ACA
The Affordable Care Act was enacted on...
March 2010
The Maryland Health Benefit Exchange (MHBE) is:
the state agency responsible for running Maryland’s state-based marketplace where users can apply and enroll in affordable health care coverage and operates the health insurance marketplace website, called Maryland Health Connection (MHC).
False representation of a good or service or deceptive pricing are examples of:
Unfair Trade Practice
A coverage group is a...
group of individuals who meet specific criteria to receive Medicaid.
QHP stands for _______________
Qualified Health Plan
The ACA allows young people to stay on their parent's health plan up to...
age 26
MHC offers a _________ application, allowing consumers to apply for multiple health care affordability programs on a single application.
"single step"
Identity theft is the...
fraudulent acquisition and use of a person's private identifying information.
If a consumer applies on August 29th and is determined Medicaid eligible, their effective date will be:
August 1st
Out of pocket maximum is...
The highest amount that a consumer will have to pay out of pocket in one plan year.
The ACA has three primary goals:
•Make affordable health insurance available to more people
•Expand Medicaid eligibility
•Support innovative medical care delivery methods including managed care systems, case management, and primary healthcare.
The MHBE operates through the Health Benefit Exchange (HBX), which includes:
Consumer Portal
Worker Portal
Broker Portal
A physician who submits a bill to Medicare for medical services they know they have not provided is an example of ________:
Most Medicaid eligible individuals in Maryland receive coverage through _______________
HealthChoice, Maryland’s Medicaid Managed Care Program.
New plan enrollments have a 31-day grace period. After the initial payment, is made, unassisted plans continue to have a grace period of 31 days. Assisted plans have a grace period of...
90 days
“Applicable large employers” (ALEs) with at least __ full-time employees are subject to employer shared responsibility provisions and are required to offer affordable coverage.
50
The ______________ administers Maryland's Medicaid programs and works with local health departments (LHDs) and caseworkers to assist consumers with Medicaid eligibility.
Maryland Department of Health (MDH)
A person violating the Maryland False Claims Act is liable to a Maryland governmental agency for a civil penalty of up to _________, plus three times the Maryland governmental agency’s damages resulting from the violation.
$10,000 per violation
Deemed newborns are newborns whose...
mothers were enrolled in Medicaid at the time of birth and are processed in the Newborn Enrollment Portal (Newborn Portal).
First initial payment made to activate a QHP is called a _______.
Binder payment
There are 10 essential benefits
1. Ambulatory Patient Services (Outpatient)
2. Emergency Services
3. Hospitalization (Inpatient)
4. Pregnancy & Newborn Care
5. Mental Health & Substance Use Disorder Services
6. Prescription Drugs
7. Rehabilitative and Habilitative Services
8. Laboratory Services
9. Preventative & Wellness
10. Pediatric Services
MHBE collaborates with other organizations including _______________, which regulates insurance companies and producers/brokers in the state, investigates complaints, and tackles insurance fraud.
Maryland Insurance Administration (MIA)
A Consumer Assistance Worker offers a consumer free event tickets if they select an MCO that employs one of their siblings is an example of:
Rebating
Parents and Caretaker relatives of dependent children under the age of 21 may qualify for Medicaid if they have incomes less than or equal to ____...
138% FPL
If I experience a Qualifying Life Event (QLE) and use the Special Enrollment Period (SEP) to enroll into a plan on August 21st, my coverage will typically become effective on _________.
October 1