ACA TEST PAPER ALL ANSWERS AND QUESTIONS
SET A+
✔✔Stand Alone Dental Plan - ✔✔Adult dental is not an EHB but can be purchased as
stand alone dental plan through marketplaces.
✔✔Five Levels of Coverage - ✔✔The five levels of generosity are called catastrophic,
bronze, silver, gold, and platinum in ascending order of generosity. These levels,
sometimes referred to as "metal levels" provide several benefits:
Help consumers, and the agents and brokers who assist those consumers, in
comparing coverage options to determine which plans best fit the consumers' needs
Help consumers understand their benefits and the cost of services once they enroll
Facilitate consumer choice based on specific value comparisons
QHP issuers do not have to offer plans in all five levels. However, each QHP issuer
must offer a silver and a gold QHP in a Marketplace. These requirements begin on
January 1, 2014.
✔✔Catastrophic Plans - ✔✔Are offered in the Individual Marketplace and cover EHB.
They provide affordable coverage options for young adults and people for whom
coverage would otherwise be unaffordable.
Catastrophic plan enrollees pay higher deductibles than enrollees in bronze, silver, gold,
or platinum plans. However, catastrophic plans have several benefits:
Lower premiums on average than bronze, silver, gold, or platinum plans
Protection against out-of-pocket costs above $6,350 for an individual and $12,700 for a
family
Coverage of recommended preventive services without cost sharing
Eligibility for catastrophic plans is limited to:
Individuals under age 30
, Individuals who otherwise do not have an affordable coverage option, or who otherwise
qualify for a hardship exemption to the minimum essential coverage rule
✔✔Out-of-Pocket Limits - ✔✔All QHPs must limit cost sharing for enrolled individuals in
the following ways:
Deductibles and copays cannot be applied to preventive services.
Deductibles for small group plans cannot exceed $2,000 for self-only coverage or
$4,000 for any other coverage (adjusted annually), except to the extent that a higher
deductible is necessary to create a reasonable bronze or silver plan.
Annual cost-sharing limits cannot exceed the limits for certain high deductible health
plans including catastrophic plans. (For 2014 the limits are $6,350 for an individual and
$12,700 for families enrolled in individual market plans.)
✔✔Minimum Essential Coverage - ✔✔Beginning January 1, 2014, individuals not
eligible for an exemption are required to demonstrate that they maintain minimum
essential coverage or make a payment when filing their federal income tax return.
Coverage purchased in the individual market including a Federally-facilitated
Marketplace, as well as coverage under government programs such as Medicare,
Medicaid, CHIP, and TRICARE, and coverage under an employer-sponsored plan,
meet the requirements.
✔✔Network Adequacy Standards - ✔✔Offer a network with a sufficient number of
providers, including mental health and substance abuse providers, to ensure access to
all services without unreasonable delay; and
In addition to the overall network adequacy requirement, a QHP's network must include
a sufficient number and geographic distribution of essential community providers to
ensure reasonable and timely access to care for low-income and medically-underserved
populations in the QHP's service area.
✔✔Effective rate Review - ✔✔The Department of Health and Human Services (HHS)
(through CMS) works with states to ensure that all proposed rate increases in the
individual and small group markets are thoroughly reviewed. The Affordable Care Act
sets minimum standards for the review of these proposed increases, called effective
rate review standards. If a state lacks the resources or authority to meet these
standards and conduct the needed reviews, HHS conducts the rate review while
continuing to make resources available to states to strengthen their rate review process.
✔✔Actuarial Value - ✔✔Is a measure of EHB coverage established to be paid by the
QHP issuer for a standard population expressed in percentages. The higher the AV the
more the enrollee will pay in premium costs and less in out of pocket limit.
✔✔Catastrophic - ✔✔Offers a level of coverage that doesn't meet specific AV but must
comply with maximum out of pocket limit
SET A+
✔✔Stand Alone Dental Plan - ✔✔Adult dental is not an EHB but can be purchased as
stand alone dental plan through marketplaces.
✔✔Five Levels of Coverage - ✔✔The five levels of generosity are called catastrophic,
bronze, silver, gold, and platinum in ascending order of generosity. These levels,
sometimes referred to as "metal levels" provide several benefits:
Help consumers, and the agents and brokers who assist those consumers, in
comparing coverage options to determine which plans best fit the consumers' needs
Help consumers understand their benefits and the cost of services once they enroll
Facilitate consumer choice based on specific value comparisons
QHP issuers do not have to offer plans in all five levels. However, each QHP issuer
must offer a silver and a gold QHP in a Marketplace. These requirements begin on
January 1, 2014.
✔✔Catastrophic Plans - ✔✔Are offered in the Individual Marketplace and cover EHB.
They provide affordable coverage options for young adults and people for whom
coverage would otherwise be unaffordable.
Catastrophic plan enrollees pay higher deductibles than enrollees in bronze, silver, gold,
or platinum plans. However, catastrophic plans have several benefits:
Lower premiums on average than bronze, silver, gold, or platinum plans
Protection against out-of-pocket costs above $6,350 for an individual and $12,700 for a
family
Coverage of recommended preventive services without cost sharing
Eligibility for catastrophic plans is limited to:
Individuals under age 30
, Individuals who otherwise do not have an affordable coverage option, or who otherwise
qualify for a hardship exemption to the minimum essential coverage rule
✔✔Out-of-Pocket Limits - ✔✔All QHPs must limit cost sharing for enrolled individuals in
the following ways:
Deductibles and copays cannot be applied to preventive services.
Deductibles for small group plans cannot exceed $2,000 for self-only coverage or
$4,000 for any other coverage (adjusted annually), except to the extent that a higher
deductible is necessary to create a reasonable bronze or silver plan.
Annual cost-sharing limits cannot exceed the limits for certain high deductible health
plans including catastrophic plans. (For 2014 the limits are $6,350 for an individual and
$12,700 for families enrolled in individual market plans.)
✔✔Minimum Essential Coverage - ✔✔Beginning January 1, 2014, individuals not
eligible for an exemption are required to demonstrate that they maintain minimum
essential coverage or make a payment when filing their federal income tax return.
Coverage purchased in the individual market including a Federally-facilitated
Marketplace, as well as coverage under government programs such as Medicare,
Medicaid, CHIP, and TRICARE, and coverage under an employer-sponsored plan,
meet the requirements.
✔✔Network Adequacy Standards - ✔✔Offer a network with a sufficient number of
providers, including mental health and substance abuse providers, to ensure access to
all services without unreasonable delay; and
In addition to the overall network adequacy requirement, a QHP's network must include
a sufficient number and geographic distribution of essential community providers to
ensure reasonable and timely access to care for low-income and medically-underserved
populations in the QHP's service area.
✔✔Effective rate Review - ✔✔The Department of Health and Human Services (HHS)
(through CMS) works with states to ensure that all proposed rate increases in the
individual and small group markets are thoroughly reviewed. The Affordable Care Act
sets minimum standards for the review of these proposed increases, called effective
rate review standards. If a state lacks the resources or authority to meet these
standards and conduct the needed reviews, HHS conducts the rate review while
continuing to make resources available to states to strengthen their rate review process.
✔✔Actuarial Value - ✔✔Is a measure of EHB coverage established to be paid by the
QHP issuer for a standard population expressed in percentages. The higher the AV the
more the enrollee will pay in premium costs and less in out of pocket limit.
✔✔Catastrophic - ✔✔Offers a level of coverage that doesn't meet specific AV but must
comply with maximum out of pocket limit
