FFM PLAN YEAR 2024 ASSISTING CONSUMERS AFTER ENROLLMENT
When care cthe cfirst cmonth's cpremium cdue? c- ccorrect canswers✔✔issuers cset cthe
cdeadlines cfor cpayment cof cthe cfirst cmonth's cpremium
QHP cIssuer cprovides can cenrollment cinformation cpacket cbefore cor cafter cthe cfirst
cmonths cpremium cis cpaid c- ccorrect canswers✔✔After
You care cassisting cclients cwith cenrollment cduring cthe cOpen cEnrollment cPeriod
c(OEP). cYou cwant cto csend ceach cof cthem can cemail cto cremind cthem cto cmake ctheir
cbinder cpayments con cthe cearliest cpossible cdeadline. cWhat cis cthe cearliest cpossible
cpayment cdeadline cdate cto cinclude cin cyour cclient creminder cemails?
December c15
December c31
January c1
January c31 c- ccorrect canswers✔✔January c1
Consumers care crequired cto creport cany cchanges cto ctheir capplication cinformation
cwithin c30,60,90 cdays cof cthe cchange cin corder cto creceive can cupdated celigibility
cdetermination. c- ccorrect canswers✔✔30
When ca cconsumer cwho cyou cpreviously cassisted cuses cany cof cthese cmethods cto
cupdate ctheir capplication cduring cthe cyear, cyour cNational cProducer cNumber c(NPN)
cwill cbe cremoved cfrom cthe capplication. cTrue cor cFalse c- ccorrect canswers✔✔False
True cor cfalse: cIf ca cconsumer cmakes ca cQHP cchange cto ca cdifferent cQHP cissuer
cbefore cthe ccoverage ceffective cdate c(and cbefore cthe cDecember c15 cdeadline), cbut
cafter cmaking ctheir cinitial cbinder cpayment, cthe cinitial cQHP cissuer cis cresponsible cfor
crefunding cthe cpremium cfor cJanuary.
True cor cFalse c- ccorrect canswers✔✔True
Policy ceffective cdates cof cSEP cfor cPast closs cof cqualifying chealth ccoverage cis c-
ccorrect canswers✔✔Up cto c60 cdays cin cthe cpast
Policy ceffective cdates cof cSEP cfor cfuture closs cof cqualifying chealth ccoverage cis c-
ccorrect canswers✔✔Up cto c60 cdays cin cthe cfuture
Scenario: cA cconsumer cmoved cto ca cnew cstate clast cweek. cSelect cthe ccorrect
ccoverage ceffective cdate.
Retroactive cto cwhen cthe cchild cwas cborn
c
, First cday cof cthe cnext cmonth cfollowing cthe clast cday cof ccoverage
c
First cday cof cthe cnext cmonth c- ccorrect canswers✔✔First cday cof cthe cnext cmonth
Scenario: cA cconsumer chad ca cchild clast cmonth. cSelect cthe ccorrect ccoverage
ceffective cdate.
Retroactive cto cwhen cthe cchild cwas cborn
First cday cof cthe cnext cmonth cfollowing cthe clast cday cof ccoverage
First cday cof cthe cnext cmonth c- ccorrect canswers✔✔Retroactive cto cwhen cthe cchild
cwas cborn
Scenario: cA cconsumer cwill cbe closing cminimum cessential ccoverage c(MEC) cnext
cmonth. cSelect cthe ccorrect ccoverage ceffective cdate.
Retroactive cto cwhen cthe cchild cwas cborn
First cday cof cthe cnext cmonth cfollowing cthe clast cday cof ccoverage
First cday cof cthe cnext cmonth c- ccorrect canswers✔✔First cday cof cthe cnext cmonth
cfollowing cthe clast cday cof ccoverage
Consumers ccan cfile can cappeal cof ca cMarketplace celigibility cdetermination conline, cby:
mail
fax
both c- ccorrect canswers✔✔Both
Appeal crequests cmust cbe csubmitted cwithin c___ cdays cof cthe ccontested celigibility
cdetermination, cunless cthe cconsumer cdemonstrates cthat ctheir cfailure cto csubmit cthe
cappeal con ca ctimely cbasis cwas cdue cto cexceptional ccircumstances cand cshould cnot
cpreclude cthe cappeal. c- ccorrect canswers✔✔90 cdays
In corder cto ccomplete can cappeal cfor ca cconsumer cyou cwill cneed cto ccomplete can
cauthorization cform c"Appoint cauthorized cRepresentative". c
True cor cFalse c- ccorrect canswers✔✔True
You chelp cyour cclient, cMaria, capply cfor cMarketplace ccoverage, cbut cshe cdisagrees
cwith cthe celigibility cdetermination cshe creceived cfrom cthe cMarketplace. cShe casks
cyou cto cassist cher cwith cfiling can cappeal conline cthrough cHealthCare.gov cand
cappoints cyou cas can cauthorized crepresentative cso cyou ccan cfile cthe cappeal con cher
cbehalf. cIf cthe cMarketplace cAppeals cCenter cfinds cthat cher cdetermination cwas
cincorrect, cwhat ccould chappen cnext? cSelect call cthat capply.
1. cThe cMarketplace cplan cmay cowe cMaria ca crefund cif cshe cpaid cpremiums cto cthe
cplan cbefore cthe cappeal cwas cdecided
2. cMaria cmay cneed cto cpay cthe cMarketplace cfor cthe ccost cof cfiling cthe cappeal
When care cthe cfirst cmonth's cpremium cdue? c- ccorrect canswers✔✔issuers cset cthe
cdeadlines cfor cpayment cof cthe cfirst cmonth's cpremium
QHP cIssuer cprovides can cenrollment cinformation cpacket cbefore cor cafter cthe cfirst
cmonths cpremium cis cpaid c- ccorrect canswers✔✔After
You care cassisting cclients cwith cenrollment cduring cthe cOpen cEnrollment cPeriod
c(OEP). cYou cwant cto csend ceach cof cthem can cemail cto cremind cthem cto cmake ctheir
cbinder cpayments con cthe cearliest cpossible cdeadline. cWhat cis cthe cearliest cpossible
cpayment cdeadline cdate cto cinclude cin cyour cclient creminder cemails?
December c15
December c31
January c1
January c31 c- ccorrect canswers✔✔January c1
Consumers care crequired cto creport cany cchanges cto ctheir capplication cinformation
cwithin c30,60,90 cdays cof cthe cchange cin corder cto creceive can cupdated celigibility
cdetermination. c- ccorrect canswers✔✔30
When ca cconsumer cwho cyou cpreviously cassisted cuses cany cof cthese cmethods cto
cupdate ctheir capplication cduring cthe cyear, cyour cNational cProducer cNumber c(NPN)
cwill cbe cremoved cfrom cthe capplication. cTrue cor cFalse c- ccorrect canswers✔✔False
True cor cfalse: cIf ca cconsumer cmakes ca cQHP cchange cto ca cdifferent cQHP cissuer
cbefore cthe ccoverage ceffective cdate c(and cbefore cthe cDecember c15 cdeadline), cbut
cafter cmaking ctheir cinitial cbinder cpayment, cthe cinitial cQHP cissuer cis cresponsible cfor
crefunding cthe cpremium cfor cJanuary.
True cor cFalse c- ccorrect canswers✔✔True
Policy ceffective cdates cof cSEP cfor cPast closs cof cqualifying chealth ccoverage cis c-
ccorrect canswers✔✔Up cto c60 cdays cin cthe cpast
Policy ceffective cdates cof cSEP cfor cfuture closs cof cqualifying chealth ccoverage cis c-
ccorrect canswers✔✔Up cto c60 cdays cin cthe cfuture
Scenario: cA cconsumer cmoved cto ca cnew cstate clast cweek. cSelect cthe ccorrect
ccoverage ceffective cdate.
Retroactive cto cwhen cthe cchild cwas cborn
c
, First cday cof cthe cnext cmonth cfollowing cthe clast cday cof ccoverage
c
First cday cof cthe cnext cmonth c- ccorrect canswers✔✔First cday cof cthe cnext cmonth
Scenario: cA cconsumer chad ca cchild clast cmonth. cSelect cthe ccorrect ccoverage
ceffective cdate.
Retroactive cto cwhen cthe cchild cwas cborn
First cday cof cthe cnext cmonth cfollowing cthe clast cday cof ccoverage
First cday cof cthe cnext cmonth c- ccorrect canswers✔✔Retroactive cto cwhen cthe cchild
cwas cborn
Scenario: cA cconsumer cwill cbe closing cminimum cessential ccoverage c(MEC) cnext
cmonth. cSelect cthe ccorrect ccoverage ceffective cdate.
Retroactive cto cwhen cthe cchild cwas cborn
First cday cof cthe cnext cmonth cfollowing cthe clast cday cof ccoverage
First cday cof cthe cnext cmonth c- ccorrect canswers✔✔First cday cof cthe cnext cmonth
cfollowing cthe clast cday cof ccoverage
Consumers ccan cfile can cappeal cof ca cMarketplace celigibility cdetermination conline, cby:
fax
both c- ccorrect canswers✔✔Both
Appeal crequests cmust cbe csubmitted cwithin c___ cdays cof cthe ccontested celigibility
cdetermination, cunless cthe cconsumer cdemonstrates cthat ctheir cfailure cto csubmit cthe
cappeal con ca ctimely cbasis cwas cdue cto cexceptional ccircumstances cand cshould cnot
cpreclude cthe cappeal. c- ccorrect canswers✔✔90 cdays
In corder cto ccomplete can cappeal cfor ca cconsumer cyou cwill cneed cto ccomplete can
cauthorization cform c"Appoint cauthorized cRepresentative". c
True cor cFalse c- ccorrect canswers✔✔True
You chelp cyour cclient, cMaria, capply cfor cMarketplace ccoverage, cbut cshe cdisagrees
cwith cthe celigibility cdetermination cshe creceived cfrom cthe cMarketplace. cShe casks
cyou cto cassist cher cwith cfiling can cappeal conline cthrough cHealthCare.gov cand
cappoints cyou cas can cauthorized crepresentative cso cyou ccan cfile cthe cappeal con cher
cbehalf. cIf cthe cMarketplace cAppeals cCenter cfinds cthat cher cdetermination cwas
cincorrect, cwhat ccould chappen cnext? cSelect call cthat capply.
1. cThe cMarketplace cplan cmay cowe cMaria ca crefund cif cshe cpaid cpremiums cto cthe
cplan cbefore cthe cappeal cwas cdecided
2. cMaria cmay cneed cto cpay cthe cMarketplace cfor cthe ccost cof cfiling cthe cappeal
