Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

ACA > MODULE 3 > Flashcards

MODULE 3 Flashcards

1
Q

WHAT IS A QUALIFIED HEALTH PLAN?

A

HEALTH INSURANCE PLAN THAT HAS PASSED A MARKETPLACE CERTIFICATION PROCESS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

WHAT IS MEC?

A

MINIMUM ESSENTIAL COVERAGE - TYPE OF COVERAGE AN INDIVIDUAL MUST HAVE TO MEET THE INDIVIDUAL RESPONSIBILITY UNDER ACA.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

WHAT ARE INSURANCE AFFORDABILITY PROGRAMS?

A

ACA PROVISIONS THAT LOWER THE AMOUNT THAT SOME ELIGIBLE CONSUMERS PAY FOR PREMIUMS AND / OR CO-PAYMENTS / COINSURANCE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

WHAT ARE THE PREMIUM TAX CREDIT AND COST-SHARING REDUCTIONS CALLED UNDER THE ACA?

A

INSURANCE AFFORDABILITY PROGRAMS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

WHAT ARE THE TWO WAYS FOR INDIVIDUALS TO BUY HEALTH INSURANCE?

A
  1. HEALTH INSURANCE MARKET

2. FEDERAL MARKETPLACE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

WHO OVERSEES THE FEDERAL MARKETPLACE?

A

THE FEDERAL DEPARTMENT OF HEALTH AND HUMAN SERVICES

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

WHAT DOES S.H.O.P. STAND FOR?

A

SMALL BUSINESS HEALTH OPTIONS PROGRAM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

WHAT IS DONE ON THE FEDERAL MARKETPLACE WEBSITE?

A
  1. ASSESS ELIGIBILITY FOR MEDICAID, PTC’S, CSR’S, AND INDIVIDUAL MANDATE EXEMPTIONS
  2. MANAGE ELIGIBILITY APPEALS
  3. FACILITATE ENROLLMENT IN QHP’S
  4. ENSURES APPROPRIATE PTC AND CSR PYMTS MADE TO HEALTH INS PLANS
  5. COLLECTS & PUBLISHES QUALITY DATA ON HEALTH PLANS
  6. OPERATES CONSUMER ASSISTANCE CALL CENTER
  7. IN 2015.. COLLECTS PREMIUMS FOR SMALL BUSINESSES
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

WHO CAN USE THE MARKETPLACE?

A

INDIVIDUAL US CITIZENS, NATIONALS AND LEGAL RESIDENTS OF THE US WHO ARE RESIDENTS OF INDIANA AND NOT INCARCERATED.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

CAN INDIVIDUALS PURCHASE INSURANCE ANYWHERE BESIDES THE FEDERAL MARKETPLACE?

A

YES. PLANS STILL MUST BE REGULATED BY THE IDOI; CANNOT USE PTC OR CSR. WILL NEED TO GO THROUGH AN AGENT OR BROKER OR SHOP DIRECTLY THROUGH INSURANCE COMPANIES

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

WHAT EMPLOYERS ARE ELIGIBLE FOR S.H.O.P.?

A

2014-2015 - <100 EMPLOYEES

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

CAN EMPLOYERS USE OBTAIN COVERAGE ANOTHER WAY?

A

YES. THROUGH BROKERS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

HOW CAN AN EMPLOYER QUALIFY FOR A TAX CREDIT?

A

MUST HAVE LESS THAN 25 EMPLOYEES

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

WHAT BENEFITS FOR BUSINESS OWNERS WILL BE ADDED TO S.H.O.P. IN 2015?

A
  1. ABILITY TO CHOOSE A PLAN LEVEL OR SPECIFIC PLAN FOR EMPLOYEES.
  2. ABILITY TO CHOOSE A REFERENCE PLAN TO SET EMPLOYER CONTRIBUTIONS.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

WHAT IS AN EHB?

A

ESSENTIAL HEALTH BENEFIT - 10 TYPES OF HEALTH COVERAGE THAT IS REQUIRED TO BE PART OF A QUALIFIED HEALTH PLAN.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

WHAT TYPE OF HEALTH PLANS ARE EXEMPT FROM THE AV REQUIREMENTS THAT APPLY TO OTHER NON-GRANDFATHERED INDIVIDUAL AND GROUP INSURANCE PLANS?

A

CATASTROPHIC PLANS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

WHAT ARE THE ELIGIBILITY CRITERIA FOR PURCHASING A CATASTROPHIC PLAN?

A

INDIVIDUAL UNDER 30
OR
INDIVIDUAL RECEIVED EXEMPTION FROM REQUIREMENT TO MAINTAIN MEC

18
Q

WHAT CHARACTERIZES A CATASTROPHIC PLAN?

A

DEDUCTIBLE IS CLOSE TO THE OUT OF POCKET MAXIMUMS
SOLD ON AND OFF FEDERAL MARKETPLACE
QUALIFIES AS MEC
NOT ELIGIBLE FOR PTC OR CSR

19
Q

WHAT ARE THE COMMON QUALITIES OF ALL HEALTH PLANS SOLD ON THE FEDERAL MARKETPLACE?

A 
ALL PROVIDE MEC
ALL COVER EHB'S
ALL MEET AV STANDARDS
ALL MEET PROVIDER NETWORK STANDARDS
NONE CAN CONSIDER THE HEALTH STATUS OF THE APPLICANT FOR THE PURPOSES OF PLAN ELIGIBILITY OR PLAN COST.
20
Q

WHO IS ELIGIBLE FOR PTC?

A

CITIZEN, NATIONAL, LEGAL U.S. RESIDENT, NON-INCARCERATED
AND
HOUSEHOLD INCOME 100%-400% OF FPL
AND
NO OTHER MEC IS AVAILABLE
OR
AVAILABLE MEC HAS PREMIUM OF 9.5% OF HOUSEHOLD INCOME OR DOES NOT PROVIDE 60% AV

21
Q

WHAT IS THE PURPOSE OF THE PTC?

A

TO REDUCE PREMIUM COSTS FOR INDIVIDUALS - CAN BE PAID DIRECTLY TO INS COMPANIES OR CAN BE CLAIMED LATER WHEN TAXES ARE FILED.

22
Q

HOW DO YOU APPLY FOR THE PTC?

A

AT THE FEDERAL MARKETPLACE

23
Q

CAN YOU OBTAIN THE PTC IF YOU PURCHASE HEALTH INS THROUGH AN AGENT OR BROKER?

A

NO

24
Q

HOW MUCH IS THE PTC?

A

IT EQUALS THE COST OF THE MARKETPLACE’S SILVER PLAN THAT WOULD COVER THE APPLICANT AND THEIR DEPENDENTS

25
Q

WHAT ARE THE THREE OPTIONS FOR USING THE PTC?

A

FULL ADVANCED PAYMENT
PARTIAL ADVANCED PAYMENT
CLAIM ON TAXES

26
Q

WHAT IS THE CALCULATION FOR THE PTC?

A

ANNUAL PREMIUM OF THE MARKETPLACE SILVER PLAN COVERING THE APPLICANT AND THEIR DEPENDENTS
MINUS
CONSUMER’S ANNUAL REQUIRED CONTRIBUTION (BASED ON FPL%)
EQUALS
CONSUMER’S PTC

27
Q

ACCORDING TO THE 2013 FPL, WHAT IS THE INCOME RANGE THAT COULD BENEFIT FROM THE PTC?

A

$11,490-$45,460 ANNUAL HOUSEHOLD INCOME

28
Q

WHAT HAPPENS IF THE CONSUMER CHOOSES A BRONZE PLAN IN THE MARKETPLACE AND APPLIES FOR THE PTC?

A

IT WILL LOWER THE CONSUMER’S PREMIUM CONTRIBUTION

29
Q

WHAT HAPPENS IF THE CONSUMER CHOOSES A GOLD PLAN IN THE MARKETPLACE AND APPLIES FOR THE PTC?

A

CONSUMER WILL NEED TO MAKE UP THE COST DIFFERENCE. THE PREMIUMS WILL BE INCREASED

30
Q

WHO IS ELIGIBLE FOR CSR?

A 
1.  MEETS ALL REQUIREMENTS FOR PTC
AND
2. HOUSEHOLD INCOME IS 100%-250% OF FPL
AND
3. CONSUMER ENROLLS IN SILVER (70%-AV) ON FEDERAL MARKETPLACE
31
Q

WHAT IS THE PURPOSE OF THE CSR?

A

IT INCREASES THE AV OF HEALTH COVERAGE PLANS FOR LOW-INCOME CONSUMERS & REDUCES THE OUT OF POCKET COSTS FOR CONSUMERS

32
Q

CAN YOU GET CSR AND PTC OR JUST ONE?

A

CSR IS IN ADDITION TO PTC

33
Q

IS THERE A SEPARATE APPLICATION FOR CSR?

A

NO.

34
Q

WHAT SITUATIONS WOULD ALLOW AN INDIVIDUAL TO HAVE A SPECIAL ENROLLMENT EVENT FOR ACA COVERAGE?

A 
LOSS OF MEC
GAIN OR LOSE DEPENDENT
CHANGE IN MARITAL STATUS
BIRTH
ADOPTION
FOSTER CARE PLACEMENT
CONSUMER OR DEPENDENT GAINS CITIZEN, NATIONAL, OR LAWFUL PRESENCE STATUS
35
Q

IF AN ERROR IS MADE AT THE DEPARTMENT OF HEALTH AND HUMAN SERVICES, FAILING TO ENROLL A CONSUMER IN A QHP, WOULD A SPECIAL ENROLLMENT BE ALLOWED?

A

YES

36
Q

IF A QHP SIGNIFICANTLY VIOLATES ITS CONTRACT WITH THE CONSUMER, COULD A SPECIAL ENROLLMENT BE ALLOWED?

A

YES

37
Q

WHAT HAPPENS IF YOU GAIN OR LOSE ELIGIBILITY FOR PTC AND CSR?

A

SPECIAL ENROLLMENT CIRCUMSTANCE

38
Q

WHAT HAPPENS IF A CONSUMER MOVES TO ANOTHER STATE OR INTO INDIANA?

A

ALLOWED TO HAVE A SPECIAL ENROLLMENT CIRCUMSTANCE

39
Q

HOW OFTEN CAN AMERICAN OR ALASKAN INDIANS ENROLL OR CHANGE QHP’S?

A

ONE TIME PER MONTH

40
Q

WHEN DOES COVERAGE BECOME ACTIVE FOR A CONSUMER WHEN ENROLLING IN A QHP?

A

IF PURCHASED BEFORE (EX.) JUNE 15TH, WILL BE EFFECTIVE ON JULY 1ST
IF PURCHASED AFTER (EX.) JUNE 16TH, WILL BE EFFECTIVE ON AUGUST 1ST

41
Q

IF A CONSUMER WANTS TO RE-ENROLL IN THE SAME QHP FOR A SECOND YEAR, WHAT SHOULD THEY DO?

A

NOTHING

42
Q

WHAT IF A CONSUMER WANTS TO CHANGE TO A DIFFERENT QHP DURING AN OPEN ENROLLMENT PERIOD?

A

RESPOND TO NOTICE OF ELIGIBILITY AT THE END OF A YEAR OF COVERAGE.

ACA (4 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions