Market place Individual UPDATED ACTUAL Questions And Correct Answers
C
Terms in this set (98)
The individual shared responsibility requirement under false
the Affordable Care Act requires all individuals to have
minimum essential coverage for themselves (and/or their
spouse or dependents) or make a payment through the
tax filing process.
Bill and Barbara are married and have two children under The individual shared responsibility payment for the months they and their
age 18. They do not have minimum essential coverage (or children were uninsured when they file their 2018 income tax return, which is due
any other form of coverage that helps to pay the cost of in April 2019
medical care) for any family member for any month
during 2018 and no one in the family qualifies for an The entire cost of any medical care they or their children receive during the year
exemption. Which of the following are Bill and Barbara
responsible for paying?
Which of the following are components of the Affordable Extension of dependent coverage of children up to age 26
Care Act?
Prohibition on charging consumers a higher premium based on health status or
gender
Prohibition on coverage limitations or exclusions based on pre-existing conditions
A consumer worries she may develop chronic asthma Health insurance issuers that offer individual policies in a state generally must
because she has a family history, but she knows she will offer all of their available individual market plans to all eligible individuals in the
not be denied health insurance coverage due to the state, and must accept all eligible individuals who apply for coverage.
guaranteed issue provision of the Affordable Care Act.
Guaranteed issue means that...
When signing up for insurance, a consumer understands A rebate to refund the excess back to the consumer
that if a health insurance issuer does not spend enough
of its premium dollars on health care services or quality
improvement activities, that issuer must provide...
What are EHB? Essential health benefits, a comprehensive package of 10 benefit categories that
all non-grandfathered individual and small group health plans must offer
Which of the following are categories of EHB? Ambulatory patient services
Emergency services, hospitalization, and prescription drugs
A 34-year-old woman is looking for health insurance false
coverage that is more affordable than the coverage
offered by her employer. She does not qualify for a
hardship or affordability exemption, but is eligible for
catastrophic coverage.
, AV can be defined as... The calculation of the average portion of the cost of providing EHB estimated to
be paid by the health insurance plan for a standard population
In which of the following ways must non-grandfathered Annual cost-sharing limits cannot exceed specified amounts.
health plans limit cost sharing for enrolled individuals?
The total family premium generally includes per-member true
rates for all members, but limits per-member premiums
for covered children to up to three dependent children
under the age of 21.
What is the allowable maximum surcharge for non- The maximum surcharge is one and a half times the non-tobacco user's rate.
grandfathered coverage for an individual who legally
uses tobacco?
To become certified, a QHP must meet which of the Benefit design standards, including non-discrimination requirements and limits on
following criteria? cost sharing
Coverage, at a minimum, of a comprehensive package of benefits, known as EHB
Network adequacy standards
Available for enrollment through the Marketplace for the full plan year for which
the plan was certified
To become certified as a QHP, a plan that has a provider true
network must have an adequate provider network, which
includes substance abuse disorder and mental health
providers, and a sufficient number and geographic
distribution of essential community providers to ensure
reasonable and timely access to a broad range of such
providers for low-income and medically underserved
populations in the QHP's service area.
Which of the following is NOT true about Marketplaces? HHS operates all Marketplaces.
Medicare Medicare is a health insurance program for people age 65 or older, people under
age 65 with certain disabilities, people of all ages with end-stage renal disease
(permanent kidney failure requiring dialysis or a kidney transplant), and certain
individuals exposed to environmental health hazards.
Department of Defense (DoD) TRICARE DoD TRICARE is health care for active or retired members of the military (i.e.,
people in the Army, Navy, Marine Corps, Air Force, Coast Guard, Public Health
Service, or the National Oceanic and Atmospheric Administration).
Veterans Health Administration (VHA) VHA is the health system for military veterans (from the Army, Navy, Marines, Air
Force, or Coast Guard). All veterans should apply to the VHA to determine
eligibility.
C
Terms in this set (98)
The individual shared responsibility requirement under false
the Affordable Care Act requires all individuals to have
minimum essential coverage for themselves (and/or their
spouse or dependents) or make a payment through the
tax filing process.
Bill and Barbara are married and have two children under The individual shared responsibility payment for the months they and their
age 18. They do not have minimum essential coverage (or children were uninsured when they file their 2018 income tax return, which is due
any other form of coverage that helps to pay the cost of in April 2019
medical care) for any family member for any month
during 2018 and no one in the family qualifies for an The entire cost of any medical care they or their children receive during the year
exemption. Which of the following are Bill and Barbara
responsible for paying?
Which of the following are components of the Affordable Extension of dependent coverage of children up to age 26
Care Act?
Prohibition on charging consumers a higher premium based on health status or
gender
Prohibition on coverage limitations or exclusions based on pre-existing conditions
A consumer worries she may develop chronic asthma Health insurance issuers that offer individual policies in a state generally must
because she has a family history, but she knows she will offer all of their available individual market plans to all eligible individuals in the
not be denied health insurance coverage due to the state, and must accept all eligible individuals who apply for coverage.
guaranteed issue provision of the Affordable Care Act.
Guaranteed issue means that...
When signing up for insurance, a consumer understands A rebate to refund the excess back to the consumer
that if a health insurance issuer does not spend enough
of its premium dollars on health care services or quality
improvement activities, that issuer must provide...
What are EHB? Essential health benefits, a comprehensive package of 10 benefit categories that
all non-grandfathered individual and small group health plans must offer
Which of the following are categories of EHB? Ambulatory patient services
Emergency services, hospitalization, and prescription drugs
A 34-year-old woman is looking for health insurance false
coverage that is more affordable than the coverage
offered by her employer. She does not qualify for a
hardship or affordability exemption, but is eligible for
catastrophic coverage.
, AV can be defined as... The calculation of the average portion of the cost of providing EHB estimated to
be paid by the health insurance plan for a standard population
In which of the following ways must non-grandfathered Annual cost-sharing limits cannot exceed specified amounts.
health plans limit cost sharing for enrolled individuals?
The total family premium generally includes per-member true
rates for all members, but limits per-member premiums
for covered children to up to three dependent children
under the age of 21.
What is the allowable maximum surcharge for non- The maximum surcharge is one and a half times the non-tobacco user's rate.
grandfathered coverage for an individual who legally
uses tobacco?
To become certified, a QHP must meet which of the Benefit design standards, including non-discrimination requirements and limits on
following criteria? cost sharing
Coverage, at a minimum, of a comprehensive package of benefits, known as EHB
Network adequacy standards
Available for enrollment through the Marketplace for the full plan year for which
the plan was certified
To become certified as a QHP, a plan that has a provider true
network must have an adequate provider network, which
includes substance abuse disorder and mental health
providers, and a sufficient number and geographic
distribution of essential community providers to ensure
reasonable and timely access to a broad range of such
providers for low-income and medically underserved
populations in the QHP's service area.
Which of the following is NOT true about Marketplaces? HHS operates all Marketplaces.
Medicare Medicare is a health insurance program for people age 65 or older, people under
age 65 with certain disabilities, people of all ages with end-stage renal disease
(permanent kidney failure requiring dialysis or a kidney transplant), and certain
individuals exposed to environmental health hazards.
Department of Defense (DoD) TRICARE DoD TRICARE is health care for active or retired members of the military (i.e.,
people in the Army, Navy, Marine Corps, Air Force, Coast Guard, Public Health
Service, or the National Oceanic and Atmospheric Administration).
Veterans Health Administration (VHA) VHA is the health system for military veterans (from the Army, Navy, Marines, Air
Force, or Coast Guard). All veterans should apply to the VHA to determine
eligibility.
