A.D. BANKER CHAPTER 14 QUESTIONS & ANSWERS
By eliminating an insurer's right to refuse to insure anyone under the Affordable Care
Act, health insurance in America can essentially be referred to as
___________________.
a) Guaranteed issue
b) Free access
c) Noncancellable
d) Conditionally renewable
a) Guaranteed issue: Health insurance, primarily in the individual market, will essentially
be considered "guaranteed issue" as a result of the changes mandated by the PPACA.
Coverage can still be denied as a result of material misrepresentations in the application
for insurance or fraudulent claims.
Medi-Cal Assistance
California expanded the Medi-Cal program to cover individuals under age 65 with
income up to 138% of the FPL. The coverage is free for those who qualify and is part of
the provisions of the Act.
Advanced Premium Tax Credits
Premium Tax Credits are available from the federal government to help lower the cost
of health coverage for individuals and small employers who meet certain income
requirements and do not have affordable health insurance that meets the minimum
essential coverage requirements. Consumers must purchase a QHP through Covered
California to obtain Premium Tax Credits.
Cost-Sharing Reduction
Provides out-of-pocket reductions for expenses such as deductibles and copayments on
policies purchased through the Exchange by consumers with income above 138% of
the Federal Poverty Line (FPL) up to 250% of the FPL.
Certified Insurance Agent
, A Certified Insurance Agent is certified by the Exchange to transact in the individual and
Small Business Health Options Program (SHOP) to write applications for Qualified
Health Plans through Covered California. All individuals licensed as a Life Licensee to
transact in accident and health insurance are eligible to apply. To become a Certified
Insurance Agent, eligible individuals must:
- Create an account for agents at www.CoveredCA.com
- Select a preferred method of payment
- Submit a completed application
- Complete the Exchange training requirements
- Pass an exam administered by the Exchange
- Recertification is required every 5 years following initial certification
What is a High Deductible Health Plan?
a) It is a health plan offered by large companies who are trying to minimize the growing
cost of providing employee health insurance
b) It is a health plan which requires the insured to absorb a relatively high deductible in
exchange for a much reduced out of pocket premium
c) It is a tax-favored savings account established by an employer for each covered
employee
d) It is a tax-favored Health Reimbursement Account established by an employer for its
highly compensated executives
b)
A High Deductible Health Plan is designed for those who are proactive about managing
their health care expenses. By opting for this type of plan, the premium savings can be
substantial. If an insured stays healthy, they also save out of pocket costs for health
care such as for office visits, prescriptions, medical tests, etc. These savings can be
used to fund a Health Savings Account.
A person may not fund an HSA unless they also do which of these?
a) Designate up to $2500 of pre-tax income to be withheld for payment of medical
expenses
b) Fully fund their 401(k), 403(b), or Roth IRA
c) Purchase basic health insurance through an Exchange
d) Purchase a High Deductible Health Plan
d) Purchase a High Deductible Health Plan: Funding an HSA is only permitted in a year
in which the contributor is covered by a High Deductible Health Plan ("HDHP").
By eliminating an insurer's right to refuse to insure anyone under the Affordable Care
Act, health insurance in America can essentially be referred to as
___________________.
a) Guaranteed issue
b) Free access
c) Noncancellable
d) Conditionally renewable
a) Guaranteed issue: Health insurance, primarily in the individual market, will essentially
be considered "guaranteed issue" as a result of the changes mandated by the PPACA.
Coverage can still be denied as a result of material misrepresentations in the application
for insurance or fraudulent claims.
Medi-Cal Assistance
California expanded the Medi-Cal program to cover individuals under age 65 with
income up to 138% of the FPL. The coverage is free for those who qualify and is part of
the provisions of the Act.
Advanced Premium Tax Credits
Premium Tax Credits are available from the federal government to help lower the cost
of health coverage for individuals and small employers who meet certain income
requirements and do not have affordable health insurance that meets the minimum
essential coverage requirements. Consumers must purchase a QHP through Covered
California to obtain Premium Tax Credits.
Cost-Sharing Reduction
Provides out-of-pocket reductions for expenses such as deductibles and copayments on
policies purchased through the Exchange by consumers with income above 138% of
the Federal Poverty Line (FPL) up to 250% of the FPL.
Certified Insurance Agent
, A Certified Insurance Agent is certified by the Exchange to transact in the individual and
Small Business Health Options Program (SHOP) to write applications for Qualified
Health Plans through Covered California. All individuals licensed as a Life Licensee to
transact in accident and health insurance are eligible to apply. To become a Certified
Insurance Agent, eligible individuals must:
- Create an account for agents at www.CoveredCA.com
- Select a preferred method of payment
- Submit a completed application
- Complete the Exchange training requirements
- Pass an exam administered by the Exchange
- Recertification is required every 5 years following initial certification
What is a High Deductible Health Plan?
a) It is a health plan offered by large companies who are trying to minimize the growing
cost of providing employee health insurance
b) It is a health plan which requires the insured to absorb a relatively high deductible in
exchange for a much reduced out of pocket premium
c) It is a tax-favored savings account established by an employer for each covered
employee
d) It is a tax-favored Health Reimbursement Account established by an employer for its
highly compensated executives
b)
A High Deductible Health Plan is designed for those who are proactive about managing
their health care expenses. By opting for this type of plan, the premium savings can be
substantial. If an insured stays healthy, they also save out of pocket costs for health
care such as for office visits, prescriptions, medical tests, etc. These savings can be
used to fund a Health Savings Account.
A person may not fund an HSA unless they also do which of these?
a) Designate up to $2500 of pre-tax income to be withheld for payment of medical
expenses
b) Fully fund their 401(k), 403(b), or Roth IRA
c) Purchase basic health insurance through an Exchange
d) Purchase a High Deductible Health Plan
d) Purchase a High Deductible Health Plan: Funding an HSA is only permitted in a year
in which the contributor is covered by a High Deductible Health Plan ("HDHP").
