2024 INDIANA NAVIGATOR TEST
STUDY GUIDE EXAM WITH
CORRECT ANSWERS
Define IHCP - CORRECT ANSWERS-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? - CORRECT
ANSWERS-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)
What are the 10 Essential Health Benefits (EHBs)? - CORRECT ANSWERS-1.
ambulatory patient services/outpatient care
2. emergency services
3. hospitalization
4. maternity and newborn care
5. mental health and substance use disorder services, including behavioral
health treatment
6. prescription drugs
7. rehabilitation and habilitative services and devices
8. laboratory services
9. preventative and wellness services and chronic disease management
10. pediatric services, including oral and vision care
what is a state's benchmark plan? - CORRECT ANSWERS-a plan that sets the
baseline requirement(s) of benefits that must be covered by other plans
offered in the state
Define Medical Loss Ratio (MLR). - CORRECT ANSWERS-the percent of
premiums collected by an insurance company that must be spent on medical
services and quality improvement; if not met by insurance company,
individuals and small businesses covered will receive a refund
What are the Medical Loss Ratio (MLR) requirements according to the ACA? -
CORRECT ANSWERS-1. large group 85%
2. small group 80%
,3. individual 80%
programs that are not MEC: - CORRECT ANSWERS-Medicaid: optional family
planning services, emergency Medicaid, tuberculosis services, outpatient
hospital services
Not Medicaid: worker's compensation, vision benefits, coverage for
employer-provided onsite medical clinics, separate policies for coverage of
only a specified disease
What programs are MEC? - CORRECT ANSWERS-1. Government sponsored
health coverage (QHPs, Medicare Pt. A or C, most Medicaid programs, CHIP,
Refugee Medical Assistance, Veterans Admin. ;programs including TriCare
and CHAMP VA, Dept. of Defense nonappropriated Fund Health Benefit
Program, coverage for Peace Corps volunteers)
2. any job based coverage
3. qualifying individual market health coverage
4. grandfatehred health plan
5. coverage under a parent's plan
6. most student health plans
7. state high-risk pools
Define FFM - CORRECT ANSWERS-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 - CORRECT ANSWERS-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 - CORRECT ANSWERS-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 - CORRECT ANSWERS-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 - CORRECT ANSWERS-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 - CORRECT ANSWERS-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 - CORRECT ANSWERS-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.
Navigator CE - CORRECT ANSWERS-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? - CORRECT ANSWERS-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? - CORRECT
ANSWERS-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? - CORRECT ANSWERS-Direct
financial incentive, indirect financial incentive, no additional financial
incentive, and conflict of loyalty.
Define direct financial incentive. - CORRECT ANSWERS-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. - CORRECT ANSWERS-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.
STUDY GUIDE EXAM WITH
CORRECT ANSWERS
Define IHCP - CORRECT ANSWERS-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? - CORRECT
ANSWERS-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)
What are the 10 Essential Health Benefits (EHBs)? - CORRECT ANSWERS-1.
ambulatory patient services/outpatient care
2. emergency services
3. hospitalization
4. maternity and newborn care
5. mental health and substance use disorder services, including behavioral
health treatment
6. prescription drugs
7. rehabilitation and habilitative services and devices
8. laboratory services
9. preventative and wellness services and chronic disease management
10. pediatric services, including oral and vision care
what is a state's benchmark plan? - CORRECT ANSWERS-a plan that sets the
baseline requirement(s) of benefits that must be covered by other plans
offered in the state
Define Medical Loss Ratio (MLR). - CORRECT ANSWERS-the percent of
premiums collected by an insurance company that must be spent on medical
services and quality improvement; if not met by insurance company,
individuals and small businesses covered will receive a refund
What are the Medical Loss Ratio (MLR) requirements according to the ACA? -
CORRECT ANSWERS-1. large group 85%
2. small group 80%
,3. individual 80%
programs that are not MEC: - CORRECT ANSWERS-Medicaid: optional family
planning services, emergency Medicaid, tuberculosis services, outpatient
hospital services
Not Medicaid: worker's compensation, vision benefits, coverage for
employer-provided onsite medical clinics, separate policies for coverage of
only a specified disease
What programs are MEC? - CORRECT ANSWERS-1. Government sponsored
health coverage (QHPs, Medicare Pt. A or C, most Medicaid programs, CHIP,
Refugee Medical Assistance, Veterans Admin. ;programs including TriCare
and CHAMP VA, Dept. of Defense nonappropriated Fund Health Benefit
Program, coverage for Peace Corps volunteers)
2. any job based coverage
3. qualifying individual market health coverage
4. grandfatehred health plan
5. coverage under a parent's plan
6. most student health plans
7. state high-risk pools
Define FFM - CORRECT ANSWERS-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 - CORRECT ANSWERS-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 - CORRECT ANSWERS-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 - CORRECT ANSWERS-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 - CORRECT ANSWERS-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 - CORRECT ANSWERS-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 - CORRECT ANSWERS-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.
Navigator CE - CORRECT ANSWERS-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? - CORRECT ANSWERS-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? - CORRECT
ANSWERS-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? - CORRECT ANSWERS-Direct
financial incentive, indirect financial incentive, no additional financial
incentive, and conflict of loyalty.
Define direct financial incentive. - CORRECT ANSWERS-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. - CORRECT ANSWERS-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.
