Certified Enroller Exam - Covered
California Questions And Correct
Answers.
The ACA requires employers with FTE (Full-Time Equivalent) employees to offer coverage with a
minimum of ____________? - Answer 50 or more FTE employees
Which state became the first state in the nation to enact legislation to establish a health
insurance marketplace after the passage of the ACA? - Answer California
Can individuals still be penalized when they file their federal tax returns for failing to have MEC
(Minimum Essential Coverage)? - Answer You will not be penalized by the federal government,
BUT can be through the state of California.
What is the eligibility criteria for consumers in a QHP (Qualified Health Plan) through Covered
CA include: - Answer - Be a citizen or national of US or a non-citizen who is lawfully present in
the US
- Be a resident (or intend to be a resident) of CA and
- Not incarcerated (other than incarceration pending the disposition or judgement of charges)
Do agents have to have a license with the California Department of Insurance before they begin
selling insurance? - Answer Yes, additionally they must also become certified with Covered
California
Certified Insurance Agents (CIA) earn and are paid commissions for effectuated enrollments
with: - Answer - Individual and Family Plans: commissions are paid by Covered CA Qualified
Health and Dental Plans
- Covered CA for Small business (CCSB): commissions are paid by CCSB
Certified Application Counselor (CAC) provide in-person consumer enrollment assistance and
are largely represented by CBOs (Community Based Organizations). - Answer These enrollment
partners ARE NOT compensated by Covered CA.
Navigator Grant Program- CEC (Certified Enrollment Counselor) - Answer Provides outreach,
education, enrollment assistance, and post-enrollment services to consumers on behalf of
,To ensure that consumer assistance is accessible to people with disabilities: - Answer -Provide
enrollment resources, websites, and tools that are accessible to individuals with disabilities
- Provide assistance in a location and manner that is physically and otherwise accessible
- Maintain knowledge to refer people with disabilities to long-term services and support
programs when appropriate
What age can children remain on their parent's health insurance plan? - Answer Until they
reach age 26
What are not subject to copayments, coinsurance, or deductibles? - Answer - Preventative
care, vaccinations, and medical screenings
- Mammograms and colonoscopies
- Wellness visits
- Gestational diabetes screening
- Additional preventative care and screenings are available to women
- Approved contraceptive methods
What is the difference between metal tiers? - Answer - Platinum-level plans cover 90 percent
of health care costs, and you pay 10 percent
- Gold plans cover 80 percent, while you pay 20 percent
- Silver plans cover 70 percent, while you pay 30 percent
- Bronze plans cover 60 percent, while you pay 40 percent.
What is a premium? - Answer The amount a consumer must pay their health or dental plan,
usually paid on a monthly basis.
What is a deductible? - Answer The amount the member pays for the covered health care
services they recieve before the health insurance plan begins to pay its portion of the costs.
What is cost sharing? - Answer Out-of-pocket costs that the member pays for covered
services.
- coinsurance
- copayments
, What is considered Coinsurance? - Answer A consumer's share of the cost of a covered health
care service, as a percentage.
What is a copayment (copay)? - Answer The fixed dollar amount the member pays for a
covered health care service. Usually paid when the service is received.
What document outlines both covered and excluded services, which are benefits not covered by
the health insurance plan? - Answer Evidence of Coverage
What is a Summary of Benefits and Coverage? - Answer provides a description of the
coverage, including any amount the member has to pay for services they use, such as
deductibles, coinsurance, and copays. It also contains exceptions, reductions, or limitations
under the coverage.
What is a list of covered prescription drugs, also called a "drug list"? - Answer Formulary
What is "Out-of-Pocket Maximum/Out-of-Pocket Limit"? - Answer The most a consumer pays
during the year before their insurance plans pays 100% of the allowed amount.
What does HMO stand for? - Answer Health Maintenance Organization
What is a key characteristic of HMOs regarding member care? - Answer Members need to
select a PCP to provide and coordinate their care
What is the role of a PCP in an HMO? - Answer PCP issues referrals for members to see other
doctors, except in urgent or emergency care situations
How does an HMO handle out-of-network care? - Answer HMOs typically do not cover the
cost of out-of-network care
What does PPO stand for? - Answer Preferred Provider Organization
How does a PPO health insurance plan work? - Answer It contracts with participating doctors
and hospitals to create a network. Out-of-Network providers charge more than a plan's allowed
California Questions And Correct
Answers.
The ACA requires employers with FTE (Full-Time Equivalent) employees to offer coverage with a
minimum of ____________? - Answer 50 or more FTE employees
Which state became the first state in the nation to enact legislation to establish a health
insurance marketplace after the passage of the ACA? - Answer California
Can individuals still be penalized when they file their federal tax returns for failing to have MEC
(Minimum Essential Coverage)? - Answer You will not be penalized by the federal government,
BUT can be through the state of California.
What is the eligibility criteria for consumers in a QHP (Qualified Health Plan) through Covered
CA include: - Answer - Be a citizen or national of US or a non-citizen who is lawfully present in
the US
- Be a resident (or intend to be a resident) of CA and
- Not incarcerated (other than incarceration pending the disposition or judgement of charges)
Do agents have to have a license with the California Department of Insurance before they begin
selling insurance? - Answer Yes, additionally they must also become certified with Covered
California
Certified Insurance Agents (CIA) earn and are paid commissions for effectuated enrollments
with: - Answer - Individual and Family Plans: commissions are paid by Covered CA Qualified
Health and Dental Plans
- Covered CA for Small business (CCSB): commissions are paid by CCSB
Certified Application Counselor (CAC) provide in-person consumer enrollment assistance and
are largely represented by CBOs (Community Based Organizations). - Answer These enrollment
partners ARE NOT compensated by Covered CA.
Navigator Grant Program- CEC (Certified Enrollment Counselor) - Answer Provides outreach,
education, enrollment assistance, and post-enrollment services to consumers on behalf of
,To ensure that consumer assistance is accessible to people with disabilities: - Answer -Provide
enrollment resources, websites, and tools that are accessible to individuals with disabilities
- Provide assistance in a location and manner that is physically and otherwise accessible
- Maintain knowledge to refer people with disabilities to long-term services and support
programs when appropriate
What age can children remain on their parent's health insurance plan? - Answer Until they
reach age 26
What are not subject to copayments, coinsurance, or deductibles? - Answer - Preventative
care, vaccinations, and medical screenings
- Mammograms and colonoscopies
- Wellness visits
- Gestational diabetes screening
- Additional preventative care and screenings are available to women
- Approved contraceptive methods
What is the difference between metal tiers? - Answer - Platinum-level plans cover 90 percent
of health care costs, and you pay 10 percent
- Gold plans cover 80 percent, while you pay 20 percent
- Silver plans cover 70 percent, while you pay 30 percent
- Bronze plans cover 60 percent, while you pay 40 percent.
What is a premium? - Answer The amount a consumer must pay their health or dental plan,
usually paid on a monthly basis.
What is a deductible? - Answer The amount the member pays for the covered health care
services they recieve before the health insurance plan begins to pay its portion of the costs.
What is cost sharing? - Answer Out-of-pocket costs that the member pays for covered
services.
- coinsurance
- copayments
, What is considered Coinsurance? - Answer A consumer's share of the cost of a covered health
care service, as a percentage.
What is a copayment (copay)? - Answer The fixed dollar amount the member pays for a
covered health care service. Usually paid when the service is received.
What document outlines both covered and excluded services, which are benefits not covered by
the health insurance plan? - Answer Evidence of Coverage
What is a Summary of Benefits and Coverage? - Answer provides a description of the
coverage, including any amount the member has to pay for services they use, such as
deductibles, coinsurance, and copays. It also contains exceptions, reductions, or limitations
under the coverage.
What is a list of covered prescription drugs, also called a "drug list"? - Answer Formulary
What is "Out-of-Pocket Maximum/Out-of-Pocket Limit"? - Answer The most a consumer pays
during the year before their insurance plans pays 100% of the allowed amount.
What does HMO stand for? - Answer Health Maintenance Organization
What is a key characteristic of HMOs regarding member care? - Answer Members need to
select a PCP to provide and coordinate their care
What is the role of a PCP in an HMO? - Answer PCP issues referrals for members to see other
doctors, except in urgent or emergency care situations
How does an HMO handle out-of-network care? - Answer HMOs typically do not cover the
cost of out-of-network care
What does PPO stand for? - Answer Preferred Provider Organization
How does a PPO health insurance plan work? - Answer It contracts with participating doctors
and hospitals to create a network. Out-of-Network providers charge more than a plan's allowed
