NEWEST 2025/2026 ACTUAL EXAM COMPLETE
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Terms in this set (236)
Indiana Health Coverage Program: programs under
Indiana Medicaid developed to address the medical
Define IHCP needs of low income, aged, disabled, pregmant and
other populations meeting the different eligibility
criteria of each program. www.dfrbenefits.in.gov
Indiana Medicaid: Hoosier Healthwise, Childrens's
What programs fall under
Health Insurance Program, Healthy Indiana Plan,
the Indiana Health
Hoosier Care Connect, Traditional Medicaid, and
Coverage Programs?
Home and Community Based Waiver Services (HCBS)
Federally-facilitated Marketplace: federally
developed and operated insurance marketplace that
makes Qualified Health Providers, Premium Tax
Define FFM 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.
, an individual/entity licensed by the state/Indiana
Dept. of Insurance (IDOI) as a health insurance
producer to sell, solicit, or negotiate insurance
Define Producer, Agent, (products) and are therefore unable to be certified as
Broker, Agency 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.
an individual certified by the state of Indiana to
provide application assistance through the Federally
Define Indiana Navigator Facilitated Marketplace (FFM: QHPs, PTCs, CSRs)
and/or the Indiana Health Coverage Program
(Medicaid, CHIP, HIP, HHW, Hoosier Care Connect)
Application Organization: an entity that must be
certified and registered with the state of Indiana to
Define AO
assist Hoosiers with applications on the FFM and/or
for IHCPs
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
Define CAC
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.
a role with the same certification requirements as a
Define Non-Navigator Navigator that complements Navigator programs in
Assistance Personnel Partnership Marketplace states; not available in
Indiana and other FFM Model states
Navigator Precertification Education: education and
training programs approved by the IDOI that must be
Define Navigator PE completed by individuals as part of the initial Indiana
Navigator certification application process and prior
to taking the Navigator Examination.
, Navigator Continuing Education: education and
training programs approved by the IDOI that must be
Navigator CE completed by certified Indiana Navigators to satisfy
their yearly two-hour Navigator CE requirement to
renew their licensure.
A state policy that establishes what may constitute an
actual or potential Conflict of Interest (Financial
What is a Conflict of
Interest or Conflict of Loyalty) and disclosure and
Interest Policy?
other requirements surrounding such conflicts by
which all Indiana Navigators and AOs must comply.
What is an example of a Conflict of loyalty- an Indiana Navigator and/or an AO
conflict of interest and have a close relationship with a hospital that prefers a
what type is it? high payment rate plan
Direct financial incentive, indirect financial incentive,
What are the kinds of
no additional financial incentive, and conflict of
conflict of interests?
loyalty.
A conflict of interest: an individual receives
Define direct financial compensation from a health insurance company for
incentive. enrolling a consumer in a specific/stop-loss plan. Not
allowed (ie agents or brokers)
Conflict of interest: must be disclosed to IDOI and all
consumers prior to assisting with coverage that an AO
Define indirect financial
or Navigator holds stock in an insurance company
incentive.
and may indirectly benefit if consumer purchases a
plan with the assistance of a Navigator.
Conflict of interest that is permissible: an Indiana
Define no additional Navigator receives an hourly wage from an
financial incentive. employer/AO, regardless of number of consumers
helped or plans selected
A business or personal interest that keeps the IN
Define conflict of loyalty. Navigator or AO from acting in the best interest of the
consumer that must be reported.