Indiana Navigator Test Study Guide Questions
With Correct Answers.
Navigator CE - ANSWER-Navigator Continuing Education: education and training
programs approved by the IDOI that must be completed by certified Indiana Navigators
to satisfy their yearly two-hour Navigator CE requirement to renew their licensure.
What is a Conflict of Interest Policy? - ANSWER-A state policy that establishes what
may constitute an actual or potential Conflict of Interest (Financial Interest or Conflict of
Loyalty) and disclosure and other requirements surrounding such conflicts by which all
Indiana Navigators and AOs must comply.
What is an example of a conflict of interest and what type is it? - ANSWER-Conflict of
loyalty- an Indiana Navigator and/or an AO have a close relationship with a hospital that
prefers a high payment rate plan
What are the kinds of conflict of interests? - ANSWER-Direct financial incentive, indirect
financial incentive, no additional financial incentive, and conflict of loyalty.
Define direct financial incentive. - ANSWER-A conflict of interest: an individual receives
compensation from a health insurance company for enrolling a consumer in a
specific/stop-loss plan. Not allowed (ie agents or brokers)
Define indirect financial incentive. - ANSWER-Conflict of interest: must be disclosed to
IDOI and all consumers prior to assisting with coverage that an AO or Navigator holds
stock in an insurance company and may indirectly benefit if consumer purchases a plan
with the assistance of a Navigator.
Define no additional financial incentive. - ANSWER-Conflict of interest that is
permissible: an Indiana Navigator receives an hourly wage from an employer/AO,
regardless of number of consumers helped or plans selected
Define conflict of loyalty. - ANSWER-A business or personal interest that keeps the IN
Navigator or AO from acting in the best interest of the consumer that must be reported.
Privacy & Security; Personal Information; Security Breach - ANSWER-All Indiana
Navigators and AOs must comply with state privacy and security agreements
established, which defines what constitutes a consumer's Personal Information and a
Security Breach or improper disclosure of such information. It also establishes privacy
and security standards and procedures that all Indiana Navigators and AOs must follow
in order to protect a consumer's personal information.
How long does a Navigator have to notify a consumer and the IDOI of a security breach
or an improper disclosure of personal information? - ANSWER-A Navigator must notify
,the consumer within 10 days of the breach/disclosure and must notify the IDOI within 5
days.
Define IHCP - ANSWER-Indiana Health Coverage Program: programs under Indiana
Medicaid developed to address the medical needs of low income, aged, disabled,
pregmant and other populations meeting the different eligibility criteria of each program.
www.dfrbenefits.in.gov
What programs fall under the Indiana Health Coverage Programs? - ANSWER-Indiana
Medicaid: Hoosier Healthwise, Childrens's Health Insurance Program, Healthy Indiana
Plan, Hoosier Care Connect, Traditional Medicaid, and Home and Community Based
Waiver Services (HCBS)
Define FFM - ANSWER-Federally-facilitated Marketplace: federally developed and
operated insurance marketplace that makes Qualified Health Providers, Premium Tax
Credits, and Cost Share Reductions available to individuals and/or employers in
accordance with the Affordable Care Act (ACA). Also referred to as www.healthcare.gov
or an Exchange.
Define Producer, Agent, Broker, Agency - ANSWER-an individual/entity licensed by the
state/Indiana Dept. of Insurance (IDOI) as a health insurance producer to sell, solicit, or
negotiate insurance (products) and are therefore unable to be certified as an Indiana
Navigator or Application Organization due to receiving compensation for enrolling an
individual in a plan. If they want to sell on the FFM, they must be federally certified
through the CMS.
Define Indiana Navigator - ANSWER-an individual certified by the state of Indiana to
provide application assistance through the Federally Facilitated Marketplace (FFM:
QHPs, PTCs, CSRs) and/or the Indiana Health Coverage Program (Medicaid, CHIP,
HIP, HHW, Hoosier Care Connect)
Define AO - ANSWER-Application Organization: an entity that must be certified and
registered with the state of Indiana to assist Hoosiers with applications on the FFM
and/or for IHCPs
Define CAC - ANSWER-Certified Application Counselors: individuals (staff members or
volunteers) who fulfill some of the same roles as Navigators and are certified as Indiana
Navigators through the IDOI; they are not responsible for outreach and education but
they do provide free information to consumers about insurance programs and they help
to facilitate the enrollment in health coverage.
Define Non-Navigator Assistance Personnel - ANSWER-a role with the same
certification requirements as a Navigator that complements Navigator programs in
Partnership Marketplace states; not available in Indiana and other FFM Model states
, Define Navigator PE - ANSWER-Navigator Precertification Education: education and
training programs approved by the IDOI that must be completed by individuals as part of
the initial Indiana Navigator certification application process and prior to taking the
Navigator Examination.
What are the reporting requirements for Indiana Navigators? - ANSWER-Information
that must be reported to the IDOI within 30 days by an Indiana Navigator (about said
party) including a change in name or contact information, administrative, criminal, or
other legal action after final disposition, a change in a conflict of interest status, and/or a
security breach or improper disclosure of a consumer's personal information.
What are the reporting requirements for Application Organizations? - ANSWER-A
change in name, Federal Employer Identification Number (FEIN), or contact information,
as well as any criminal, administrative, or other legal action, a changed or new conflict
of interest, an addition/removal of associated Indiana Navigators, a security breach or
improper disclosure of consumer information, or a change/addition/removal of a location
with more than one location
What are the requirements for producers (agents and brokers) to sell on the Federally-
facilitated Marketplace? - ANSWER-Post-Affordable Care Act 2010: must have health
producer license with IDOI and must complete FFM registration and training through the
Centers for Medicare and Medicaid Services (CMS)
What is the Department of Health and Human Services (HHS)? - ANSWER-The United
States federal government's principal health agency that develops and manages the
federal Marketplace/www.healthcare.gov through the Centers for Medicare & Medicaid
Services (CMS) and manages the establishment, training, certification, monitoring, and
oversight of Marketplace agents, brokers, carriers, and federally-certified consumer
assistants.
What is the Centers for Medicare & Medicaid Services (CMS)? - ANSWER-A federal
agency within the US Department of Health and Human Services (HHS) that
administers Medicare, works with state governments to administer Medicaid and the
Children's Health Insurance Programs (CHIP), and oversees the federal
Marketplace/healthcare.gov
What is the Affordable Care Act (ACA)? - ANSWER-Also known as Obamacare. A
federal statute that was signed into law March 23, 2010 and later amended by the
federal Health Care and Education Reconciliation Act of 2010. The law reformed
healthcare and health insurance systems by establishing health insurance Marketplaces
and federal consumer assistance programs (such as federal Navigators, Certified
Application Counselors (CACs), and non-Navigator Assistance Personnel. The law also
enacted that there are no lifetime limits on coverage and that insurance is guaranteed to
be available and renewable, it subsidized coverage for low-income people, and made it
illegal for companies to deny coverage or raise premiums based on preexisting
With Correct Answers.
Navigator CE - ANSWER-Navigator Continuing Education: education and training
programs approved by the IDOI that must be completed by certified Indiana Navigators
to satisfy their yearly two-hour Navigator CE requirement to renew their licensure.
What is a Conflict of Interest Policy? - ANSWER-A state policy that establishes what
may constitute an actual or potential Conflict of Interest (Financial Interest or Conflict of
Loyalty) and disclosure and other requirements surrounding such conflicts by which all
Indiana Navigators and AOs must comply.
What is an example of a conflict of interest and what type is it? - ANSWER-Conflict of
loyalty- an Indiana Navigator and/or an AO have a close relationship with a hospital that
prefers a high payment rate plan
What are the kinds of conflict of interests? - ANSWER-Direct financial incentive, indirect
financial incentive, no additional financial incentive, and conflict of loyalty.
Define direct financial incentive. - ANSWER-A conflict of interest: an individual receives
compensation from a health insurance company for enrolling a consumer in a
specific/stop-loss plan. Not allowed (ie agents or brokers)
Define indirect financial incentive. - ANSWER-Conflict of interest: must be disclosed to
IDOI and all consumers prior to assisting with coverage that an AO or Navigator holds
stock in an insurance company and may indirectly benefit if consumer purchases a plan
with the assistance of a Navigator.
Define no additional financial incentive. - ANSWER-Conflict of interest that is
permissible: an Indiana Navigator receives an hourly wage from an employer/AO,
regardless of number of consumers helped or plans selected
Define conflict of loyalty. - ANSWER-A business or personal interest that keeps the IN
Navigator or AO from acting in the best interest of the consumer that must be reported.
Privacy & Security; Personal Information; Security Breach - ANSWER-All Indiana
Navigators and AOs must comply with state privacy and security agreements
established, which defines what constitutes a consumer's Personal Information and a
Security Breach or improper disclosure of such information. It also establishes privacy
and security standards and procedures that all Indiana Navigators and AOs must follow
in order to protect a consumer's personal information.
How long does a Navigator have to notify a consumer and the IDOI of a security breach
or an improper disclosure of personal information? - ANSWER-A Navigator must notify
,the consumer within 10 days of the breach/disclosure and must notify the IDOI within 5
days.
Define IHCP - ANSWER-Indiana Health Coverage Program: programs under Indiana
Medicaid developed to address the medical needs of low income, aged, disabled,
pregmant and other populations meeting the different eligibility criteria of each program.
www.dfrbenefits.in.gov
What programs fall under the Indiana Health Coverage Programs? - ANSWER-Indiana
Medicaid: Hoosier Healthwise, Childrens's Health Insurance Program, Healthy Indiana
Plan, Hoosier Care Connect, Traditional Medicaid, and Home and Community Based
Waiver Services (HCBS)
Define FFM - ANSWER-Federally-facilitated Marketplace: federally developed and
operated insurance marketplace that makes Qualified Health Providers, Premium Tax
Credits, and Cost Share Reductions available to individuals and/or employers in
accordance with the Affordable Care Act (ACA). Also referred to as www.healthcare.gov
or an Exchange.
Define Producer, Agent, Broker, Agency - ANSWER-an individual/entity licensed by the
state/Indiana Dept. of Insurance (IDOI) as a health insurance producer to sell, solicit, or
negotiate insurance (products) and are therefore unable to be certified as an Indiana
Navigator or Application Organization due to receiving compensation for enrolling an
individual in a plan. If they want to sell on the FFM, they must be federally certified
through the CMS.
Define Indiana Navigator - ANSWER-an individual certified by the state of Indiana to
provide application assistance through the Federally Facilitated Marketplace (FFM:
QHPs, PTCs, CSRs) and/or the Indiana Health Coverage Program (Medicaid, CHIP,
HIP, HHW, Hoosier Care Connect)
Define AO - ANSWER-Application Organization: an entity that must be certified and
registered with the state of Indiana to assist Hoosiers with applications on the FFM
and/or for IHCPs
Define CAC - ANSWER-Certified Application Counselors: individuals (staff members or
volunteers) who fulfill some of the same roles as Navigators and are certified as Indiana
Navigators through the IDOI; they are not responsible for outreach and education but
they do provide free information to consumers about insurance programs and they help
to facilitate the enrollment in health coverage.
Define Non-Navigator Assistance Personnel - ANSWER-a role with the same
certification requirements as a Navigator that complements Navigator programs in
Partnership Marketplace states; not available in Indiana and other FFM Model states
, Define Navigator PE - ANSWER-Navigator Precertification Education: education and
training programs approved by the IDOI that must be completed by individuals as part of
the initial Indiana Navigator certification application process and prior to taking the
Navigator Examination.
What are the reporting requirements for Indiana Navigators? - ANSWER-Information
that must be reported to the IDOI within 30 days by an Indiana Navigator (about said
party) including a change in name or contact information, administrative, criminal, or
other legal action after final disposition, a change in a conflict of interest status, and/or a
security breach or improper disclosure of a consumer's personal information.
What are the reporting requirements for Application Organizations? - ANSWER-A
change in name, Federal Employer Identification Number (FEIN), or contact information,
as well as any criminal, administrative, or other legal action, a changed or new conflict
of interest, an addition/removal of associated Indiana Navigators, a security breach or
improper disclosure of consumer information, or a change/addition/removal of a location
with more than one location
What are the requirements for producers (agents and brokers) to sell on the Federally-
facilitated Marketplace? - ANSWER-Post-Affordable Care Act 2010: must have health
producer license with IDOI and must complete FFM registration and training through the
Centers for Medicare and Medicaid Services (CMS)
What is the Department of Health and Human Services (HHS)? - ANSWER-The United
States federal government's principal health agency that develops and manages the
federal Marketplace/www.healthcare.gov through the Centers for Medicare & Medicaid
Services (CMS) and manages the establishment, training, certification, monitoring, and
oversight of Marketplace agents, brokers, carriers, and federally-certified consumer
assistants.
What is the Centers for Medicare & Medicaid Services (CMS)? - ANSWER-A federal
agency within the US Department of Health and Human Services (HHS) that
administers Medicare, works with state governments to administer Medicaid and the
Children's Health Insurance Programs (CHIP), and oversees the federal
Marketplace/healthcare.gov
What is the Affordable Care Act (ACA)? - ANSWER-Also known as Obamacare. A
federal statute that was signed into law March 23, 2010 and later amended by the
federal Health Care and Education Reconciliation Act of 2010. The law reformed
healthcare and health insurance systems by establishing health insurance Marketplaces
and federal consumer assistance programs (such as federal Navigators, Certified
Application Counselors (CACs), and non-Navigator Assistance Personnel. The law also
enacted that there are no lifetime limits on coverage and that insurance is guaranteed to
be available and renewable, it subsidized coverage for low-income people, and made it
illegal for companies to deny coverage or raise premiums based on preexisting
