INDIANA NAVIGATOR TEST QUESTIONS & ANSWERS
3 month retroactive eligibility does not apply to... - Answer -HIP or CHIP
A complaint about an IN Navigator can be made to the IDOI and will be processed
within... - Answer -72 hours
A federally-designated consumer assistant may be which of the following?
Certified Application Counselor (CAC)
Federal Navigator
Producer (Broker and/or Agent) - Answer -Certified Application Counselor (CAC)
True or False: A pregnant woman does not count the number of children she is
expecting when determining household size for MAGI? - Answer -False
What indicates the average percentage of plan charges the insurer expects to pay for
ALL enrollees in that plan? The higher the AV, the higher the premium but lower the
cost sharing. - Answer -Actuarial Value (AV)
What are the Actuarial Value (AV) statistics by tier?
A. Bronze 60%
Silver 70%
Gold 80%
Platinum 90% (not available in Indiana)
B. Platinum 90% (not available in Indiana)
Silver 70%
Gold 80%
Bronze 60% - Answer -A.
In the Actuarial Value statistics by tier, are Platinum 90% available in Indiana? - Answer
-No
What is Advanced Premium Tax Credit (APTC)? - Answer -Credits paid directly to
insurance company to reduce individual's premium costs.
True or False: After close to 12 months, QHPs will send a re-enrollment notice to
consumers stating they will be automatically re-enrolled in their current plan as long as
their information meets eligibility requrements. - Answer -True
Can an individual be an Indiana Navigator if they have been denied, suspended, or
revoked of an insurance agent/broker license, IN Navigator Certification, or an
equivalent license certification? - Answer -No
Can an individual be an IN Navigator if they have been convicted of a disqualifying
felony or crime as determined by the Commissioner of Insurance? - Answer -No
,Can an individual be an IN Navigator if they have been convicted of unfair trade practice
or fraud in the insurance business? - Answer -No
Can an individual be an IN Navigator if they have an unpaid state income tax or child
support obligation? - Answer -No
An unborn child counts toward family size for which two programs? - Answer -
Presumptive Eligibility OR Hoosier Healthwise
True or False: Applicants are considered disabled when applying for FFM plans if they
received Social Security Disability Insurance (SSDI) or Supplemental Security Income
(SSI)? - Answer -True
What are Catastrophic Plans? - Answer -They are plans that are exempt for Actuarial
Value requirements and the deductible is close to the out of pocket maximum.
What plan qualifies as minimum essentials coverage (MEC) and is not eligible for PTCs
or CSRs? - Answer -Catastrophic Plan
What plan must an individual be under 30 OR they have received an exemption to
maintain MEC to receive benefits? - Answer -Catastrophic Plan
What is cost-sharing? - Answer -The share of costs covered out of pocket by an
individual through deductibles, coinsurance, and copayments.
What is cost-sharing reduction (CSR)? - Answer -A discount that lowers the amount
consumers have to pay for deductibles, copayments, and coinsurance.
What is offered in addition to PTCs, and individuals do not have to apply separately
from PTC, if qualified? - Answer -Cost-Sharing reduction
CSRs increase the _______________ of health coverage plans for low-income
people/reduces out of pocket costs. - Answer -Actuarial Value (AV)
What is the non-institutionalized spouse of an institutionalized person that may maintain
all of their personal income, and half of the income from assets owned by both spouses;
is this totals less than $2250/month., the community spouse may keep some of the
institutionalize spouse's income? - Answer -Community Spouse
Define Application Organization (AO). - Answer -An entity that must be certified and
registered with the state of Indiana to assist Hoosiers with applications on the FFM
and/or for IHCPs.
Define Certified Application Counselors (CAC). - Answer -Individuals who fulfill some of
the same roles as Navigators and are certified as IN Navigators through the IDOI; they
, are not responsible for outreach and education but they do provide free information to
consumers about insurance programs and they help to facilitate the enrollment in health
coverage.
Define coinsurance. - Answer -A bill from an enrollee's healthcare provider for a
percentage of the cost of care after a visit.
What is a business or personal interest that keeps the IN Navigator or AO from acting in
the best interest of the consumer that must be reported? - Answer -Conflict of Loyalty
What is a flat fee paid by enrollee before they can see a healthcare provider? - Answer
-Copayment
When does application inconsistency or data matching issue (DMI) occur? - Answer -
When FFMs cannot verify electronic information through trusted data sources and
applicants have to submit documentation.
Are Native Americans required to pay cost sharing fees when enrolled in HIP? -
Answer -No, by federal rule they are exempt from cost sharing.
Are undocumented individuals eligible for Medicaid coverage? - Answer -Yes and no;
They are eligible for Emergency Services only through their selected program, but they
still have to meet the eligibility requirements for that selected plan (Medicaid).
What is Batch Auto Re-enrollment (BAR)? - Answer -The auto re-enrollment process
that marketplace / FFM uses to ensure enrollees continue to have coverage if they do
not make an active plan selection.
Besides children, who does Hoosier Healthwise cover? - Answer -Pregnant women up
to 208% FPL, but there are monthly premiums and copays.
Can inmates be covered under Presumptive Eligibility (PE)? - Answer -Yes, but only for
inpatient hospital stays and they must be in a correctional facility and under contract
with the FSSA.
What is the amount an enrollee has to pay fully out of pocket for healthcare before
insurance will make payments; once met, there may be copays, coinsurance, or they
may pay entire cost? - Answer -Deductible
Define direct financial incentive. - Answer -A conflict of interest: an individual receives
compensation from a health insurance company for enrolling a consumer in a
specific/stop-loss plan. Not allowed (ie agents or brokers)
What is a federally developed and operated insurance marketplace that makes
Qualified Health Providers, Premium Tax Credits, and Cost Share Reductions available
to individuals and/or employers in accordance with the Affordable Care Act (ACA)? Also
3 month retroactive eligibility does not apply to... - Answer -HIP or CHIP
A complaint about an IN Navigator can be made to the IDOI and will be processed
within... - Answer -72 hours
A federally-designated consumer assistant may be which of the following?
Certified Application Counselor (CAC)
Federal Navigator
Producer (Broker and/or Agent) - Answer -Certified Application Counselor (CAC)
True or False: A pregnant woman does not count the number of children she is
expecting when determining household size for MAGI? - Answer -False
What indicates the average percentage of plan charges the insurer expects to pay for
ALL enrollees in that plan? The higher the AV, the higher the premium but lower the
cost sharing. - Answer -Actuarial Value (AV)
What are the Actuarial Value (AV) statistics by tier?
A. Bronze 60%
Silver 70%
Gold 80%
Platinum 90% (not available in Indiana)
B. Platinum 90% (not available in Indiana)
Silver 70%
Gold 80%
Bronze 60% - Answer -A.
In the Actuarial Value statistics by tier, are Platinum 90% available in Indiana? - Answer
-No
What is Advanced Premium Tax Credit (APTC)? - Answer -Credits paid directly to
insurance company to reduce individual's premium costs.
True or False: After close to 12 months, QHPs will send a re-enrollment notice to
consumers stating they will be automatically re-enrolled in their current plan as long as
their information meets eligibility requrements. - Answer -True
Can an individual be an Indiana Navigator if they have been denied, suspended, or
revoked of an insurance agent/broker license, IN Navigator Certification, or an
equivalent license certification? - Answer -No
Can an individual be an IN Navigator if they have been convicted of a disqualifying
felony or crime as determined by the Commissioner of Insurance? - Answer -No
,Can an individual be an IN Navigator if they have been convicted of unfair trade practice
or fraud in the insurance business? - Answer -No
Can an individual be an IN Navigator if they have an unpaid state income tax or child
support obligation? - Answer -No
An unborn child counts toward family size for which two programs? - Answer -
Presumptive Eligibility OR Hoosier Healthwise
True or False: Applicants are considered disabled when applying for FFM plans if they
received Social Security Disability Insurance (SSDI) or Supplemental Security Income
(SSI)? - Answer -True
What are Catastrophic Plans? - Answer -They are plans that are exempt for Actuarial
Value requirements and the deductible is close to the out of pocket maximum.
What plan qualifies as minimum essentials coverage (MEC) and is not eligible for PTCs
or CSRs? - Answer -Catastrophic Plan
What plan must an individual be under 30 OR they have received an exemption to
maintain MEC to receive benefits? - Answer -Catastrophic Plan
What is cost-sharing? - Answer -The share of costs covered out of pocket by an
individual through deductibles, coinsurance, and copayments.
What is cost-sharing reduction (CSR)? - Answer -A discount that lowers the amount
consumers have to pay for deductibles, copayments, and coinsurance.
What is offered in addition to PTCs, and individuals do not have to apply separately
from PTC, if qualified? - Answer -Cost-Sharing reduction
CSRs increase the _______________ of health coverage plans for low-income
people/reduces out of pocket costs. - Answer -Actuarial Value (AV)
What is the non-institutionalized spouse of an institutionalized person that may maintain
all of their personal income, and half of the income from assets owned by both spouses;
is this totals less than $2250/month., the community spouse may keep some of the
institutionalize spouse's income? - Answer -Community Spouse
Define Application Organization (AO). - Answer -An entity that must be certified and
registered with the state of Indiana to assist Hoosiers with applications on the FFM
and/or for IHCPs.
Define Certified Application Counselors (CAC). - Answer -Individuals who fulfill some of
the same roles as Navigators and are certified as IN Navigators through the IDOI; they
, are not responsible for outreach and education but they do provide free information to
consumers about insurance programs and they help to facilitate the enrollment in health
coverage.
Define coinsurance. - Answer -A bill from an enrollee's healthcare provider for a
percentage of the cost of care after a visit.
What is a business or personal interest that keeps the IN Navigator or AO from acting in
the best interest of the consumer that must be reported? - Answer -Conflict of Loyalty
What is a flat fee paid by enrollee before they can see a healthcare provider? - Answer
-Copayment
When does application inconsistency or data matching issue (DMI) occur? - Answer -
When FFMs cannot verify electronic information through trusted data sources and
applicants have to submit documentation.
Are Native Americans required to pay cost sharing fees when enrolled in HIP? -
Answer -No, by federal rule they are exempt from cost sharing.
Are undocumented individuals eligible for Medicaid coverage? - Answer -Yes and no;
They are eligible for Emergency Services only through their selected program, but they
still have to meet the eligibility requirements for that selected plan (Medicaid).
What is Batch Auto Re-enrollment (BAR)? - Answer -The auto re-enrollment process
that marketplace / FFM uses to ensure enrollees continue to have coverage if they do
not make an active plan selection.
Besides children, who does Hoosier Healthwise cover? - Answer -Pregnant women up
to 208% FPL, but there are monthly premiums and copays.
Can inmates be covered under Presumptive Eligibility (PE)? - Answer -Yes, but only for
inpatient hospital stays and they must be in a correctional facility and under contract
with the FSSA.
What is the amount an enrollee has to pay fully out of pocket for healthcare before
insurance will make payments; once met, there may be copays, coinsurance, or they
may pay entire cost? - Answer -Deductible
Define direct financial incentive. - Answer -A conflict of interest: an individual receives
compensation from a health insurance company for enrolling a consumer in a
specific/stop-loss plan. Not allowed (ie agents or brokers)
What is a federally developed and operated insurance marketplace that makes
Qualified Health Providers, Premium Tax Credits, and Cost Share Reductions available
to individuals and/or employers in accordance with the Affordable Care Act (ACA)? Also
