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ACA > MODULE 2 > Flashcards

MODULE 2 Flashcards

1
Q

WHAT ARE THE REQUIREMENTS FOR THOSE WHO WILL ASSIST THE PUBLIC IN OBTAINING HEALTH COVERAGE UNDER THE ACA?

A

COMPLETE TRAINING AND CERTIFICATION
COMPLETE INDIANA NAVIGATOR CERTIFICATIONS
ORGANIZATIONS MUST REGISTER AS APPLICATION ORGANIZATIONS

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2
Q

DO CONSUMERS NEED TO USE A CONSUMER ASSISTANT TO APPLY FOR HEALTH COVERAGE?

A

NO

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3
Q

IF A CONSUMER CHOOSES TO USE A CONSUMER ASSISTANT, HOW CAN THEY PROTECT THEMSELVES FROM FRAUD?

A

ASK IF THE PERSON IS CERTIFIED BY INDIANA AS AN INDIANA NAVIGATOR OR LICENSED HEALTH INSURANCE AGENT
FIND OR VERIFY A CERTIFIED OR LICENSED INDIVIDUAL AT THE IDOI WEBSITE
ASK TO SEE A COPY OF THEIR CERTIFICATION OR LICENSE

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4
Q

WHAT IS THE ROLE OF AN INDIANA NAVIGATOR?

A

TO PROVIDE CONSUMERS W/ FAIR, ACCURATE INFORMATION ABOUT HEALTH COVERAGE OPTIONS.

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5
Q

WHAT ARE THE RESPONSIBILITIES OF AN INDIANA NAVIGATOR?

A

ASSIST CONSUMERS W/ APPLICATIONS FOR THE FEDERAL MARKETPLACE FOR QUALIFIED HEALTH PLANS, PREMIUM TAX CREDITS, AND COST SHARING REDUCTIONS
ASSIST CONSUMERS IN APPLYING FOR MEDICAID AND HIP

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6
Q

WHO MUST BE CERTIFIED AS AN INDIANA NAVIGATOR?

A

ANYONE WORKING DIRECTLY WITH THE FEDERAL MARKETPLACE AND THE INDIANA HEALTH COVERAGE PROGRAM (IHCP) TO COMPLETE APPLICATIONS

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7
Q

WHAT WILL PROHIBIT SOMEONE FROM BECOMING AN INDIANA NAVIGATOR?

A

HAVING A DENIED, SUSPENDED OR REVOKED INSURANCE AGENT OR BROKER LICENSE OR NAVIGATOR CERTIFICATION
BEING CONVICTED OR A DISQUALIFYING FELONY OR OTHER CRIME
ADMITTING TO/OR BEING CONVICTED OF UNFAIR TRADE PRACTICES OR FRAUD IN THE INSURANCE BUSINESS

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8
Q

WHAT STEPS NEED TO BE COMPLETED TO BECOME AN INDIANA NAVIGATOR?

A

COMPLETE APPLICATION
COMPLETE CRIMINAL BACKGROUND CHECK
SIGN CONFLICT OF INTEREST POLICY
COMPLETE CONFLICT OF INTEREST DISCLOSURE FORM
SIGN PRIVACY AND CONFIDENTIALITY AGREEMENT
PAY NON-REFUNDABLE REGISTRATION FEE

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9
Q

WHAT TRAINING IS REQUIRED TO BE AN INDIANA NAVIGATOR?

A

PRE-CERTIFICATION TRAINING COURSE WITH IDOI AUTHORIZED TRAINER
TRAINER MUST REPORT TRAINING TO IDOI

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10
Q

WHAT PERCENTAGE OF CORRECT ANSWERS MUST BE SCORED IN ORDER TO PASS THE CERTIFICATION EXAM?

A

70%

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11
Q

WHAT REMINDERS WILL BE RECEIVED BY AN INDIANA NAVIGATOR?

A

CERTIFICATION EXPIRATION - 60 DAYS PRIOR

CERTIFICATION EXPIRED GRACE PERIOD - 30 DAYS AFTER EXPIRATION

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12
Q

HOW CAN THE INDIANA NAVIGATOR LICENSE BE RENEWED?

A

COMPLETE THE RENEWAL APPLICATION
SUBMIT A FEE
COMPLETE 2 HOURS OF CE
REPORT THE CE TO IDOI

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13
Q

WHAT IS AN APPLICATION ORGANIZATION? (AO)

A

AN ORGANIZATION WITH EMPLOYEES OR VOLUNTEERS WHO ASSIST CONSUMERS WITH APPLICATIONS ON THE FEDERAL MARKETPLACE OR WITH INDIANA HEALTH COVERAGE PROGRAMS.

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14
Q

HOW CAN AN ORGANIZATION BECOME AN AO?

A

COMPLETE THE AO REGISTRATION FORM
SIGN CONFLICT OF INTEREST POLICY
COMPLETE CONFLICT OF INTEREST DISCLOSURE FORM
SIGN PRIVACY & CONFIDENTIALITY AGREEMENT
PAY REGISTRATION FEE
REPORT ALL NAVIGATORS WORKING ON BEHALF OF THE AO TO IDOI, UPDATING WITHIN 30 DAYS OF CHANGE.

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15
Q

WHAT REQUIREMENTS DO AO’S HAVE FOR THE APPLICATIONS?

A

PAY THE FEES, ATTEST THAT ALL NAVIGATORS ARE ELIGIBLE

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16
Q

WHAT REQUIREMENTS DO AO’S HAVE FOR THE PRE-CERTIFICATION?

A

ATTEST THAT ALL NAVIGATORS HAVE COMPLETED THE TRAINING

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17
Q

WHAT REQUIREMENTS DO AO’S HAVE FOR THE CERTIFICATION EXAMS?

A

N/A

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18
Q

WHAT REQUIREMENTS DO THE AO’S HAVE FOR THE ANNUAL RE-CERTIFICATION?

A

COMPLETE NEW APPLICATION
PAY FEE
UPDATE NAVIGATOR REPORTS W/IN 30 DAYS

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19
Q

WHEN SHOULD THE CONFLICT OF INTEREST POLICY BE SUBMITTED?

A

WITH THE APPLICATION/REGISTRATION

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20
Q

WHAT DOES THE CONFLICT OF INTEREST POLICY SAY?

A

IT DEFINES PERSONAL/BUSINESS INTERESTS THAT MAY INFLUENCE ADVICE & ASSISTANCE

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21
Q

WHAT HAPPENS IF CONFLICTS OF INTEREST ARE PROHIBITED BY POLICY?

A

NAVIGATOR OR AO IS DQ’ED

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22
Q

WHAT HAPPENS IF CONFLICTS OF INTEREST ARE NOT PROHIBITED BY POLICY?

A

MUST BE REPORTED TO IDOI AND DISCLOSED TO CONSUMERS. THE CONFLICT OF INTEREST DISCLOSURE FORM MUST BE SUBMITTED.

23
Q 
WHICH OF THE FOLLOWING CAN BE ACCEPTED BY AO'S OR NAVIGATORS FROM INSURANCE COMPANIES?
GRANTS
CASH
COMMISSION
CREDIT/LOANS
GOODS OR OTHER ADVERTISEMENT WITH A VALUE OF LESS THAN $100 PER YEAR PER INSURANCE ISSUER.
GIFTS
FREE/DISCOUNTED TRAVEL/PRIZES
A

GOODS OR OTHER ADVERTISEMENT WITH A VALUE OF LESS THAN $100 PER YEAR PER INSURANCE ISSUER.

24
Q

IF AN INSURANCE BROKER OR AGENT RECEIVES COMPENSATION FROM A HEALTH INS OR STOP LOSS COMPANY FOR ENROLLING IN SPECIFIC PLANS, WHAT IS THIS CALLED AND IS IT ALLOWED?

A

DIRECT FINANCIAL INCENTIVE

NO

25
Q

IF AN AO STAFF OR BOARD MEMBER HOLDS STOCK IN AN INSURANCE CO AND MAY INDIRECTLY BENEFIT IF THE NAVIGATOR HELPS CONSUMER PURCHASE A PLAN FROM THE INS CO, IS THIS ALLOWED? WHAT IS THIS CALLED?

A

YES… WITH DISCLOSURE

INDIRECT FINANCIAL INCENTIVE

26
Q

IF A NAVIGATOR RECEIVES AN HOURLY RATE FROM THEIR EMPLOYER REGARDLESS OF HOW MANY PEOPLE ARE HELPED OR THE PLAN THAT THEY CHOOSE, IS THIS ALLOWED?

A

YES

27
Q

WHAT IS A CONFLICT OF LOYALTY?

A

A BUSINESS OR FAMILY INTEREST THAT KEEPS THE NAVIGATOR OR AO FROM ACTING IN THE BEST INTEREST OF THE CONSUMER

28
Q

WHAT SHOULD BE DONE IF THERE IS A CONFLICT OF LOYALTY?

A

COMPLETE THE CONFLICT OF INTEREST DISCLOSURE FORM AND SUBMIT TO IDOI

29
Q

WHO MUST SIGN THE PRIVACY AND SECURITY AGREEMENT?

A

ALL INDIANA NAVIGATORS AND AO’S

30
Q

WHAT DOES THE PRIVACY & SECURITY AGREEMENT DO?

A

PROTECT PERSONAL INFORMATION

31
Q

WHAT SHOULD BE DONE IF THERE IS A BREACH OF PERSONAL INFORMATION?

A

CONTACT THE IDOI AND CONSUMER IMMEDIATELY

32
Q

CAN NAVIGATORS OR AO’S SUGGEST A SPECIFIC PLAN OR GENERAL INFORMATION?

A

GENERAL INFORMATION

33
Q

IS IT OK TO RECEIVE CONSIDERATION FROM A HEALTH INSURANCE COMPANY?

A

NO

34
Q

WHERE WILL COMPLAINTS ABOUT CONSUMER ASSISTANTS BE FILED?

A

IDOI

35
Q

WHO WILL TRACK INACCURATE, INCOMPLETE APPLICATIONS?

A

IDOI

36
Q

IN WHAT WAYS WILL THE IDOI RESPOND TO COMPLAINTS?

A 
REPRIMAND
CIVIL PENALTY
SUSPENSION OF CERTIFICATION
REVOCATION OF CERTIFICATION (TEMP OR PERM)
CEASE AND DESIST ORDER
37
Q

WHO IS AUTHORIZED TO SELL INSURANCE PLANS IN INDIANA?

A

LICENSED BROKERS OR AGENTS

38
Q

WHAT INSURANCE PLANS CAN BROKERS/AGENTS SELL?

A

PLANS ON EXISTING HEALTH INSURANCE MARKET FROM COMPANIES THAT THEY HAVE SIGNED AN AGREEMENT WITH THE ISSUING COMPANY

39
Q

HOW ARE AGENTS/BROKERS COMPENSATED?

A

COMMISSIONS PAID DIRECTLY FROM INSURANCE COMPANIES FOR EACH PLAN SOLD

40
Q

WHAT CHANGES WILL AGENTS/BROKERS FACE ON 10/1/13?

A

MUST BE LICENSED AND COMPLETE FEDERAL REGISTRATION/TRAINING AND CERTIFICATION EXAMS BEFORE SELLING ON THE MARKETPLACE
WILL BE USING MARKETPLACE OR INSURANCE COMPANY WEBSITES TO SELL POLICIES
MUST INFORM CONSUMERS OF OPTION TO ACCESS FEDERAL MARKETPLACE AND QHP

41
Q

WHO IS AN AUTHORIZED REPRESENTATIVE?

A

SOMEONE WHO ACTS IN THE PLACE OF THE APPLYING INDIVIDUAL

42
Q

WHAT ROLE DOES AN AR PLAY?

A

ASSIST WITH APPLICATION

SUPPORT ONGOING HEALTH COVERAGE NEEDS

43
Q

HOW DO YOU BECOME AN AR?

A

PROVIDE SUPPORTING LEGAL DOCUMENTATION SUCH AS A POA

COMPLETE AN AR FORM

44
Q

T/F - IT IS THE NAVIGATOR’S RESPONSIBILITY TO TRY TO THE BEST OF THEIR ABILITY TO BE SURE THAT THE CONSUMER IS MAKING AN INFORMED DECISION

A

T

45
Q

T/F - IT IS THE NAVIGATOR’S RESPONSIBILITY TO TRY TO THE BEST OF THEIR ABILITY TO ACT IN A PROFESSIONAL MANNER, PROTECTING PRIVACY AND CONFIDENTIALITY

A

T

46
Q

OTHER THAN FINANCIAL CHALLENGES, WHAT OTHER BARRIERS TO HEALTH COVERAGE MIGHT A CONSUMER BE FACING?

A

LANGUAGE

DISABILITY

47
Q

WHERE CAN RESOURCES BE FOUND TO ADDRESS CONSUMER BARRIERS?

A

FEDERAL MARKETPLACE CALL CENTER
FEDERAL MARKETPLACE WEBSITE
AREA AGENCY ON AGING
DIVISION OF DISABILITY & REHAB SVCS

48
Q

WHERE CAN I FIND OUT MORE ABOUT THE ACA?

A

FEDERAL MARKETPLACE CALL CENTER

49
Q

WHERE CAN I LEARN MORE ABOUT HEALTH INSURANCE TERMS?

A

GLOSSARY OF COMMONLY USED TERMS FROM A HEALTH INSURANCE COMPANY

50
Q

WHERE CAN I FIND OUT THE DETAILS OF MY HEALTH PLAN?

A

HEALTH PLAN SUMMARY OF PLAN BENEFITS

51
Q

IF A CONSUMER WANTS MORE INFORMATION ON PLAN QUALITY, WHERE CAN I SEND THEM?

A

FEDERAL MARKETPLACE - CONSUMER EXPERIENCE

52
Q

IF A CONSUMER WANTS MORE RECOMMENDATIONS ON PLAN EXPERIENCE, WHERE CAN I SEND THEM?

A

FEDERAL MARKETPLACE - FIND AGENT/BROKER

53
Q

IF A CONSUMER HAS A COMPLAINT ABOUT THEIR HEALTH INSURANCE, WHERE SHOULD THEY START?

A

THE INSURANCE COMPANY AND THEN GO TO THE IDOI

54
Q

WHAT IS THE PHONE NUMBER FOR THE FEDERAL CALL CENTER?

A

800-318-2596

ACA (4 decks)

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