CAW Certification Exam Questions with Correct Answers Latest Update 2025-2026
10 essential benefits plans must cover - Answers preventive care, maternity & newborn care, emergency
care, pediatric care, hospitalization, mental health care, prescription drugs, substance use disorder
treatment, doctor visits, laboratory test
The Affordable Care Act (ACA) - Answers allows states to expand healthcare coverage through the
creation of health insurance marketplaces and the expansion of Medicaid. It does this by allowing states
to create health insurance marketplaces and expand who they can offer Medicaid to.
Main components of the Affordable Care Act - Answers The ACA requires states to establish and operate
a Health Insurance Exchange for those who do not have health insurance. Exchanges provide coverage
options for those who do not have health coverage or lose health coverage during the year. In Maryland,
this exchange is called the Maryland Health Benefit Exchange (MHBE).
Small Business Health Options Program (SHOP) - Answers This program includes incentives for small
employers (up to 50 employees) to offer employer-based coverage. To qualify for SHOP, a small business
must have at least 1 full-time equivalent (FTE) employee other than owners, spouses, and family
members.
Pre-Existing Conditions - Answers Under ACA, insurance plans are required to cover people with pre-
existing health conditions - Pre-existing conditions are health problems (e.g., diabetes or cancer) that
started before an individual's health insurance went into effect. The Affordable Care Act guarantees that
consumers with pre-existing conditions can apply for and purchase health insurance if they are
otherwise eligible
Coverage for young adults - Answers The ACA allows children to stay on their parent's health insurance
plan until age 26. Previously, insurance companies could limit the age.
Employer mandate - Answers Under the employer shared responsibility provision of the ACA, large
employers must offer health insurance that is affordable and provides minimum value to their full-time
employees, or be subject to penalties. Large employers are generally defined as those with 50 or more
full-time employees/ full-timeequivalents.
Minimum Essential Coverage (MEC) - Answers The ACA requires consumers to have health coverage that
is considered Minimum Essential Coverage (MEC), which generally means the plan has an "Actuarial
Value" of 60% or more and covers the 10 Essential Health Benefits (EHBs).
Plans that qualify as minimum essential coverage - Answers include employer-sponsored plans,
individual major medical plans (including Qualified Health Plans (QHPs), TRICARE, Medicare, most
Medicaid plans, and CHIP, among others.
Affordable coverage - Answers Under ACA regulations, a job-based health plan covering only the
employee that costs 9.56% (9.78%?) or less of the employee's household income is considered
affordable
, Medicaid Expansion - Answers allows states to expand healthcare coverage through the creation of
health insurance marketplaces and the expansion of Medicaid. It does this by allowing states to create
health insurance marketplaces and expand who they can offer Medicaid to
Maryland Health Benefit Exchange (MHBE) - Answers Maryland's exchange market/insurance
marketplace
Plan Requirements - Answers Minimum Actuarial Value (60%) & Essential Health Benefits (10 essential
benefits)
Summary of Benefits and Coverage (SBC) - Answers The ACA requires insurance companies to provide a
standardized Summary of Benefits and Coverage (SBC) document for each plan offered on the state
health insurance exchange. Summary of plan benefits and plan coverage-unique to each plan • Includes
coverage examples to show what the plan will cover in common scenarios • Provides apples to apples
comparison between plans • Language is easier to understand • Not a contract or policy • Uniform
glossary-list and definition of commonly used terms
Open Enrollment - Answers is a period of time, usually occurring once per year, when consumers may
make changes to their elected fringe benefit options, such as health insurance. This is also the time of
year when households can sign up for QHPs and/or SADPs for the first time.
Special Enrollment Period (SEP) - Answers Consumers who experience certain life events, such as getting
married, divorced, or having a child, may qualify for this creating a certain period of time to enroll in or
change health plans outside of the open enrollment period.
Maryland Children's Health Insurance Program (MCHP) - Answers A special program within Medicaid
that offers full health benefits for lower income children under the age of 19. MCHP is also available
year-round for those who are eligible
available year-round - Answers Health coverage for low income individuals and families is called
Medicaid. Maryland's expanded Medicaid program, known as HealthChoice, is
A Qualified Health Plan (QHP) - Answers Health insurance plan offered on Maryland Health Connection.
It is certified by MHC to meet the requirements set forth by the Affordable Care Act and Maryland Law.
Stand Alone Dental Plan (SADP) - Answers Dental insurance plan that meets ACA requirements and
include pediatric dental Essential Health Benefits.
Carrier - Answers A health and/or dental insurance provider
Cost Sharing - Answers A consumer's share, or out of pocket amount, of the cost of their covered
services
Premium - Answers The amount a consumer pays for their health insurance every month
10 essential benefits plans must cover - Answers preventive care, maternity & newborn care, emergency
care, pediatric care, hospitalization, mental health care, prescription drugs, substance use disorder
treatment, doctor visits, laboratory test
The Affordable Care Act (ACA) - Answers allows states to expand healthcare coverage through the
creation of health insurance marketplaces and the expansion of Medicaid. It does this by allowing states
to create health insurance marketplaces and expand who they can offer Medicaid to.
Main components of the Affordable Care Act - Answers The ACA requires states to establish and operate
a Health Insurance Exchange for those who do not have health insurance. Exchanges provide coverage
options for those who do not have health coverage or lose health coverage during the year. In Maryland,
this exchange is called the Maryland Health Benefit Exchange (MHBE).
Small Business Health Options Program (SHOP) - Answers This program includes incentives for small
employers (up to 50 employees) to offer employer-based coverage. To qualify for SHOP, a small business
must have at least 1 full-time equivalent (FTE) employee other than owners, spouses, and family
members.
Pre-Existing Conditions - Answers Under ACA, insurance plans are required to cover people with pre-
existing health conditions - Pre-existing conditions are health problems (e.g., diabetes or cancer) that
started before an individual's health insurance went into effect. The Affordable Care Act guarantees that
consumers with pre-existing conditions can apply for and purchase health insurance if they are
otherwise eligible
Coverage for young adults - Answers The ACA allows children to stay on their parent's health insurance
plan until age 26. Previously, insurance companies could limit the age.
Employer mandate - Answers Under the employer shared responsibility provision of the ACA, large
employers must offer health insurance that is affordable and provides minimum value to their full-time
employees, or be subject to penalties. Large employers are generally defined as those with 50 or more
full-time employees/ full-timeequivalents.
Minimum Essential Coverage (MEC) - Answers The ACA requires consumers to have health coverage that
is considered Minimum Essential Coverage (MEC), which generally means the plan has an "Actuarial
Value" of 60% or more and covers the 10 Essential Health Benefits (EHBs).
Plans that qualify as minimum essential coverage - Answers include employer-sponsored plans,
individual major medical plans (including Qualified Health Plans (QHPs), TRICARE, Medicare, most
Medicaid plans, and CHIP, among others.
Affordable coverage - Answers Under ACA regulations, a job-based health plan covering only the
employee that costs 9.56% (9.78%?) or less of the employee's household income is considered
affordable
, Medicaid Expansion - Answers allows states to expand healthcare coverage through the creation of
health insurance marketplaces and the expansion of Medicaid. It does this by allowing states to create
health insurance marketplaces and expand who they can offer Medicaid to
Maryland Health Benefit Exchange (MHBE) - Answers Maryland's exchange market/insurance
marketplace
Plan Requirements - Answers Minimum Actuarial Value (60%) & Essential Health Benefits (10 essential
benefits)
Summary of Benefits and Coverage (SBC) - Answers The ACA requires insurance companies to provide a
standardized Summary of Benefits and Coverage (SBC) document for each plan offered on the state
health insurance exchange. Summary of plan benefits and plan coverage-unique to each plan • Includes
coverage examples to show what the plan will cover in common scenarios • Provides apples to apples
comparison between plans • Language is easier to understand • Not a contract or policy • Uniform
glossary-list and definition of commonly used terms
Open Enrollment - Answers is a period of time, usually occurring once per year, when consumers may
make changes to their elected fringe benefit options, such as health insurance. This is also the time of
year when households can sign up for QHPs and/or SADPs for the first time.
Special Enrollment Period (SEP) - Answers Consumers who experience certain life events, such as getting
married, divorced, or having a child, may qualify for this creating a certain period of time to enroll in or
change health plans outside of the open enrollment period.
Maryland Children's Health Insurance Program (MCHP) - Answers A special program within Medicaid
that offers full health benefits for lower income children under the age of 19. MCHP is also available
year-round for those who are eligible
available year-round - Answers Health coverage for low income individuals and families is called
Medicaid. Maryland's expanded Medicaid program, known as HealthChoice, is
A Qualified Health Plan (QHP) - Answers Health insurance plan offered on Maryland Health Connection.
It is certified by MHC to meet the requirements set forth by the Affordable Care Act and Maryland Law.
Stand Alone Dental Plan (SADP) - Answers Dental insurance plan that meets ACA requirements and
include pediatric dental Essential Health Benefits.
Carrier - Answers A health and/or dental insurance provider
Cost Sharing - Answers A consumer's share, or out of pocket amount, of the cost of their covered
services
Premium - Answers The amount a consumer pays for their health insurance every month
