NYSOH Assistors Exam Questions & Detailed Answers
| New York State of Health Certification Study Guide |
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Updated| Latest Exam and Brand new Version!!!!
What is the age limit for Child Health Plus?
ANSWER:
under 19
Are there co-pays and coinsurance or deductibles for CHP?
ANSWER:
No
What is the income guidelines for CHP?
ANSWER:
no income limit, premium contribution varies on household size and
FPL
What makes you ineligible for CHP?
ANSWER:
can't be eligible for Medicaid, can't have other insurance, don't have
access to or aren't enrolled in NYSHIP
What is the FPL of CHP for no premium?
ANSWER:
<160%
What is the QHP open enrollment period?
,ANSWER:
November 1- January 31st
When QHP Enroll is completed, when does coverage begin?
Nov. 1-Dec. 15
Dec. 16- Jan 15
Jan 16-Jan 31
ANSWER:
Jan. 1
Feb 1
March 1
When are payments due for full pay QHP?
ANSWER:
consumers have a 10 day grace period for the first month and then
30 days every month after
When are payments due for a subsidized QHP?
ANSWER:
consumers have a 10 day grace period for the first month and then
90 days after that
What must quality rating include?
ANSWER:
effectiveness, access and availability of care, cost of care, use of
frequency of services, satisfaction
What features does a QHP has to have?
ANSWER:
Adequate networks, quality ratings
What does the Platinum, Gold, Silver and Bronze pay?
ANSWER:
,Platinum 90-10
Gold 80-20
Silver 70-30
Bronze 60-40
What are the QHP deductibles for the metal levels?
ANSWER:
Platinum 0
Gold $600
Silver $2000
Bronze $4000
What must all insurance offer across all metal levels?
ANSWER:
same benefits, same cost sharing
How can Standard QHP's vary?
ANSWER:
premiums, provider networks, formularies and quality ratings
What are the Eligibility for PTC and CSR Tax Filing requirements?
ANSWER:
consumers must attest that they will file taxes
if married, must file jointly unless they have a special exception
What are premium tax credits?
ANSWER:
Lower the cost of premiums, making health insurance more
affordable
What is the FPL for PTCs?
ANSWER:
more than 200% and at or below 400% FPL
, How can you help consumers choose a plan?
ANSWER:
help consumers identify priorities
help consumers use marketplace tools to narrow down plan options
help consumers enroll in a plan
What is Cost Sharing Reduction?
ANSWER:
helps reduce out of pocket costs including co-pays, co-insurance,
deductibles, MOOP
What is Non Standard QHPs?
ANSWER:
has different networks, variations on cost sharing, additional
benefits not included in EHBs, limited substitutions in 2 benefit
categories.
What is APTC reconciliation?
ANSWER:
consumers who receive APTC must report all life events, such as
change in household size, income, or job related insurance
What will people receive at the end of year who receive APTC?
ANSWER:
APTC recipients will receive a 1095A tax form from the Marketplace
to reconcile their APTC
What is the Medicaid enrollment period and when does coverage
begin?
ANSWER:
| New York State of Health Certification Study Guide |
100% Guarantee Pass| Graded A+, Verified and
Updated| Latest Exam and Brand new Version!!!!
What is the age limit for Child Health Plus?
ANSWER:
under 19
Are there co-pays and coinsurance or deductibles for CHP?
ANSWER:
No
What is the income guidelines for CHP?
ANSWER:
no income limit, premium contribution varies on household size and
FPL
What makes you ineligible for CHP?
ANSWER:
can't be eligible for Medicaid, can't have other insurance, don't have
access to or aren't enrolled in NYSHIP
What is the FPL of CHP for no premium?
ANSWER:
<160%
What is the QHP open enrollment period?
,ANSWER:
November 1- January 31st
When QHP Enroll is completed, when does coverage begin?
Nov. 1-Dec. 15
Dec. 16- Jan 15
Jan 16-Jan 31
ANSWER:
Jan. 1
Feb 1
March 1
When are payments due for full pay QHP?
ANSWER:
consumers have a 10 day grace period for the first month and then
30 days every month after
When are payments due for a subsidized QHP?
ANSWER:
consumers have a 10 day grace period for the first month and then
90 days after that
What must quality rating include?
ANSWER:
effectiveness, access and availability of care, cost of care, use of
frequency of services, satisfaction
What features does a QHP has to have?
ANSWER:
Adequate networks, quality ratings
What does the Platinum, Gold, Silver and Bronze pay?
ANSWER:
,Platinum 90-10
Gold 80-20
Silver 70-30
Bronze 60-40
What are the QHP deductibles for the metal levels?
ANSWER:
Platinum 0
Gold $600
Silver $2000
Bronze $4000
What must all insurance offer across all metal levels?
ANSWER:
same benefits, same cost sharing
How can Standard QHP's vary?
ANSWER:
premiums, provider networks, formularies and quality ratings
What are the Eligibility for PTC and CSR Tax Filing requirements?
ANSWER:
consumers must attest that they will file taxes
if married, must file jointly unless they have a special exception
What are premium tax credits?
ANSWER:
Lower the cost of premiums, making health insurance more
affordable
What is the FPL for PTCs?
ANSWER:
more than 200% and at or below 400% FPL
, How can you help consumers choose a plan?
ANSWER:
help consumers identify priorities
help consumers use marketplace tools to narrow down plan options
help consumers enroll in a plan
What is Cost Sharing Reduction?
ANSWER:
helps reduce out of pocket costs including co-pays, co-insurance,
deductibles, MOOP
What is Non Standard QHPs?
ANSWER:
has different networks, variations on cost sharing, additional
benefits not included in EHBs, limited substitutions in 2 benefit
categories.
What is APTC reconciliation?
ANSWER:
consumers who receive APTC must report all life events, such as
change in household size, income, or job related insurance
What will people receive at the end of year who receive APTC?
ANSWER:
APTC recipients will receive a 1095A tax form from the Marketplace
to reconcile their APTC
What is the Medicaid enrollment period and when does coverage
begin?
ANSWER:
