Cer fied Enroller Exam - Covered California Ques ons
and answers Newest RATED A+ 2025/2026 NEWEST
RATED A+ UPDATED
The ACA requires employers with FTE (Full-Time Equivalent) employees to offer coverage with a
minimum of ____________? - 50 or more FTE employees
Which state became the first state in the na&on to enact legisla&on to establish a health
insurance marketplace a(er the passage of the ACA? - California
Can individuals s&ll be penalized when they file their federal tax returns for failing to have MEC
(Minimum Essen&al Coverage)? - You will not be penalized by the federal government, BUT can
be through the state of California.
What is the eligibility criteria for consumers in a QHP (Qualified Health Plan) through Covered
CA include: - - Be a ci&zen or na&onal of US or a non-ci&zen who is lawfully present in the US
- Be a resident (or intend to be a resident) of CA and
- Not incarcerated (other than incarcera&on pending the disposi&on or judgement of charges)
Do agents have to have a license with the California Department of Insurance before they begin
selling insurance? - Yes, addi&onally they must also become cer&fied with Covered California
Cer&fied Insurance Agents (CIA) earn and are paid commissions for effectuated enrollments
with: - - Individual and Family Plans: commissions are paid by Covered CA Qualified Health and
Dental Plans
- Covered CA for Small business (CCSB): commissions are paid by CCSB
,Cer&fied Applica&on Counselor (CAC) provide in-person consumer enrollment assistance and
are largely represented by CBOs (Community Based Organiza&ons). - These enrollment partners
ARE NOT compensated by Covered CA.
Navigator Grant Program- CEC (Cer&fied Enrollment Counselor) - Provides outreach, educa&on,
enrollment assistance, and post-enrollment services to consumers on behalf of Covered CA
What is considered SEP (Special Enrollment Period)? - Qualifying life events such as birth or
adop&ons, marriage, moving to or within California, or loss of MEC (Minimum Essen&al
Coverage)
To ensure that consumer assistance is accessible to people with disabili&es: - -Provide
enrollment resources, websites, and tools that are accessible to individuals with disabili&es
- Provide assistance in a loca&on and manner that is physically and otherwise accessible
- Maintain knowledge to refer people with disabili&es to long-term services and support
programs when appropriate
What age can children remain on their parent's health insurance plan? - Un&l they reach age 26
What are not subject to copayments, coinsurance, or deduc&bles? - - Preventa&ve care,
vaccina&ons, and medical screenings
- Mammograms and colonoscopies
- Wellness visits
- Gesta&onal diabetes screening
- Addi&onal preventa&ve care and screenings are available to women
- Approved contracep&ve methods
What is the difference between metal &ers? - - Pla&num-level plans cover 90 percent of health
care costs, and you pay 10 percent
, - Gold plans cover 80 percent, while you pay 20 percent
- Silver plans cover 70 percent, while you pay 30 percent
- Bronze plans cover 60 percent, while you pay 40 percent.
What is a premium? - The amount a consumer must pay their health or dental plan, usually
paid on a monthly basis.
What is a deduc&ble? - The amount the member pays for the covered health care services they
recieve before the health insurance plan begins to pay its por&on of the costs.
What is cost sharing? - Out-of-pocket costs that the member pays for covered services.
- coinsurance
- copayments
- deduc&bles
What is coinsurance? - A type of cost sharing in which a member pays for a medical service
a(er mee&ng a deduc&ble.
What is considered Coinsurance? - A consumer's share of the cost of a covered health care
service, as a percentage.
What is a copayment (copay)? - The fixed dollar amount the member pays for a covered health
care service. Usually paid when the service is received.
What document outlines both covered and excluded services, which are benefits not covered
by the health insurance plan? - Evidence of Coverage
and answers Newest RATED A+ 2025/2026 NEWEST
RATED A+ UPDATED
The ACA requires employers with FTE (Full-Time Equivalent) employees to offer coverage with a
minimum of ____________? - 50 or more FTE employees
Which state became the first state in the na&on to enact legisla&on to establish a health
insurance marketplace a(er the passage of the ACA? - California
Can individuals s&ll be penalized when they file their federal tax returns for failing to have MEC
(Minimum Essen&al Coverage)? - You will not be penalized by the federal government, BUT can
be through the state of California.
What is the eligibility criteria for consumers in a QHP (Qualified Health Plan) through Covered
CA include: - - Be a ci&zen or na&onal of US or a non-ci&zen who is lawfully present in the US
- Be a resident (or intend to be a resident) of CA and
- Not incarcerated (other than incarcera&on pending the disposi&on or judgement of charges)
Do agents have to have a license with the California Department of Insurance before they begin
selling insurance? - Yes, addi&onally they must also become cer&fied with Covered California
Cer&fied Insurance Agents (CIA) earn and are paid commissions for effectuated enrollments
with: - - Individual and Family Plans: commissions are paid by Covered CA Qualified Health and
Dental Plans
- Covered CA for Small business (CCSB): commissions are paid by CCSB
,Cer&fied Applica&on Counselor (CAC) provide in-person consumer enrollment assistance and
are largely represented by CBOs (Community Based Organiza&ons). - These enrollment partners
ARE NOT compensated by Covered CA.
Navigator Grant Program- CEC (Cer&fied Enrollment Counselor) - Provides outreach, educa&on,
enrollment assistance, and post-enrollment services to consumers on behalf of Covered CA
What is considered SEP (Special Enrollment Period)? - Qualifying life events such as birth or
adop&ons, marriage, moving to or within California, or loss of MEC (Minimum Essen&al
Coverage)
To ensure that consumer assistance is accessible to people with disabili&es: - -Provide
enrollment resources, websites, and tools that are accessible to individuals with disabili&es
- Provide assistance in a loca&on and manner that is physically and otherwise accessible
- Maintain knowledge to refer people with disabili&es to long-term services and support
programs when appropriate
What age can children remain on their parent's health insurance plan? - Un&l they reach age 26
What are not subject to copayments, coinsurance, or deduc&bles? - - Preventa&ve care,
vaccina&ons, and medical screenings
- Mammograms and colonoscopies
- Wellness visits
- Gesta&onal diabetes screening
- Addi&onal preventa&ve care and screenings are available to women
- Approved contracep&ve methods
What is the difference between metal &ers? - - Pla&num-level plans cover 90 percent of health
care costs, and you pay 10 percent
, - Gold plans cover 80 percent, while you pay 20 percent
- Silver plans cover 70 percent, while you pay 30 percent
- Bronze plans cover 60 percent, while you pay 40 percent.
What is a premium? - The amount a consumer must pay their health or dental plan, usually
paid on a monthly basis.
What is a deduc&ble? - The amount the member pays for the covered health care services they
recieve before the health insurance plan begins to pay its por&on of the costs.
What is cost sharing? - Out-of-pocket costs that the member pays for covered services.
- coinsurance
- copayments
- deduc&bles
What is coinsurance? - A type of cost sharing in which a member pays for a medical service
a(er mee&ng a deduc&ble.
What is considered Coinsurance? - A consumer's share of the cost of a covered health care
service, as a percentage.
What is a copayment (copay)? - The fixed dollar amount the member pays for a covered health
care service. Usually paid when the service is received.
What document outlines both covered and excluded services, which are benefits not covered
by the health insurance plan? - Evidence of Coverage
