Definitions
What permits an individual to apply a credit toward monthly health insurance premiums--up to a maximum amount?
Advance Premium Tax Credits
solicitation, negotiations, or effectuation of a contract A. Premium Tax Credit
B. 30 or more hours per week
C. Insurance Transaction
D. Essential Health Benefits
Insurance Transaction
What is the highest amount a person can pay during a policy period before the health plan begins paying 100% for covered essential health benefits?
Out-of-pocket limit
Who may sell qualified health plans through the Marketplace?
Licensed agents and brokers
What term is used to describe the 10 statutory benefits provided by a qualified health plan?
A. Essential Health Benefits
B. Copayments
C. Patient Navigator
D. Minimum Value
1. Essential Health Benefits
The ACA does not allow insurers to underwrite or rate health insurance based on which of the following factors?
Gender
Under the ACA, what are individuals and families eligible for if they have household incomes that represent a specific percentage of the Federal Poverty Level?
A. Administering an Insurance Exam
B. HIPPAA Privacy rule protects protected health info (PHI)
C. Minimum Necessary Use and Disclosure
D. Premium Tax Credit
Premium Tax Credit
Conflict of interest provisions in the ACA do NOT allow which one of the following to become navigators?
Anyone receiving compensation from a health insurer.
What is the primary purpose of navigators?
Provide education, outreach, and assistance
Factor of an individual's eligibility for APTCs.
A. Insurance Transaction
B. Affordable
C. 30 or more hours per week
D. Copayment
Affordable
What is the name of the ACA provision that requires all health plans to use a certain percentage of all premium dollars collected as payments on claims for health care costs?
Medical Loss Ratio (MLR)
What is a fixed dollar amount an insured person must pay for a specific covered service at the time it is provided?
A. Gramm-Leach-Bailey Act (GLBA)
B. Copayments
C. Temporary License
D. Because of their specialized knowledge about health insurance
Copayments
similar to POS because it's PPO plan that doesn't allow the use of OON providers without prior approval from EPO. May require pcp for routine health care without restricting in network specialist.
A. Exclusive Provider Organization (EPO)
B. HHS establish 4 variables to identify medically underserved
C. Examination of Record
D. Consolidated Omnibus Budget Reconciliation Act (COBRA)
A. Exclusive Provider Organization (EPO)
Which of the following organizations is NOT permitted to act as a navigator entity?
Insurance company
What permits an individual to apply a credit toward monthly health insurance premiums--up to a maximum amount?
A. Premium
B. Advance Premium Tax Credit
C. Copayment
D. Cost Sharing Reduction
Advance Premium Tax Credit
The ACA expanded which two government programs?
Medicaid and CHIP
allow employers with similar business characteristics to pool their employees into a single larger entity, enabling all participating business to pay lower premiums.
A. Multiple Employer Trusts (METs)
B. Copayments
C. Essential Health Benefits
D. Insurance Transaction
Multiple Employer Trusts (METs)
Full-time employees are defined by the ACA as those who work an average of:
30 or more hours per week
What term is used to define the percentage of total costs used by a qualified health plan to pay the cost of benefits? --EX: Insurance company pays 80%; Consumer pays 20%
Actuarial Value
The ACA does not allow insurers to underwrite or rate health insurance based on which of the following factors?
A. Age
B. Copayments
C. Tobacco Use
D. Gender
Gender
Under the ACA, what are individuals and families eligible for if they have household incomes that represent a specific percentage of the Federal Poverty Level?
If an agent dies or is unable to transact business due to illness, disability, term or an appointment by an insurer, or active duty service in the military, an unlicensed person may be granted a temporary insurance license to act on behalf of that agent.
A. Patient Navigator
B. Multiple Employer Trusts (METs)
C. Commissioner
D. Temporary License
D. Temporary License
Any time outside open enrollment and during which an individual is permitted to sign up for a QHP through a Marketplace.
Special Enrollment Period
Under the ACA, which of the following terms BEST describes any individual whose ability to make fully informed health care decisions is diminished due to acute or chronic health conditions?
A vulnerable person
What is the name of the ACA provision that requires all health plans to use a certain percentage of all premium dollars collected as payments on claims for health care costs?
A. Modified adjusted gross income (MAGI)
B. Premium Tax Credits
C. Medical Loss Ratio (MLR)
D. Minimum Value (MV) calculator
Medical Loss Ratio