Navigator Exam Questions and Answers
Catastrophic Plans - Correct Answers -Low monthly premiums --> very high deductible.
cover same EHB's as other marketplace plans
Minimum Essential Coverage (MEC) - Correct Answers -Benefits that insurance carriers
in individual and small groups must cover
Qualified Health Plans (QHP) - Correct Answers -Health insurance plan that has passed
a federal certification process to be offered on the FFM
Large group; small group; & Individual market - Correct Answers -large group= more
than 50 employees
small group= less than 50 employees
individual market for individuals and their dependents
Presumptive Eligibility - Correct Answers -A determination of limited Medicaid eligibility
for PE, pregnant women (PEPW), Hospital (HPE), and Inmate PE completed by
qualified providers.
*Full medicaid application MUST be completed within 60 days.
Special enrollment period - Correct Answers -May enroll outside of the open enrollment
period if they have a certain life event such as:
-Loss of MEC
-Gain/lose dependnt
-consumer gains citizenship
-permanent move to other state/service area
When does health coverage begin? - Correct Answers -a consumer is not considered
enrolled in a QHP until they pay their portion the the 1st months premium.
(coverage purchased before the 15th is effective the 1st of next month)
(coverage purchased after the 15th is active the 1st of the NEXT month)
Types of Consumer Assistants (CA) - Correct Answers --federal navigators
-CACs
-non navigator assistance personnel
-health insurance brokers/agents
, Healthy Indiana Plan (HIP) - Correct Answers -non-disabled hoosiers *ages 19-64 whos
family income is less than 138% of FPL & are not eligible for Medicare or other
medicaid category (has 4 pathways to coverage)
*Qualifies as MEC* & copay for non-emergency use or ER
Hoosier Healthwise - Correct Answers -Low-income parents/caretakers, pregnant
women, & kids up to 19 y.o.
covers medical (dr. visits, prescriptions, mental health, dental, hospitalizations,
surgeries, & family planning)
Premium Tax Credit (PTC) ;
Cost Sharing Reduction (CSR) - Correct Answers -ACA provisions that lower the
amount some eligible consumers pay for premiums, copayment, coinsurance, &/or
deductibles
Essential Health Benefit (EHB) - Correct Answers -Type of coverage individuals must
have to meet individual mandate requirement under the ACA
Individual & Employer mandates - Correct Answers -Individual= tax penalty for
individual that does not have MEC
Employer= large employers that don't offer MEC.
Federal Poverty Level (FPL) - Correct Answers -income guidelines established annually
by the federal government. estimates minimum amount individual/family needs to cover
basic living expenses.
POWER account - Correct Answers -account used to pay medical bills for HIP. covers
first $2500 of services.
monthly member contributions approx. 2% of family income.
Children's Health Insurance Program (CHIP) - Correct Answers -*Children whos income
is too high to qualify for medicaid.
administered by states with joint funding from federal government and states.
Medicaid - Correct Answers -Federal-state program providing free/low-cost health
insurance coverage to people meeting eligibility developed within the parameters
established by the federal government
Reporting Requirements - Correct Answers -Information that must be reported to IDOI:
change in name/address, administrative/criminal actions, conflict of interest, security
breach, add/removal of navigator/AO
Indiana Health Coverage Program (IHCP) - Correct Answers -Any of the programs
operating under:
Medicaid, Hoosier Healthwise, HIP, Hoosier Care Connect, CHIP, traditional medicaid,
home/community base
Catastrophic Plans - Correct Answers -Low monthly premiums --> very high deductible.
cover same EHB's as other marketplace plans
Minimum Essential Coverage (MEC) - Correct Answers -Benefits that insurance carriers
in individual and small groups must cover
Qualified Health Plans (QHP) - Correct Answers -Health insurance plan that has passed
a federal certification process to be offered on the FFM
Large group; small group; & Individual market - Correct Answers -large group= more
than 50 employees
small group= less than 50 employees
individual market for individuals and their dependents
Presumptive Eligibility - Correct Answers -A determination of limited Medicaid eligibility
for PE, pregnant women (PEPW), Hospital (HPE), and Inmate PE completed by
qualified providers.
*Full medicaid application MUST be completed within 60 days.
Special enrollment period - Correct Answers -May enroll outside of the open enrollment
period if they have a certain life event such as:
-Loss of MEC
-Gain/lose dependnt
-consumer gains citizenship
-permanent move to other state/service area
When does health coverage begin? - Correct Answers -a consumer is not considered
enrolled in a QHP until they pay their portion the the 1st months premium.
(coverage purchased before the 15th is effective the 1st of next month)
(coverage purchased after the 15th is active the 1st of the NEXT month)
Types of Consumer Assistants (CA) - Correct Answers --federal navigators
-CACs
-non navigator assistance personnel
-health insurance brokers/agents
, Healthy Indiana Plan (HIP) - Correct Answers -non-disabled hoosiers *ages 19-64 whos
family income is less than 138% of FPL & are not eligible for Medicare or other
medicaid category (has 4 pathways to coverage)
*Qualifies as MEC* & copay for non-emergency use or ER
Hoosier Healthwise - Correct Answers -Low-income parents/caretakers, pregnant
women, & kids up to 19 y.o.
covers medical (dr. visits, prescriptions, mental health, dental, hospitalizations,
surgeries, & family planning)
Premium Tax Credit (PTC) ;
Cost Sharing Reduction (CSR) - Correct Answers -ACA provisions that lower the
amount some eligible consumers pay for premiums, copayment, coinsurance, &/or
deductibles
Essential Health Benefit (EHB) - Correct Answers -Type of coverage individuals must
have to meet individual mandate requirement under the ACA
Individual & Employer mandates - Correct Answers -Individual= tax penalty for
individual that does not have MEC
Employer= large employers that don't offer MEC.
Federal Poverty Level (FPL) - Correct Answers -income guidelines established annually
by the federal government. estimates minimum amount individual/family needs to cover
basic living expenses.
POWER account - Correct Answers -account used to pay medical bills for HIP. covers
first $2500 of services.
monthly member contributions approx. 2% of family income.
Children's Health Insurance Program (CHIP) - Correct Answers -*Children whos income
is too high to qualify for medicaid.
administered by states with joint funding from federal government and states.
Medicaid - Correct Answers -Federal-state program providing free/low-cost health
insurance coverage to people meeting eligibility developed within the parameters
established by the federal government
Reporting Requirements - Correct Answers -Information that must be reported to IDOI:
change in name/address, administrative/criminal actions, conflict of interest, security
breach, add/removal of navigator/AO
Indiana Health Coverage Program (IHCP) - Correct Answers -Any of the programs
operating under:
Medicaid, Hoosier Healthwise, HIP, Hoosier Care Connect, CHIP, traditional medicaid,
home/community base
