Indiana Navigator Exam Questions and
Answers
Auto Assignment - Correct Answers -the process by which an individual who does not
select a Hoosier Healthwise (HHW) or HIP Managed Care Entity (MCE) at the time of
the HHW or HIP application, or within 14 days of the submission of the application, is
automatically assigned to a Managed Care Entity (MCE)
Certificate of Coverage - Correct Answers -a list of benefits, services, cost sharing,
exclusions, and limits applied by a particular health insurance policy.
What is Cobra Insurance also known as? - Correct Answers -Consolidated Omnibus
Budget Reconciliation Act
COBRA Insurance - Correct Answers -a type of temporary health insurance coverage
authorized under federal law that may allow an individual to elect to keep their
insurance coverage if the individual's employment ends, loses coverage as a dependent
of the covered employee, or another qualifying event occurs.
What happens if an individual elects COBRA coverage? - Correct Answers -the
individual pays 100% of the premiums, including the share the employer used to pay,
plus a small administrative fee.
Coinsurance - Correct Answers -is a consumer's share/percentage of the cost of a
healthcare service, paid in addition to the deductible amount.
Consumer Directed Health Plan (CDHP) - Correct Answers -a health plan that has a
high deductible cost but often lower premiums. An individual with this plan is eligible for
a health savings account (HSA) to which the individual can contribute pre-tax dollars for
qualified healthcare expenses, which employers may also contribute to.
Dependent - Correct Answers -a child up to 26 years old under the Affordable Care Act
(ACA).
What is the abbreviation for Authorized Representative? - Correct Answers -AR
What is Consumer Directed Health Plan (CDHP) also known as? - Correct Answers -
High Deductible Health Plan (HDHP)
What organization is not required to cover services provided by out-of-network
providers? - Correct Answers -Health Maintenance Organization (HMO)
,What type of health plans does the pre-existing conditions rule not apply to? - Correct
Answers -Grandfathered health plans
The ACA requires plans and issuers that offer dependent coverage, to make the
coverage available until a child reaches 26 years old. What plans does this rule apply
to? - Correct Answers -plans in the individual market and to new employer plans. It also
applies to existing employer plans unless the adult child has another offer of employer-
based coverage (such as through the adult child's job).
Division of Family Resources (DFR) - Correct Answers -a division of the Indiana Family
and Social Services Administration (FSSA), which establishes eligibility for Medicaid,
HIP, the Supplemental Nutrition Assistance Program (SNAP - food assistance), and the
Temporary Assistance for Needy Families (TANF - cash assistance).
Explanation of Benefits (EOB) - Correct Answers -is a document that describes what an
insurer paid for a health service accessed by a consumer enrolled in one of the insurer's
health insurance policies, what the consumer paid and/or owes for the service, and a
summary of the consumer's remaining deductible and out-of-pocket maximum amounts.
Each time a health service is accessed by a consumer, the consumer will receive one of
these from their insurer.
Financial Interest - Correct Answers -is for purposes of the IDOI Conflict of Interest
Policy for Indiana Navigators and AOs, when an Indiana Navigator or AO will receive, or
may receive, any compensation or other financial arrangement or benefit, either directly
or indirectly, from a third party.
Flexible Spending Account (FSA) - Correct Answers -is a medical savings account that
allows an individual and the individual's employer to contribute pre-tax dollars towards
future medical costs. Funds in this account will expire at the end of the year.
Health Maintenance Organization (HMO) - Correct Answers -is a designation given to
health insurers offering products or services in any market segment (individual, small
group, large group, or self-insured) in order to also provide or arrange for the delivery of
health care services to enrollees on a prepaid basis. Individuals covered under this
organization will have a prescribed set of providers that may provide covered services.
Except for certain services, including emergency services.
Health Savings Account (HSA) - Correct Answers -is a medical savings account that
allows the individual and the individual's employer to contribute pre-tax dollars towards
the cost of future health costs. Dollars in this account do not expire and belong solely to
the individual (including the employer contribution)
What happens to an individual if they use the HSA funds for anything other than
qualified health care expenses? - Correct Answers -they must pay a penalty
,Navigator Designation Form - Correct Answers -is a form developed by the IDOI that
may be completed by insurance producers or consultants licensed in Indiana as part of
the initial Indiana Navigator certification application process, in place of the online new
or renewal application for Indiana Navigators.
Individual Market - Correct Answers -is the market for health insurance coverage
offered to individuals other than in connection with a group health plan.
In-Network Provider - Correct Answers -is a healthcare provider in a contract with an
insurer, agreeing to provide healthcare/medical services at a discounted rate in return
for access to a large group of insured individuals.
What is an Insurer also referred to as? - Correct Answers -health insurance issuer,
carrier, or company
Insurer - Correct Answers -for health insurance purposes, is an insurance company,
insurance service, or insurance organization, which has a certificate of authority to
engage in the business and sale of health insurance policies in a state and is subject to
state law which regulates insurance. This term may include an HMO.
Medical Review Team (MRT) - Correct Answers -is a group that determines a Medicaid
applicant's eligibility for Indiana Medicaid based on a disability. To meet the disability
requirement, a person must have a significant impairment that is expected to last a
minimum of 12 months. This team makes their determination and notifies the DFR of its
decision.
Medically Frail - Correct Answers -a term used to describe an individual who has one or
more of the following:
-Disabling mental disorder
-Chronic substance abuse disorder
-Serious and complex medical conditions
-Physical, intellectual, or developmental disability that significantly impair the individual's
ability to perform one or more activities of daily living
-Disability determination based on Social Security Administration (SSA) criteria.
Office of Medicad Policy and Planning (OMPP) - Correct Answers -a division of the
Indiana FSSA that administers Medicaid programs and performs medical review of
Medicaid disability claims.
Out-of-Network Provider - Correct Answers -is a healthcare provider that is not
contracted with a particular insurer to provide healthcare/medical services at a
discounted rate for consumers covered by the insurer.
How do you determine whether a provider is in-network or out-of-network with an
insurer? - Correct Answers -You can access a list of in-network providers through the
health insurer's website or by calling the health insurers consumer help desk.
, Some out-of-network providers may not accept an individual's health insurance, and
payment may be requested up front. What should the individual do in this case? -
Correct Answers -they may submit a form directly to their insurer showing what they
paid for the service. If this form is submitted, the amount the enrollee spent for covered
services will count toward the plan deductible and out-of-pocket maximum, and if the
enrollee has met the deductible the insurer may issue compensation.
Out-of-pocket Maximum - Correct Answers -(also referred to as Out-of-pocket Limit) is
the greatest amount that a consumer pays for healthcare services in any plan year
before the insurance carrier pays 100% of healthcare costs and is set by the IRS.
Partnership Marketplace - Correct Answers -(Also referred to as Partnership Exchange)
is a mix between the FFM and a State-based Marketplace, which allows a state to
assume primary responsibility for certain functions of the Federal Marketplace
permanently or as the state works toward operating a State-based Marketplace. These
functions may include, for example, plan management and/or consumer assistance and
outreach. Indiana does not follow this marketplace model, but rather operates as a
Federal Marketplace.
Pediatric - Correct Answers -refers to children under the age of nineteen. Under the
ACA, these healthcare services, including oral and vision care, are considered essential
health benefits (EHBs) that an insurance carrier in the individual and small group
markets are required to cover.
Policy Year - Correct Answers -is either: (1) the 12-month period that is designated as
the policy year in the policy documents of a grandfathered health plan offered in the
individual health insurance market. If there is no designation of a policy year in the
policy document (or no such policy document is available), then the policy year is the
deductible or limit year used under the coverage. If deductibles or other limits are not
imposed on a yearly basis, the policy year is the calendar year. Or (2) A calendar year
for a non-grandfathered health plan offered in the individual health insurance market, or
in a market in which the state has merged the individual and small group risk pools.
Pre-existing Condition - Correct Answers -is a health issue (such as cancer, diabetes,
asthma, etc.) that an individual has prior to obtaining health insurance.
Preferred Provider Organization (PPO) - Correct Answers -is a type of health plan that
contracts with certain providers (referred to as in "network providers"). Individuals may
choose to receive service from among the network providers or may choose to go to an
out-of-network provider and in general be subject to greater cost sharing.
Premium - Correct Answers -is the amount that a consumer must periodically pay to the
insurance carrier for a health insurance plan. Individuals pay the premium regardless of
whether or not they use the health insurance. It is meant to compensate the insurer for
Answers
Auto Assignment - Correct Answers -the process by which an individual who does not
select a Hoosier Healthwise (HHW) or HIP Managed Care Entity (MCE) at the time of
the HHW or HIP application, or within 14 days of the submission of the application, is
automatically assigned to a Managed Care Entity (MCE)
Certificate of Coverage - Correct Answers -a list of benefits, services, cost sharing,
exclusions, and limits applied by a particular health insurance policy.
What is Cobra Insurance also known as? - Correct Answers -Consolidated Omnibus
Budget Reconciliation Act
COBRA Insurance - Correct Answers -a type of temporary health insurance coverage
authorized under federal law that may allow an individual to elect to keep their
insurance coverage if the individual's employment ends, loses coverage as a dependent
of the covered employee, or another qualifying event occurs.
What happens if an individual elects COBRA coverage? - Correct Answers -the
individual pays 100% of the premiums, including the share the employer used to pay,
plus a small administrative fee.
Coinsurance - Correct Answers -is a consumer's share/percentage of the cost of a
healthcare service, paid in addition to the deductible amount.
Consumer Directed Health Plan (CDHP) - Correct Answers -a health plan that has a
high deductible cost but often lower premiums. An individual with this plan is eligible for
a health savings account (HSA) to which the individual can contribute pre-tax dollars for
qualified healthcare expenses, which employers may also contribute to.
Dependent - Correct Answers -a child up to 26 years old under the Affordable Care Act
(ACA).
What is the abbreviation for Authorized Representative? - Correct Answers -AR
What is Consumer Directed Health Plan (CDHP) also known as? - Correct Answers -
High Deductible Health Plan (HDHP)
What organization is not required to cover services provided by out-of-network
providers? - Correct Answers -Health Maintenance Organization (HMO)
,What type of health plans does the pre-existing conditions rule not apply to? - Correct
Answers -Grandfathered health plans
The ACA requires plans and issuers that offer dependent coverage, to make the
coverage available until a child reaches 26 years old. What plans does this rule apply
to? - Correct Answers -plans in the individual market and to new employer plans. It also
applies to existing employer plans unless the adult child has another offer of employer-
based coverage (such as through the adult child's job).
Division of Family Resources (DFR) - Correct Answers -a division of the Indiana Family
and Social Services Administration (FSSA), which establishes eligibility for Medicaid,
HIP, the Supplemental Nutrition Assistance Program (SNAP - food assistance), and the
Temporary Assistance for Needy Families (TANF - cash assistance).
Explanation of Benefits (EOB) - Correct Answers -is a document that describes what an
insurer paid for a health service accessed by a consumer enrolled in one of the insurer's
health insurance policies, what the consumer paid and/or owes for the service, and a
summary of the consumer's remaining deductible and out-of-pocket maximum amounts.
Each time a health service is accessed by a consumer, the consumer will receive one of
these from their insurer.
Financial Interest - Correct Answers -is for purposes of the IDOI Conflict of Interest
Policy for Indiana Navigators and AOs, when an Indiana Navigator or AO will receive, or
may receive, any compensation or other financial arrangement or benefit, either directly
or indirectly, from a third party.
Flexible Spending Account (FSA) - Correct Answers -is a medical savings account that
allows an individual and the individual's employer to contribute pre-tax dollars towards
future medical costs. Funds in this account will expire at the end of the year.
Health Maintenance Organization (HMO) - Correct Answers -is a designation given to
health insurers offering products or services in any market segment (individual, small
group, large group, or self-insured) in order to also provide or arrange for the delivery of
health care services to enrollees on a prepaid basis. Individuals covered under this
organization will have a prescribed set of providers that may provide covered services.
Except for certain services, including emergency services.
Health Savings Account (HSA) - Correct Answers -is a medical savings account that
allows the individual and the individual's employer to contribute pre-tax dollars towards
the cost of future health costs. Dollars in this account do not expire and belong solely to
the individual (including the employer contribution)
What happens to an individual if they use the HSA funds for anything other than
qualified health care expenses? - Correct Answers -they must pay a penalty
,Navigator Designation Form - Correct Answers -is a form developed by the IDOI that
may be completed by insurance producers or consultants licensed in Indiana as part of
the initial Indiana Navigator certification application process, in place of the online new
or renewal application for Indiana Navigators.
Individual Market - Correct Answers -is the market for health insurance coverage
offered to individuals other than in connection with a group health plan.
In-Network Provider - Correct Answers -is a healthcare provider in a contract with an
insurer, agreeing to provide healthcare/medical services at a discounted rate in return
for access to a large group of insured individuals.
What is an Insurer also referred to as? - Correct Answers -health insurance issuer,
carrier, or company
Insurer - Correct Answers -for health insurance purposes, is an insurance company,
insurance service, or insurance organization, which has a certificate of authority to
engage in the business and sale of health insurance policies in a state and is subject to
state law which regulates insurance. This term may include an HMO.
Medical Review Team (MRT) - Correct Answers -is a group that determines a Medicaid
applicant's eligibility for Indiana Medicaid based on a disability. To meet the disability
requirement, a person must have a significant impairment that is expected to last a
minimum of 12 months. This team makes their determination and notifies the DFR of its
decision.
Medically Frail - Correct Answers -a term used to describe an individual who has one or
more of the following:
-Disabling mental disorder
-Chronic substance abuse disorder
-Serious and complex medical conditions
-Physical, intellectual, or developmental disability that significantly impair the individual's
ability to perform one or more activities of daily living
-Disability determination based on Social Security Administration (SSA) criteria.
Office of Medicad Policy and Planning (OMPP) - Correct Answers -a division of the
Indiana FSSA that administers Medicaid programs and performs medical review of
Medicaid disability claims.
Out-of-Network Provider - Correct Answers -is a healthcare provider that is not
contracted with a particular insurer to provide healthcare/medical services at a
discounted rate for consumers covered by the insurer.
How do you determine whether a provider is in-network or out-of-network with an
insurer? - Correct Answers -You can access a list of in-network providers through the
health insurer's website or by calling the health insurers consumer help desk.
, Some out-of-network providers may not accept an individual's health insurance, and
payment may be requested up front. What should the individual do in this case? -
Correct Answers -they may submit a form directly to their insurer showing what they
paid for the service. If this form is submitted, the amount the enrollee spent for covered
services will count toward the plan deductible and out-of-pocket maximum, and if the
enrollee has met the deductible the insurer may issue compensation.
Out-of-pocket Maximum - Correct Answers -(also referred to as Out-of-pocket Limit) is
the greatest amount that a consumer pays for healthcare services in any plan year
before the insurance carrier pays 100% of healthcare costs and is set by the IRS.
Partnership Marketplace - Correct Answers -(Also referred to as Partnership Exchange)
is a mix between the FFM and a State-based Marketplace, which allows a state to
assume primary responsibility for certain functions of the Federal Marketplace
permanently or as the state works toward operating a State-based Marketplace. These
functions may include, for example, plan management and/or consumer assistance and
outreach. Indiana does not follow this marketplace model, but rather operates as a
Federal Marketplace.
Pediatric - Correct Answers -refers to children under the age of nineteen. Under the
ACA, these healthcare services, including oral and vision care, are considered essential
health benefits (EHBs) that an insurance carrier in the individual and small group
markets are required to cover.
Policy Year - Correct Answers -is either: (1) the 12-month period that is designated as
the policy year in the policy documents of a grandfathered health plan offered in the
individual health insurance market. If there is no designation of a policy year in the
policy document (or no such policy document is available), then the policy year is the
deductible or limit year used under the coverage. If deductibles or other limits are not
imposed on a yearly basis, the policy year is the calendar year. Or (2) A calendar year
for a non-grandfathered health plan offered in the individual health insurance market, or
in a market in which the state has merged the individual and small group risk pools.
Pre-existing Condition - Correct Answers -is a health issue (such as cancer, diabetes,
asthma, etc.) that an individual has prior to obtaining health insurance.
Preferred Provider Organization (PPO) - Correct Answers -is a type of health plan that
contracts with certain providers (referred to as in "network providers"). Individuals may
choose to receive service from among the network providers or may choose to go to an
out-of-network provider and in general be subject to greater cost sharing.
Premium - Correct Answers -is the amount that a consumer must periodically pay to the
insurance carrier for a health insurance plan. Individuals pay the premium regardless of
whether or not they use the health insurance. It is meant to compensate the insurer for
