Colorado Health Insurance Exam | Questions and Verified
Answers | 100% Correct (Latest Update ) - 147
Questions and Answers Already Graded A+ Premium Exam
Tested And Verified
Subject Area Colorado Health Insurance Exam | Questions and Verified Answers | 100%
Correct (Latest Update )
Description Comprehensive examination on Colorado Health Insurance Exam | Questions and
Verified Answers | 100% Correct (Latest Update ).
Expected Grade A+
Total Questions 147
Duration 3 hours
Learning Outcomes 1. Demonstrate mastery of core concepts
Accreditation Aligned with US university standards.
Page 1
,1. A Colorado resident enrolls in a Silver plan on the individual market. The
plan has a $4,500 deductible and a $7,900 out-of-pocket maximum. The
resident qualifies for cost-sharing reductions (CSR) due to income between
150-200% of FPL. Which of the following best describes the impact of CSR on
the plan's actuarial value and cost-sharing structure?
Answer: The actuarial value increases to at least 87%, and the deductible and
out-of-pocket maximum are reduced.
CSR only applies to Silver plans for eligible individuals (100-250% FPL). For
150-200% FPL, the actuarial value increases from 70% (standard Silver) to at
least 87%, and cost-sharing like deductible and OOP max are reduced. Option B
is incorrect because 94% applies to lower incomes (100-150% FPL). Option C is
false; the plan tier does not change. Option D is false as CSR specifically applies
to Silver plans.
2. Under Colorado's Medicaid expansion (Health First Colorado), which of the
following individuals is eligible solely due to expansion criteria, assuming no
other categorical eligibility?
Answer: A single adult with annual income at 138% of the federal poverty
level.
Medicaid expansion covers non-disabled, non-elderly adults with income up to
138% FPL regardless of other categories. Option B qualifies for
pregnancy-related coverage through separate programs, not solely expansion.
Option C: parents in Colorado have pre-expansion limits below 150% FPL, but
expansion covers parents up to 138% FPL; 150% exceeds the expansion
threshold. Option D: children up to 260% FPL qualify for CHP+, not expansion.
3. An employee covered by a group health plan in Colorado loses coverage due
to a reduction in work hours from 40 to 30 per week (not a termination). The
employee is now eligible for COBRA continuation coverage. For how many
months must the employee be offered COBRA coverage under federal law?
Answer: 18 months
Reduction in hours is a qualifying event for COBRA, entitling the employee to 18
months of continuation coverage. Option B (29 months) applies if a disability
extension is granted. Option C (36 months) is for certain events like death or
divorce of the covered employee. Option D (60 months) is not a standard COBRA
duration.
Page 2
,4. Which of the following services is NOT considered an essential health benefit
under the Affordable Care Act, and therefore may be excluded from individual
and small group plans sold on Colorado's exchange?
Answer: Long-term nursing home care (custodial care).
Essential health benefits include ten categories: hospitalization, prescription
drugs, pediatric services (including oral and vision), etc. Long-term custodial
care (nursing home care for daily living) is not an EHB; it is often covered by
Medicaid or long-term care insurance. Options A, B, and D are explicitly
included as EHBs.
5. Colorado's Division of Insurance enforces network adequacy standards for
health plans. A carrier proposes a new HMO plan in a rural county. Which of
the following is a true requirement regarding access to certain provider types?
Answer: The plan must include at least one hospital and one primary care
provider within 30 minutes travel time for 90% of enrollees.
Colorado has specific time/distance standards for various provider types; for
primary care and hospitals, the standard is typically 30 minutes/30 miles for 90%
of enrollees. Option B is too broad; specialist standards vary. Option C is false;
standards apply to all fully insured plans. Option D is false; telehealth can count
if appropriate.
6. A Colorado health plan uses a four-tier formulary: Tier 1 (generic), Tier 2
(preferred brand), Tier 3 (non-preferred brand), Tier 4 (specialty). An
enrollee's physician prescribes a brand-name drug that is on Tier 3. The
enrollee fails the required step therapy for the Tier 1 alternative. Which of the
following correctly describes the plan's obligation under Colorado law or
ACA?
Answer: The plan must provide an exception process allowing the enrollee to
obtain the drug at the Tier 2 cost-sharing if medical necessity is shown.
ACA and Colorado law require plans to have a formulary exception process that
allows enrollees to obtain non-preferred drugs at a lower tier cost-sharing when
medical necessity is demonstrated. While step therapy must be followed, after
failure, an exception can be granted. Option A is not automatic; option C is
incorrect; option D is too restrictive as step therapy may already have been tried.
Page 3
, 7. A Colorado couple expects a combined household income of $55,000 in 2025
for a family of three. The second-lowest-cost Silver plan (SLCSP) premium for
their rating area is $14,000 annually. The applicable percentage for their
income bracket is 8.5% of income. What is their maximum premium tax credit
(PTC)?
Answer: $9,325
The PTC is calculated as SLCSP premium minus (income × applicable
percentage). Income is $55,000, and 8.5% of that is $4,675. So PTC = $14,000 -
$4,675 = $9,325. Option A is incorrect; option B is just 8.5% of income; option D
is the full premium.
8. An employer in Colorado maintained a group health plan that was in effect
on March 23, 2010, and has made none of the changes that would cause it to
lose grandfathered status. In 2025, the employer wants to increase the
employee contribution for dependent coverage. Which of the following changes
would cause the plan to lose grandfathered status?
Answer: Increasing the employee contribution rate for dependent coverage
by 5 percentage points above the rate of medical inflation.
To maintain grandfathered status, a plan cannot increase employee contribution
rates beyond the maximum percentage increase (medical inflation plus 5
percentage points). Option A exceeds this threshold. Options B and C are
permissible changes. Option D: deductible increases up to the maximum
percentage increase plus 15 percentage points are allowed, so this is permissible.
9. An individual with a history of hypertension applies for an individual health
plan during the open enrollment period in Colorado. The insurer is allowed to
vary the premium based on which of the following factors?
Answer: Age, tobacco use, and geographic area
Under the ACA, community rating rules in Colorado allow insurers to vary
premiums only by age (limited to 3:1 ratio), tobacco use (1.5:1 ratio), and
geographic area. Gender and health status (including pre-existing conditions)
cannot be used as rating factors.
Page 4
Answers | 100% Correct (Latest Update ) - 147
Questions and Answers Already Graded A+ Premium Exam
Tested And Verified
Subject Area Colorado Health Insurance Exam | Questions and Verified Answers | 100%
Correct (Latest Update )
Description Comprehensive examination on Colorado Health Insurance Exam | Questions and
Verified Answers | 100% Correct (Latest Update ).
Expected Grade A+
Total Questions 147
Duration 3 hours
Learning Outcomes 1. Demonstrate mastery of core concepts
Accreditation Aligned with US university standards.
Page 1
,1. A Colorado resident enrolls in a Silver plan on the individual market. The
plan has a $4,500 deductible and a $7,900 out-of-pocket maximum. The
resident qualifies for cost-sharing reductions (CSR) due to income between
150-200% of FPL. Which of the following best describes the impact of CSR on
the plan's actuarial value and cost-sharing structure?
Answer: The actuarial value increases to at least 87%, and the deductible and
out-of-pocket maximum are reduced.
CSR only applies to Silver plans for eligible individuals (100-250% FPL). For
150-200% FPL, the actuarial value increases from 70% (standard Silver) to at
least 87%, and cost-sharing like deductible and OOP max are reduced. Option B
is incorrect because 94% applies to lower incomes (100-150% FPL). Option C is
false; the plan tier does not change. Option D is false as CSR specifically applies
to Silver plans.
2. Under Colorado's Medicaid expansion (Health First Colorado), which of the
following individuals is eligible solely due to expansion criteria, assuming no
other categorical eligibility?
Answer: A single adult with annual income at 138% of the federal poverty
level.
Medicaid expansion covers non-disabled, non-elderly adults with income up to
138% FPL regardless of other categories. Option B qualifies for
pregnancy-related coverage through separate programs, not solely expansion.
Option C: parents in Colorado have pre-expansion limits below 150% FPL, but
expansion covers parents up to 138% FPL; 150% exceeds the expansion
threshold. Option D: children up to 260% FPL qualify for CHP+, not expansion.
3. An employee covered by a group health plan in Colorado loses coverage due
to a reduction in work hours from 40 to 30 per week (not a termination). The
employee is now eligible for COBRA continuation coverage. For how many
months must the employee be offered COBRA coverage under federal law?
Answer: 18 months
Reduction in hours is a qualifying event for COBRA, entitling the employee to 18
months of continuation coverage. Option B (29 months) applies if a disability
extension is granted. Option C (36 months) is for certain events like death or
divorce of the covered employee. Option D (60 months) is not a standard COBRA
duration.
Page 2
,4. Which of the following services is NOT considered an essential health benefit
under the Affordable Care Act, and therefore may be excluded from individual
and small group plans sold on Colorado's exchange?
Answer: Long-term nursing home care (custodial care).
Essential health benefits include ten categories: hospitalization, prescription
drugs, pediatric services (including oral and vision), etc. Long-term custodial
care (nursing home care for daily living) is not an EHB; it is often covered by
Medicaid or long-term care insurance. Options A, B, and D are explicitly
included as EHBs.
5. Colorado's Division of Insurance enforces network adequacy standards for
health plans. A carrier proposes a new HMO plan in a rural county. Which of
the following is a true requirement regarding access to certain provider types?
Answer: The plan must include at least one hospital and one primary care
provider within 30 minutes travel time for 90% of enrollees.
Colorado has specific time/distance standards for various provider types; for
primary care and hospitals, the standard is typically 30 minutes/30 miles for 90%
of enrollees. Option B is too broad; specialist standards vary. Option C is false;
standards apply to all fully insured plans. Option D is false; telehealth can count
if appropriate.
6. A Colorado health plan uses a four-tier formulary: Tier 1 (generic), Tier 2
(preferred brand), Tier 3 (non-preferred brand), Tier 4 (specialty). An
enrollee's physician prescribes a brand-name drug that is on Tier 3. The
enrollee fails the required step therapy for the Tier 1 alternative. Which of the
following correctly describes the plan's obligation under Colorado law or
ACA?
Answer: The plan must provide an exception process allowing the enrollee to
obtain the drug at the Tier 2 cost-sharing if medical necessity is shown.
ACA and Colorado law require plans to have a formulary exception process that
allows enrollees to obtain non-preferred drugs at a lower tier cost-sharing when
medical necessity is demonstrated. While step therapy must be followed, after
failure, an exception can be granted. Option A is not automatic; option C is
incorrect; option D is too restrictive as step therapy may already have been tried.
Page 3
, 7. A Colorado couple expects a combined household income of $55,000 in 2025
for a family of three. The second-lowest-cost Silver plan (SLCSP) premium for
their rating area is $14,000 annually. The applicable percentage for their
income bracket is 8.5% of income. What is their maximum premium tax credit
(PTC)?
Answer: $9,325
The PTC is calculated as SLCSP premium minus (income × applicable
percentage). Income is $55,000, and 8.5% of that is $4,675. So PTC = $14,000 -
$4,675 = $9,325. Option A is incorrect; option B is just 8.5% of income; option D
is the full premium.
8. An employer in Colorado maintained a group health plan that was in effect
on March 23, 2010, and has made none of the changes that would cause it to
lose grandfathered status. In 2025, the employer wants to increase the
employee contribution for dependent coverage. Which of the following changes
would cause the plan to lose grandfathered status?
Answer: Increasing the employee contribution rate for dependent coverage
by 5 percentage points above the rate of medical inflation.
To maintain grandfathered status, a plan cannot increase employee contribution
rates beyond the maximum percentage increase (medical inflation plus 5
percentage points). Option A exceeds this threshold. Options B and C are
permissible changes. Option D: deductible increases up to the maximum
percentage increase plus 15 percentage points are allowed, so this is permissible.
9. An individual with a history of hypertension applies for an individual health
plan during the open enrollment period in Colorado. The insurer is allowed to
vary the premium based on which of the following factors?
Answer: Age, tobacco use, and geographic area
Under the ACA, community rating rules in Colorado allow insurers to vary
premiums only by age (limited to 3:1 ratio), tobacco use (1.5:1 ratio), and
geographic area. Gender and health status (including pre-existing conditions)
cannot be used as rating factors.
Page 4
