1
What does the affordability percentage refer to?
The premium of an employer-sponsored plan is greater than 8.39% (for 2024) of the employee's income.
What is the difference between metal tiers?
The premium cost vs. out-of-pocket cost
HP's may charge a Rx deductible (separate from the HP's deductible) and they both apply to the OOP maximum the member has to pay in a plan's year (T/F)
True
What is the EXCEPTION to the rule that married couples must file jointly in order to be eligible for financial assistance?
The rule does not apply in the case of spousal abandonment or abse
When a Certified counselor provides the consumer with enrollment assistance, what must be completed with the consumer?
Authorization For Enrollment Assistance Form aka Consent Form
indicate the type of authorization provided
- Written
- Oral
Miguel enrolled in a silver metal tier plan, what is the average percentage of his healthcare expense that he should expect to pay?
If one member of the family is eligible for Medi-Cal, the entire family is eligible for Medi-Cal (T/ F)
False
Income eligibility limits are higher for children, so they may qualify for Medi-Cal while their parents do not. This is a mixed household.
What does MAGI stand for?
Modified Adjusted Gross Income
Are American Indians/ Alaskan Natives (AI/AN) subject to the State of CA: Individual Mandate
No
Will the State of CA: Individual Mandate apply to DACA recipients for 2025?
Yes
What two health plan types allow enrollees to choose an in-network specialist without a referral from a Primary Care Physician?
EPO & PPO
How long are we required to retain consumer authorization forms?
Consumer authorization forms should be retained for 10 years
What are the actuarial values of each metal tier?
Bronze - 60
Silver - 70
Gold - 80
Platinum - 90
An applicant can let CovCA re-verify their application information for up to 10 years for timely renewal (T/F)
False
Applicants are asked to give consent for up to five years.
In addition to the tax filer and his or her spouse, who else is included in the tax household?
A. All roommates
B. Declared Dependents
C. Adult children (over 26)
D. Unborn children
What benefit is free across all tiers?
The annual wellness exam
How long after the loss of MEC does a new applicant have before they must apply and select a QHP through CovCA?
60 days
Who is eligible for minimum coverage plans?
People under the age of 30
Health insurance rates for the year are subject to change, even if previously set. (T/F)
False
Once a health insurance rate is set for the year it does not change
Are DACA recipients eligible to enroll in CovCA?
Yes
They can now sign up for a health plan through CovCA starting Nov. 1, 2024
Consumers must be eligible for financial assistance to enroll in a QHP through CovCA (T/F)
False
Free services provided through pediatric dental plans include what?
X-rays
Name two qualifying life events that provide a Special Enrollment Period for a consumer
- Got married
- Had a baby
- Lost coverage (including Medi-Cal)
- Moved to California
In addition to completing an application, a consumer needs to do what to effectuate their coverage with CovCA?
A consumer must make their first month's health insurance premium by the due date.
How often a consumer uses their healthcare benefits is one factor in determining the best metal tier option (T/F)
True
Why?