Indiana Navigator Test Study Guide
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 cost limits? - Correct Answers -the maximum cost sharing a plan may charge
in a year; in-network healthcare providers are subject to only charging cost sharing up
to an out-of-pocket maximum amount
what are the current out of pocket maximum amount limits for FFM plans? - Correct
Answers -Individual plans: $7,350
Family plans: $14,700
Catastrophic Plan - Correct Answers -plans that are exempt for Actuarial Value
requirements and the deductible is close to the out of pocket maximum; this plan
qualifies as Minimum Essential Coverage (MEC) and is not eligible for PTCs or CSRs.
to receive this plan, individual must be under 30 OR they have received an exemption to
maintain MEC
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.
Define no additional financial incentive. - Correct Answers -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. - Correct Answers -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 - Correct Answers -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? - Correct Answers -A Navigator must
notify the consumer within 10 days of the breach/disclosure and must notify the IDOI
within 5 days.
What are the reporting requirements for Indiana Navigators? - Correct Answers -
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? - Correct Answers -
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? - Correct Answers -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)? - Correct Answers -The
United States federal government's principal health agency that develops and manages
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 cost limits? - Correct Answers -the maximum cost sharing a plan may charge
in a year; in-network healthcare providers are subject to only charging cost sharing up
to an out-of-pocket maximum amount
what are the current out of pocket maximum amount limits for FFM plans? - Correct
Answers -Individual plans: $7,350
Family plans: $14,700
Catastrophic Plan - Correct Answers -plans that are exempt for Actuarial Value
requirements and the deductible is close to the out of pocket maximum; this plan
qualifies as Minimum Essential Coverage (MEC) and is not eligible for PTCs or CSRs.
to receive this plan, individual must be under 30 OR they have received an exemption to
maintain MEC
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.
Define no additional financial incentive. - Correct Answers -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. - Correct Answers -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 - Correct Answers -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? - Correct Answers -A Navigator must
notify the consumer within 10 days of the breach/disclosure and must notify the IDOI
within 5 days.
What are the reporting requirements for Indiana Navigators? - Correct Answers -
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? - Correct Answers -
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? - Correct Answers -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)? - Correct Answers -The
United States federal government's principal health agency that develops and manages
