LLQP Accident & Sickness · Component 2.1 · 30% of the exam
An extended health plan's drug benefit administered through a 'managed formulary' means:
- AThe plan pays for drugs only after the provincial program has refused to cover them
- BEvery prescription drug approved for sale in Canada is reimbursed at the same rate
- The plan reimburses only listed drugs, with an appeal route for exceptional cases
- DThe member must use a single pharmacy chain designated by the plan sponsor
Correct answer: C) The plan reimburses only listed drugs, with an appeal route for exceptional cases
A managed formulary controls cost by limiting the list of reimbursed drugs and directing members to therapeutic alternatives, with exceptions handled through a prior authorization process.
Why the other options are wrong
- APrivate plans pay alongside provincial programs rather than after a refusal.
- BAn open formulary would defeat the cost control the design exists to provide.
- DPharmacy networks are a separate feature from the formulary.
Exam tip
Managed formulary means a list, with an appeal route.
Common mistake
Telling a member every prescribed drug will be reimbursed.
What this tests
CISRO competency component 2.1 — Analyze the available products that meet the client's needs — which is weighted at 30% of the Accident & Sickness module. Written against the published curriculum.
More from component 2
- A group benefits booklet lists AD&D coverage alongside life and LTD. The AD&D benefit pays:
- A hospital indemnity (hospital cash) policy pays:
- Employment Insurance sickness benefits are available to:
- Which government program coordinates with an individual DI policy through a possible offset AND also affects the definition of insurable income?
- A group plan's 'eligibility waiting period' (probationary period) is:
- A CI policy that is 'convertible' allows the insured to:
Practice the whole Accident & Sickness module
Timed sets weighted like the exam, and review of every question you miss. Free to start.