Indiana Navigator Test Study Guide
Questions With Correct Answers
Define |IHCP |- |CORRECT |ANSWER✔✔-Indiana |Health |Coverage |Program: |programs |under |
Indiana |Medicaid |developed |to |address |the |medical |needs |of |low |income, |aged, |disabled, |
pregmant |and |other |populations |meeting |the |different |eligibility |criteria |of |each |program. |
www.dfrbenefits.in.gov
What |programs |fall |under |the |Indiana |Health |Coverage |Programs? |- |CORRECT |ANSWER✔✔-
Indiana |Medicaid: |Hoosier |Healthwise, |Childrens's |Health |Insurance |Program, |Healthy |Indiana |
Plan, |Hoosier |Care |Connect, |Traditional |Medicaid, |and |Home |and |Community |Based |Waiver |
Services |(HCBS)
Define |FFM |- |CORRECT |ANSWER✔✔-Federally-facilitated |Marketplace: |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 |referred |to |as |www.healthcare.gov |or |an |Exchange.
Define |Producer, |Agent, |Broker, |Agency |- |CORRECT |ANSWER✔✔-an |individual/entity |licensed |
by |the |state/Indiana |Dept. |of |Insurance |(IDOI) |as |a |health |insurance |producer |to |sell, |solicit, |or
|negotiate |insurance |(products) |and |are |therefore |unable |to |be |certified |as |an |Indiana |
Navigator |or |Application |Organization |due |to |receiving |compensation |for |enrolling |an |
individual |in |a |plan. |If |they |want |to |sell |on |the |FFM, |they |must |be |federally |certified |through |
the |CMS.
Define |Indiana |Navigator |- |CORRECT |ANSWER✔✔-an |individual |certified |by |the |state |of |
Indiana |to |provide |application |assistance |through |the |Federally |Facilitated |Marketplace |(FFM: |
QHPs, |PTCs, |CSRs) |and/or |the |Indiana |Health |Coverage |Program |(Medicaid, |CHIP, |HIP, |HHW, |
Hoosier |Care |Connect)
,Define |AO |- |CORRECT |ANSWER✔✔-Application |Organization: |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 |CAC |- |CORRECT |ANSWER✔✔-Certified |Application |Counselors: |individuals |(staff |
members |or |volunteers) |who |fulfill |some |of |the |same |roles |as |Navigators |and |are |certified |as |
Indiana |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 |Non-Navigator |Assistance |Personnel |- |CORRECT |ANSWER✔✔-a |role |with |the |same |
certification |requirements |as |a |Navigator |that |complements |Navigator |programs |in |Partnership
|Marketplace |states; |not |available |in |Indiana |and |other |FFM |Model |states
Define |Navigator |PE |- |CORRECT |ANSWER✔✔-Navigator |Precertification |Education: |education |
and |training |programs |approved |by |the |IDOI |that |must |be |completed |by |individuals |as |part |of |
the |initial |Indiana |Navigator |certification |application |process |and |prior |to |taking |the |Navigator |
Examination.
Navigator |CE |- |CORRECT |ANSWER✔✔-Navigator |Continuing |Education: |education |and |training |
programs |approved |by |the |IDOI |that |must |be |completed |by |certified |Indiana |Navigators |to |
satisfy |their |yearly |two-hour |Navigator |CE |requirement |to |renew |their |licensure.
What |is |a |Conflict |of |Interest |Policy? |- |CORRECT |ANSWER✔✔-A |state |policy |that |establishes |
what |may |constitute |an |actual |or |potential |Conflict |of |Interest |(Financial |Interest |or |Conflict |of
|Loyalty) |and |disclosure |and |other |requirements |surrounding |such |conflicts |by |which |all |
Indiana |Navigators |and |AOs |must |comply.
What |is |an |example |of |a |conflict |of |interest |and |what |type |is |it? |- |CORRECT |ANSWER✔✔-
Conflict |of |loyalty- |an |Indiana |Navigator |and/or |an |AO |have |a |close |relationship |with |a |hospital
|that |prefers |a |high |payment |rate |plan
,What |are |the |kinds |of |conflict |of |interests? |- |CORRECT |ANSWER✔✔-Direct |financial |incentive, |
indirect |financial |incentive, |no |additional |financial |incentive, |and |conflict |of |loyalty.
Define |direct |financial |incentive. |- |CORRECT |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)
Define |indirect |financial |incentive. |- |CORRECT |ANSWER✔✔-Conflict |of |interest: |must |be |
disclosed |to |IDOI |and |all |consumers |prior |to |assisting |with |coverage |that |an |AO |or |Navigator |
holds |stock |in |an |insurance |company |and |may |indirectly |benefit |if |consumer |purchases |a |plan |
with |the |assistance |of |a |Navigator.
Define |no |additional |financial |incentive. |- |CORRECT |ANSWER✔✔-Conflict |of |interest |that |is |
permissible: |an |Indiana |Navigator |receives |an |hourly |wage |from |an |employer/AO, |regardless |of
|number |of |consumers |helped |or |plans |selected
Define |conflict |of |loyalty. |- |CORRECT |ANSWER✔✔-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.
Privacy |& |Security; |Personal |Information; |Security |Breach |- |CORRECT |ANSWER✔✔-All |Indiana |
Navigators |and |AOs |must |comply |with |state |privacy |and |security |agreements |established, |
which |defines |what |constitutes |a |consumer's |Personal |Information |and |a |Security |Breach |or |
improper |disclosure |of |such |information. |It |also |establishes |privacy |and |security |standards |and
|procedures |that |all |Indiana |Navigators |and |AOs |must |follow |in |order |to |protect |a |consumer's |
personal |information.
How |long |does |a |Navigator |have |to |notify |a |consumer |and |the |IDOI |of |a |security |breach |or |an |
improper |disclosure |of |personal |information? |- |CORRECT |ANSWER✔✔-A |Navigator |must |notify
|the |consumer |within |10 |days |of |the |breach/disclosure |and |must |notify |the |IDOI |within |5 |days.
, What |are |the |reporting |requirements |for |Indiana |Navigators? |- |CORRECT |ANSWER✔✔-
Information |that |must |be |reported |to |the |IDOI |within |30 |days |by |an |Indiana |Navigator |(about |
said |party) |including |a |change |in |name |or |contact |information, |administrative, |criminal, |or |
other |legal |action |after |final |disposition, |a |change |in |a |conflict |of |interest |status, |and/or |a |
security |breach |or |improper |disclosure |of |a |consumer's |personal |information.
What |are |the |reporting |requirements |for |Application |Organizations? |- |CORRECT |ANSWER✔✔-
A |change |in |name, |Federal |Employer |Identification |Number |(FEIN), |or |contact |information, |as |
well |as |any |criminal, |administrative, |or |other |legal |action, |a |changed |or |new |conflict |of |
interest, |an |addition/removal |of |associated |Indiana |Navigators, |a |security |breach |or |improper |
disclosure |of |consumer |information, |or |a |change/addition/removal |of |a |location |with |more |
than |one |location
What |are |the |requirements |for |producers |(agents |and |brokers) |to |sell |on |the |Federally-
facilitated |Marketplace? |- |CORRECT |ANSWER✔✔-Post-Affordable |Care |Act |2010: |must |have |
health |producer |license |with |IDOI |and |must |complete |FFM |registration |and |training |through |
the |Centers |for |Medicare |and |Medicaid |Services |(CMS)
What |is |the |Department |of |Health |and |Human |Services |(HHS)? |- |CORRECT |ANSWER✔✔-The |
United |States |federal |government's |principal |health |agency |that |develops |and |manages |the |
federal |Marketplace/www.healthcare.gov |through |the |Centers |for |Medicare |& |Medicaid |
Services |(CMS) |and |manages |the |establishment, |training, |certification, |monitoring, |and |
oversight |of |Marketplace |agents, |brokers, |carriers, |and |federally-certified |consumer |assistants.
What |is |the |Centers |for |Medicare |& |Medicaid |Services |(CMS)? |- |CORRECT |ANSWER✔✔-A |
federal |agency |within |the |US |Department |of |Health |and |Human |Services |(HHS) |that |
administers |Medicare, |works |with |state |governments |to |administer |Medicaid |and |the |
Children's |Health |Insurance |Programs |(CHIP), |and |oversees |the |federal
|Marketplace/healthcare.gov
What |is |the |Affordable |Care |Act |(ACA)? |- |CORRECT |ANSWER✔✔-Also |known |as |Obamacare. |A |
federal |statute |that |was |signed |into |law |March |23, |2010 |and |later |amended |by |the |federal |
Health |Care |and |Education |Reconciliation |Act |of |2010. |The |law |reformed |healthcare |and |
Questions With Correct Answers
Define |IHCP |- |CORRECT |ANSWER✔✔-Indiana |Health |Coverage |Program: |programs |under |
Indiana |Medicaid |developed |to |address |the |medical |needs |of |low |income, |aged, |disabled, |
pregmant |and |other |populations |meeting |the |different |eligibility |criteria |of |each |program. |
www.dfrbenefits.in.gov
What |programs |fall |under |the |Indiana |Health |Coverage |Programs? |- |CORRECT |ANSWER✔✔-
Indiana |Medicaid: |Hoosier |Healthwise, |Childrens's |Health |Insurance |Program, |Healthy |Indiana |
Plan, |Hoosier |Care |Connect, |Traditional |Medicaid, |and |Home |and |Community |Based |Waiver |
Services |(HCBS)
Define |FFM |- |CORRECT |ANSWER✔✔-Federally-facilitated |Marketplace: |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 |referred |to |as |www.healthcare.gov |or |an |Exchange.
Define |Producer, |Agent, |Broker, |Agency |- |CORRECT |ANSWER✔✔-an |individual/entity |licensed |
by |the |state/Indiana |Dept. |of |Insurance |(IDOI) |as |a |health |insurance |producer |to |sell, |solicit, |or
|negotiate |insurance |(products) |and |are |therefore |unable |to |be |certified |as |an |Indiana |
Navigator |or |Application |Organization |due |to |receiving |compensation |for |enrolling |an |
individual |in |a |plan. |If |they |want |to |sell |on |the |FFM, |they |must |be |federally |certified |through |
the |CMS.
Define |Indiana |Navigator |- |CORRECT |ANSWER✔✔-an |individual |certified |by |the |state |of |
Indiana |to |provide |application |assistance |through |the |Federally |Facilitated |Marketplace |(FFM: |
QHPs, |PTCs, |CSRs) |and/or |the |Indiana |Health |Coverage |Program |(Medicaid, |CHIP, |HIP, |HHW, |
Hoosier |Care |Connect)
,Define |AO |- |CORRECT |ANSWER✔✔-Application |Organization: |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 |CAC |- |CORRECT |ANSWER✔✔-Certified |Application |Counselors: |individuals |(staff |
members |or |volunteers) |who |fulfill |some |of |the |same |roles |as |Navigators |and |are |certified |as |
Indiana |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 |Non-Navigator |Assistance |Personnel |- |CORRECT |ANSWER✔✔-a |role |with |the |same |
certification |requirements |as |a |Navigator |that |complements |Navigator |programs |in |Partnership
|Marketplace |states; |not |available |in |Indiana |and |other |FFM |Model |states
Define |Navigator |PE |- |CORRECT |ANSWER✔✔-Navigator |Precertification |Education: |education |
and |training |programs |approved |by |the |IDOI |that |must |be |completed |by |individuals |as |part |of |
the |initial |Indiana |Navigator |certification |application |process |and |prior |to |taking |the |Navigator |
Examination.
Navigator |CE |- |CORRECT |ANSWER✔✔-Navigator |Continuing |Education: |education |and |training |
programs |approved |by |the |IDOI |that |must |be |completed |by |certified |Indiana |Navigators |to |
satisfy |their |yearly |two-hour |Navigator |CE |requirement |to |renew |their |licensure.
What |is |a |Conflict |of |Interest |Policy? |- |CORRECT |ANSWER✔✔-A |state |policy |that |establishes |
what |may |constitute |an |actual |or |potential |Conflict |of |Interest |(Financial |Interest |or |Conflict |of
|Loyalty) |and |disclosure |and |other |requirements |surrounding |such |conflicts |by |which |all |
Indiana |Navigators |and |AOs |must |comply.
What |is |an |example |of |a |conflict |of |interest |and |what |type |is |it? |- |CORRECT |ANSWER✔✔-
Conflict |of |loyalty- |an |Indiana |Navigator |and/or |an |AO |have |a |close |relationship |with |a |hospital
|that |prefers |a |high |payment |rate |plan
,What |are |the |kinds |of |conflict |of |interests? |- |CORRECT |ANSWER✔✔-Direct |financial |incentive, |
indirect |financial |incentive, |no |additional |financial |incentive, |and |conflict |of |loyalty.
Define |direct |financial |incentive. |- |CORRECT |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)
Define |indirect |financial |incentive. |- |CORRECT |ANSWER✔✔-Conflict |of |interest: |must |be |
disclosed |to |IDOI |and |all |consumers |prior |to |assisting |with |coverage |that |an |AO |or |Navigator |
holds |stock |in |an |insurance |company |and |may |indirectly |benefit |if |consumer |purchases |a |plan |
with |the |assistance |of |a |Navigator.
Define |no |additional |financial |incentive. |- |CORRECT |ANSWER✔✔-Conflict |of |interest |that |is |
permissible: |an |Indiana |Navigator |receives |an |hourly |wage |from |an |employer/AO, |regardless |of
|number |of |consumers |helped |or |plans |selected
Define |conflict |of |loyalty. |- |CORRECT |ANSWER✔✔-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.
Privacy |& |Security; |Personal |Information; |Security |Breach |- |CORRECT |ANSWER✔✔-All |Indiana |
Navigators |and |AOs |must |comply |with |state |privacy |and |security |agreements |established, |
which |defines |what |constitutes |a |consumer's |Personal |Information |and |a |Security |Breach |or |
improper |disclosure |of |such |information. |It |also |establishes |privacy |and |security |standards |and
|procedures |that |all |Indiana |Navigators |and |AOs |must |follow |in |order |to |protect |a |consumer's |
personal |information.
How |long |does |a |Navigator |have |to |notify |a |consumer |and |the |IDOI |of |a |security |breach |or |an |
improper |disclosure |of |personal |information? |- |CORRECT |ANSWER✔✔-A |Navigator |must |notify
|the |consumer |within |10 |days |of |the |breach/disclosure |and |must |notify |the |IDOI |within |5 |days.
, What |are |the |reporting |requirements |for |Indiana |Navigators? |- |CORRECT |ANSWER✔✔-
Information |that |must |be |reported |to |the |IDOI |within |30 |days |by |an |Indiana |Navigator |(about |
said |party) |including |a |change |in |name |or |contact |information, |administrative, |criminal, |or |
other |legal |action |after |final |disposition, |a |change |in |a |conflict |of |interest |status, |and/or |a |
security |breach |or |improper |disclosure |of |a |consumer's |personal |information.
What |are |the |reporting |requirements |for |Application |Organizations? |- |CORRECT |ANSWER✔✔-
A |change |in |name, |Federal |Employer |Identification |Number |(FEIN), |or |contact |information, |as |
well |as |any |criminal, |administrative, |or |other |legal |action, |a |changed |or |new |conflict |of |
interest, |an |addition/removal |of |associated |Indiana |Navigators, |a |security |breach |or |improper |
disclosure |of |consumer |information, |or |a |change/addition/removal |of |a |location |with |more |
than |one |location
What |are |the |requirements |for |producers |(agents |and |brokers) |to |sell |on |the |Federally-
facilitated |Marketplace? |- |CORRECT |ANSWER✔✔-Post-Affordable |Care |Act |2010: |must |have |
health |producer |license |with |IDOI |and |must |complete |FFM |registration |and |training |through |
the |Centers |for |Medicare |and |Medicaid |Services |(CMS)
What |is |the |Department |of |Health |and |Human |Services |(HHS)? |- |CORRECT |ANSWER✔✔-The |
United |States |federal |government's |principal |health |agency |that |develops |and |manages |the |
federal |Marketplace/www.healthcare.gov |through |the |Centers |for |Medicare |& |Medicaid |
Services |(CMS) |and |manages |the |establishment, |training, |certification, |monitoring, |and |
oversight |of |Marketplace |agents, |brokers, |carriers, |and |federally-certified |consumer |assistants.
What |is |the |Centers |for |Medicare |& |Medicaid |Services |(CMS)? |- |CORRECT |ANSWER✔✔-A |
federal |agency |within |the |US |Department |of |Health |and |Human |Services |(HHS) |that |
administers |Medicare, |works |with |state |governments |to |administer |Medicaid |and |the |
Children's |Health |Insurance |Programs |(CHIP), |and |oversees |the |federal
|Marketplace/healthcare.gov
What |is |the |Affordable |Care |Act |(ACA)? |- |CORRECT |ANSWER✔✔-Also |known |as |Obamacare. |A |
federal |statute |that |was |signed |into |law |March |23, |2010 |and |later |amended |by |the |federal |
Health |Care |and |Education |Reconciliation |Act |of |2010. |The |law |reformed |healthcare |and |
