ACA Certification EXAM| 79 QUESTIONS| WITH COMPLETE SOLUTIONS

Young Adult Coverage Correct Answer: Under the Affordable Care Act, health plans that cover children must make coverage available to children up to age 26. Young adults can join or remain on a parent's plan even if they are: Married (coverage does not extend to married child's spouse) Not living with a parent Not attending school Not financially dependent on a parent Eligible to enroll in their employer's plan (starting in 2014) Guaranteed Issue Correct Answer: The Affordable Care Act requires health insurance issuers to offer all of their individual market and group market plans to any applicant in the state. It also requires health insurance issuers to accept any individual who applies for those policies, as long as the applicant agrees to the terms and conditions of the policy, including the payment of premiums. This provision is called "guaranteed issue." Guaranteed Renewability Correct Answer: Additionally, the Affordable Care Act requires health insurance issuers to offer to renew or continue in force coverage at the option of the policyholder. This is called "guaranteed renewability." Pre-existing Conditions Correct Answer: Effective for all health plans with plan years beginning on or after January 1, 2014, the Affordable Care Act prohibits health insurance issuers from limiting or excluding coverage related to pre-existing health conditions, regardless of the age of the covered individual. For persons under age 19, this provision became effective for policy years beginning on or after September 23, 2010. Generally, a pre-existing condition is any health condition or illness that was present before the coverage effective date, regardless of whether medical advice or treatment was actually received or recommended. Clinical Trials Correct Answer: The Affordable Care Act prohibits health insurance issuers from: Precluding participation of qualified individuals in an approved clinical trial Denying, limiting, or placing additional conditions on the coverage of routine patient costs for items and services furnished in connection with participation in an approved clinical trial Discriminating against qualified individuals on the basis of their participation in an approved clinical trial Medical Loss Ratio Correct Answer: Is a basic financial measurement that shows how much of the premium dollars a health insurance issuer spends on health care expenses, as opposed to profits or administrative costs. As of 2012, a health insurance issuer that does not spend enough