Indiana Navigator Module 1 Study Gide Questions With Correct Answers

What is the Affordable Care Act? - Answer In 2010 Federal Health Insurance Marketplace and the option for states to expand Medicaid to adults up to 138% Federal Health Insurance Marketplace? - Answer Individuals with income over FPL can purchase insurance through the Marketplace (up to 400% FPL) Department of Health & Human Services - Answer HHS-Federal govt's principal health agency. Manages the FFM; establishes training, certification, monitoring Centers for Medicare & Medicaid Services - Answer CMS - Federal agency w/in HHS that administers Medicare, works w/ state govt's to administer Medicaid & oversees FFM What is the Patient Protection Affordable Care Act? - Answer Law that provides fundamental reforms to the US healthcare and health insurance systems. What are the 4 types of Federally Designated Consumer Assistants - Answer Federal Navigators; Certified Application Counselors; Non-Navigator Assistance Personnel; Producers What is a Federal Navigator? - Answer They provide unbiased & accurate education, outreach and insurance enrollment assistance on a marketplace. They receive CMS funding & certification. They must apply & be selected to receive cooperative agreement funds from CMS, complete the CMS training and certification requirements; THEN.also complete the certification and registration requirements of Indiana AO's and Navigators What is a Certified Application Counselor? - Answer CAC-Assist consumers through unbiased and accurate education and application assistance. They do not receive federal grant awards to act as CAC organizations and are not required to provide public education and outreach services to the same extent as Federal Navigators. They receive training and certification from CMS. Individuals must do so through a federally-designated organization. They must also be registered as AO's or Indiana Navigators to serve Hoosiers What is a Non-Navigator? - Answer N/A in Indiana; Developed to complement Federal Navigator program while staying distinct and separate. Same standards and requirements apply as for Federal Navigators. They provide consumer education and support How do you become a Producer? - Answer Complete licensing requirements for IDOI; sign agreements with one or more insurance companies to sell; receive compensation from insurance companies How does a Producer sell on the FFM? - Answer Must have health producer license w/ IDOI and complete FFM registration and training What do Federally-Designated consumer assistants who serve Hoosiers need to do? - Answer Complete federal training and certification; Complete Indiana Navigator certification What is a Navigator? - Answer Individuals who are certified with the IDOI to provide application assistance through the FFM or IHCP What is a Federal Navigator? - Answer Federally trained and certified consumer assistant to provide FFM education & enrollment assistance; must also be certified as Indiana Navigator w/ IDOI What is the COI Policy? - Answer Policy that establishes that Financial or Loyalty COI must be disclosed and other requirements State Privacy & Security Agreements? - Answer All IN Navigators must comply w/ this policy which defines what constitutes a consumer's personal information and a security breach or improper disclosure of information What do Navigators need to report to IDOI? - Answer Change of addres; an administrative or criminal action; change in COI; Security breach; removal of Navigator or AO What is IHCP? - Answer Indiana Health Coverage Program - Covers programs under Medicaid and apps can be accessed via dfr What is the FFM? - Answer Federally Facilitated Marketplace - Marketplace that makes QHP's (Qualified Health Plans available to individuals or qualified employers under the ACA- available at Navigator Precertification Education - Answer Education and training programs approved by the IDOI that must be completed as part of the initial Indiana Navigator certification application process and prior to the Navigator examination Navigator Continuing Education - Answer Education and training that must be completed by certified Indiana Navigators to satisfy their yearly 2 hr CE requirement. What is a Producer? - Answer Individual or business licensed by the state to sell, solicit, or negotiate insurance products; receives compensation from a health insurance carrier and is prohibited from becoming an Indiana Navigator What consumer assistants serve Hoosiers? - Answer Indiana Navigators; Application Organizations; Authorized Representatives; Producers What is an Authorized Representative? - Answer Assist w/ IAHC; receive notice of application determination; appeal decision; report changes; complete redeterminations; receive appointment notices; support ongoing health coverage needs How do you become an AR? - Answer Complete and submit AR form that is barcoded to match IAHC... submit together Who needs to be certified as an Indiana Navigator or AO? - Answer Federally-funded & certified Federal Navigators; Federally-designated CAC's; Medicaid Enrollment Center staff or volunteers; Staff or volunteers who help with insurance affordability program applications What is an AO? - Answer Organizations with employees and/or volunteers assisting Hoosier consumers with either FFM apps (QHP's and Cost lowering programs) or with the IHCP What activities are required for an AO during the online application? - Answer Affirm all Indiana Navigators are eligible , w/o COI's or disqualifying criminal histories and to pay non-refundable fee What activities are required for AO during pre-certification education? - Answer Attest that all Indiana Navigators have completed the precertification education What activities are required for AO's during the Certification Exam? - Answer N/A What activities are required for AO's during the annual re-certification? - Answer Complete online renewal app; Pay non-refundable renewal fee; update Navigator associations w/in 30 days of any changes Initial AO Registration steps? - Answer 1. Complete online AO app & pay non-refundable app fee and online processing fee. 2. Review the COI and submit COI Disclosure Form; 3. Review & submit the AO Privacy and Security Agreement; 4. Provide a contact list of each location of the AO including name, address, phone, email, website and main contact person Where can an AO check the status of their application? - Answer Who else needs to submit the COI Disclosure Form with the AO one for app? - Answer Authorized Submitter What is the list of locations provided by AO's used for? - Answer By the county on the Indiana Healthcare Reform website What are the 3 steps to renew the AO license? - Answer 1. Complete the online AO renewal application and submit non-refundable renewal and online processing fee; 2. Submit Name, Address, Phone, Email, Website & Contact Person for each location; 3. Submit new COI form if it has changed What is the role of an Indiana Navigator? - Answer To provide consumers with fair, accurate and impartial health coverage application assistance