Navigator License Exam Questions With Correct Answers

indiana navigator - Answer must be certified/registered with IDOI to provide assistance for marketplace, IHCPs federal navigator - Answer federally certified to provide FMM education & enrollment assistance reporting requirements - Answer info that must be reported to IDOI (change in name/address,administrative/criminal action, a change in conflict of interest status, security breach of consumer's personal info, or a removal or addition of navigator from AO to AO). producer - Answer individual or business entity licensed by the state to sell, solicit, or negotiate insurance products HHS - Answer department of health and human services - US federal government, manages marketplace and agents, brokers, carriers, and federal certified consumer assistants CMS - Answer center of medicare/medicaid services - administers Medicare and works in tandem with state governments to administer Medicaid, CHIP, and marketplace marketplace - Answer website owned by CMS to facilitate sale of QHPs and eligibility determinations for premium tax credits and cost sharing reductions federal navigators - Answer provide unbiased and accurate education outreach and insurance enrollment assistance CAC - Answer certified application counselors - like federal navigators, except they do not receive grants and are not required to provide public education and outreach services AR - Answer authorized representatives - assists with IHCP applications, receives notice of application decisions, appeal decision and act on behalf of applicant at hearing, report changes, act for periodic redeterminations, receive app notices and any redetermination mail-in forms, support on going coverage needs conflicts of interest - Answer receives direct compensation from health insurance or stop/loss insurance issuer; AO staff/board member holds stock in an insurance company conflict of loyalty - Answer IN navigator or AO has relationship with hospital that prefers certain plans with higher rates 10 days - Answer how many business days do you have to notify consumer if discovery of a breach occurs? 5 days - Answer how many days do you have to notify the IDOI commitment to consumer - Answer identify and address the needs of the consumer, use best judgement to determine needs and refer to other resources; if needed self-determination - Answer help consumer make informed choices, present complete and accurate info on all options available state monitoring and oversight - Answer complaints and internal tracking are completed by the IDOI, FSSA conducts internal tracking of application submissions state admin actions - Answer - consequences for violation of navigator/AO (reprimand, civil penalty, suspension of certificate, revocation of certificate, cease and desist order) - for complaints about navigator (contact IDOI) - for complaints about a health insurance company (contact health insurance company and IDOI - For complaints about FFM () - consumer complaints are processed within 72 hours and consumer must write back in 20 days) grandfathered - Answer plans that were in existence prior to the affordable care act and have not have a substantial change. these plans do not have to comply with many ACA requirements. non-plans are required to comply with all ACA requirements individual and employer mandates - Answer a tax penalty for an individual that does not have minimum essential coverage; and employer mandate is a tax penalty for large employers that do not offer MEC. also referred to as the individual and employer shared-responsibility requirements essential health benefits - Answer a benefit that insurance carriers in the individual and small group markets must cover. within each of the 10 EHB categories established by the ACA, exact benefits may vary by state as provided in the state's "benchmark plan" affordable care act - Answer goal is to increase the number of individuals with health insurance coverage. creates subsidized coverage for lower incomes and cannot be denied coverage for preexisting conditions - review of insurance rate increases by state insurance department - requires insurance companies to spend a certain percentage of premiums on direct medical care federally facilitated marketplace - Answer federal government set guidelines; set up marketplace; runs marketplace; state observes federal guidelines, maintains oversight of state-regulated insurance products (IN and OH) functions of marketplace - Answer - consumers can use the marketplaces to find and apply for health coverage that fits their budgets and specific needs. eligibility : 1. to enroll in qualified health plans through a marketplace 2. for programs to help lower their costs 3. to enroll in medicaid or CHIP accepting consumers QHPs selections and sending enrollment information to QHP issuers. QHP issuers enroll consumers in the QHP they select monitoring QHP issuers: monitoring health insurance companies that sell QHPs other functions: 1. manages eligibility appeals 2. facilitates enrollment in QHPs 3. ensures appropriate PTC and CSR payments to insurance plans 4. collects and publishes quality data on health plans 5. operates consumer assistance call center 6. collects premiums for small businesses insurance affordability programs - Answer designed to make insurance premiums and cost-sharing more affordable. these programs are referred to as: cost-sharing reductions (CSR) and premium tax credits (PTC) cost sharing reduction - Answer are discounts that lower the amount consumers have to pay for deductibles, copayments, and coinsurance - consumers will find out if they qualify for CSR when they complete a marketplace application - to be eligible, the individual or household must also be eligible for the PTC and have income before 250% FPL - consumers must enroll in silver category to get extra savings whos eligible for CSR - Answer - meet all requirements for PTCs - and enroll in a silver plan (70% acturarial value) on FFM - and household income is between 100-250% FPL - or household income between 100-300% FPL for native americans