FEHBP premiums.

Option D

Each spring, OPM sends all plan providers its call letter, a document that specifies the kinds of benefits that must be available to plan participants and cost goals and procedural changes that the plans need to adopt.

Correct Answer A
Explanation

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