Navigator Exam with 100% correct
Answers
Define Maryland Health Connection - Correct Answers -The new marketplace in the
state to compare health insurance options and enroll in health coverage.
Name the important elements of the Maryland Health Connection - Correct Answers -1.
New Marketplace to shop and compare health insurance.
2. No Wrong Door
3. Only place to qualify for Advance Premium Tax Credits and Cost Sharing Reductions
4. Private and Government plans
What are the four ways consumers can apply for health care coverage? - Correct
Answers -1. Online at www.marylandhealthconnection.gov
2. In person
3. On the phone
4. By mail
What are the 6 types of consumer assistance workers - Correct Answers -Navigators
Assisters
Caseworkers
Consolidated Services Center Representatives
Producers
Application Counselors
True or False
If Sally enrolls in Qualified Health Plan and her payment is posted by the 18th of
February, Sally can submit her health bills for services she received for the entire month
of February. - Correct Answers -False
There are no retroactive enrollment dates for private health insurance
What is the date that a payment must be POSTED for coverage to be effective on the
1st day of the following month? - Correct Answers -18 th
Identify three provisions of The Federal Civil False Claims Act. - Correct Answers -1. It
is against federal law to submit false or fraudulent claims to the federal government or
to use false records or statements to obtain payment for false or fraudulent claims.
2. Violators are subject to fins of $5,500 to $11,000 per claim and three times the
amount of damages that the federal government sustains.
3. Violators could be excluded from participation in all federal and state health care
programs.
, Name the key State anti-fraud law. - Correct Answers -Maryland False Claims Act.
Identify two provisions of the Maryland False Claims Act. - Correct Answers -1. It is
against state law to submit false or fraudulent claims to state health programs.
2. Violators are subject to a fine of not more than $10,000 for each violation and not
more than three times the amount of the damages that the state sustains.
When will individuals eligible for Medicaid have coverage effective? - Correct Answers -
On the first day of the month in which they enroll
What does the acronym FPL stand for? - Correct Answers -Federal Poverty Level
Define "Affordable" health insurance - Correct Answers -Health Insurance with premium
costs less than a certain percentage of an individual's income. The percentage is based
on the Federal Poverty Level
Up to 133% FPL = 2.00%
134 - 150% = 4.00%
151 - 200% = 6.30%
201 - 250% = 8.05%
251 - 400% = 9.5%
Some people may be exempt from having health insurance. Name the 6 exemptions. -
Correct Answers -1. Financial hardship
2. Religious objections
3. Members of a federally recognized Indian tribe
4. Those without coverage for less than three months
5. Incarcerated individuals
6. Consumers with incomes below the tax filing threshold
Consumers without health insurance coverage will be required to pay a tax penalty. Tax
penalties will be phased in how? - Correct Answers -2014 - $95 per adult or 1% of
income (whichever is higher)
2015 - $325 or 2% of income (whichever is higher)
2016 - $695 or 2.5% of income (whichever is higher)
What does the acronym SBC stand for - Correct Answers -Summary of Benefits and
Coverage
Insurance companies and group health plans must provide consumers with two things.
What are they? - Correct Answers -Summary of Benefits and Coverage
Uniform Glossary of Terms
True or False
Lifetime and yearly dollar limits on coverage of essential health benefits are no longer
permitted. - Correct Answers -True
Answers
Define Maryland Health Connection - Correct Answers -The new marketplace in the
state to compare health insurance options and enroll in health coverage.
Name the important elements of the Maryland Health Connection - Correct Answers -1.
New Marketplace to shop and compare health insurance.
2. No Wrong Door
3. Only place to qualify for Advance Premium Tax Credits and Cost Sharing Reductions
4. Private and Government plans
What are the four ways consumers can apply for health care coverage? - Correct
Answers -1. Online at www.marylandhealthconnection.gov
2. In person
3. On the phone
4. By mail
What are the 6 types of consumer assistance workers - Correct Answers -Navigators
Assisters
Caseworkers
Consolidated Services Center Representatives
Producers
Application Counselors
True or False
If Sally enrolls in Qualified Health Plan and her payment is posted by the 18th of
February, Sally can submit her health bills for services she received for the entire month
of February. - Correct Answers -False
There are no retroactive enrollment dates for private health insurance
What is the date that a payment must be POSTED for coverage to be effective on the
1st day of the following month? - Correct Answers -18 th
Identify three provisions of The Federal Civil False Claims Act. - Correct Answers -1. It
is against federal law to submit false or fraudulent claims to the federal government or
to use false records or statements to obtain payment for false or fraudulent claims.
2. Violators are subject to fins of $5,500 to $11,000 per claim and three times the
amount of damages that the federal government sustains.
3. Violators could be excluded from participation in all federal and state health care
programs.
, Name the key State anti-fraud law. - Correct Answers -Maryland False Claims Act.
Identify two provisions of the Maryland False Claims Act. - Correct Answers -1. It is
against state law to submit false or fraudulent claims to state health programs.
2. Violators are subject to a fine of not more than $10,000 for each violation and not
more than three times the amount of the damages that the state sustains.
When will individuals eligible for Medicaid have coverage effective? - Correct Answers -
On the first day of the month in which they enroll
What does the acronym FPL stand for? - Correct Answers -Federal Poverty Level
Define "Affordable" health insurance - Correct Answers -Health Insurance with premium
costs less than a certain percentage of an individual's income. The percentage is based
on the Federal Poverty Level
Up to 133% FPL = 2.00%
134 - 150% = 4.00%
151 - 200% = 6.30%
201 - 250% = 8.05%
251 - 400% = 9.5%
Some people may be exempt from having health insurance. Name the 6 exemptions. -
Correct Answers -1. Financial hardship
2. Religious objections
3. Members of a federally recognized Indian tribe
4. Those without coverage for less than three months
5. Incarcerated individuals
6. Consumers with incomes below the tax filing threshold
Consumers without health insurance coverage will be required to pay a tax penalty. Tax
penalties will be phased in how? - Correct Answers -2014 - $95 per adult or 1% of
income (whichever is higher)
2015 - $325 or 2% of income (whichever is higher)
2016 - $695 or 2.5% of income (whichever is higher)
What does the acronym SBC stand for - Correct Answers -Summary of Benefits and
Coverage
Insurance companies and group health plans must provide consumers with two things.
What are they? - Correct Answers -Summary of Benefits and Coverage
Uniform Glossary of Terms
True or False
Lifetime and yearly dollar limits on coverage of essential health benefits are no longer
permitted. - Correct Answers -True
