FFM Prep ( Individual Market Certification)
Questions With Correct Answers
AFA Basics extension to age 26
guarantee issue
MLR
NON DISCRIMINATORY
EHB ( ESSENTIAL HEALTH BENEFITS)
MENTAL HEALTH
catastrophic plans
Marketplace Basics The key points from this module are:
Each state and the District of Columbia has a Marketplace where qualified individuals, qualified
employers, and qualified employees may purchase and select health insurance.
QHPs must be licensed and meet certain transparency requirements. To become certified, a QHP
must meet a minimum set of criteria, including coverage of the EHB, benefit design standards,
and network adequacy standards.
Other types of plans may be offered through the Marketplace, including CO-OPs, Multi-State
Plans, and stand-alone dental plans.
People who enroll in federal health care programs, such as Medicaid and Medicare, generally
have minimum essential coverage and do not need to obtain additional coverage through the
Marketplace in order to comply with the requirement to maintain minimum essential coverage.
, Agents and brokers can assist individuals with enrolling in QHPs through the Individual
Marketplace and can assist employers with selecting and enrolling in SHOP coverage.
Web-brokers can assist consumers in the Individual Marketplace to select and enroll in a QHP
through the web-brokers' own website.
Agents and brokers who participate in the Marketplace are compensated in accordance with their
agreements with QHP issuers and any state-specific requirements. The Marketplace does not set
compensation levels.
All agents and brokers—including web-brokers—seeking to enroll individuals through the
Marketplace must be licensed by the applicable state, adhere to all applicable state laws, and
complete the applicable FFM registration requirements.
All agents, brokers, and web-brokers who participate in the Marketplace must comply with the
FFM standards of conduct to protect against conduct that is harmful to consumers or prevents the
efficient operation of the Marketplace.
HHS may terminate an agent's, broker'
PRIVACY STANDARDS AND DEFINITIONS The key points of this module are:
PII is defined as information that can be used to distinguish or trace an individual's identity,
either alone or when combined with other information that is linked or linkable to a specific
individual.
Agents and brokers operating in the Marketplace:
May only use or disclose PII to the extent necessary to carry out the functions authorized in their
Privacy and Security Agreement(s) with CMS; and
Must comply with the privacy and security standards established by CMS and defined in the
Agreements' Appendix A, titled "Privacy and Security Standards and Implementation
Specifications for Non-Exchange Entities."
Questions With Correct Answers
AFA Basics extension to age 26
guarantee issue
MLR
NON DISCRIMINATORY
EHB ( ESSENTIAL HEALTH BENEFITS)
MENTAL HEALTH
catastrophic plans
Marketplace Basics The key points from this module are:
Each state and the District of Columbia has a Marketplace where qualified individuals, qualified
employers, and qualified employees may purchase and select health insurance.
QHPs must be licensed and meet certain transparency requirements. To become certified, a QHP
must meet a minimum set of criteria, including coverage of the EHB, benefit design standards,
and network adequacy standards.
Other types of plans may be offered through the Marketplace, including CO-OPs, Multi-State
Plans, and stand-alone dental plans.
People who enroll in federal health care programs, such as Medicaid and Medicare, generally
have minimum essential coverage and do not need to obtain additional coverage through the
Marketplace in order to comply with the requirement to maintain minimum essential coverage.
, Agents and brokers can assist individuals with enrolling in QHPs through the Individual
Marketplace and can assist employers with selecting and enrolling in SHOP coverage.
Web-brokers can assist consumers in the Individual Marketplace to select and enroll in a QHP
through the web-brokers' own website.
Agents and brokers who participate in the Marketplace are compensated in accordance with their
agreements with QHP issuers and any state-specific requirements. The Marketplace does not set
compensation levels.
All agents and brokers—including web-brokers—seeking to enroll individuals through the
Marketplace must be licensed by the applicable state, adhere to all applicable state laws, and
complete the applicable FFM registration requirements.
All agents, brokers, and web-brokers who participate in the Marketplace must comply with the
FFM standards of conduct to protect against conduct that is harmful to consumers or prevents the
efficient operation of the Marketplace.
HHS may terminate an agent's, broker'
PRIVACY STANDARDS AND DEFINITIONS The key points of this module are:
PII is defined as information that can be used to distinguish or trace an individual's identity,
either alone or when combined with other information that is linked or linkable to a specific
individual.
Agents and brokers operating in the Marketplace:
May only use or disclose PII to the extent necessary to carry out the functions authorized in their
Privacy and Security Agreement(s) with CMS; and
Must comply with the privacy and security standards established by CMS and defined in the
Agreements' Appendix A, titled "Privacy and Security Standards and Implementation
Specifications for Non-Exchange Entities."
