Certified Enroller Exam - Covered
California questions and answers
The ACA requires employers with FTE (Full-Time Equivalent) employees to offer coverage with a
minimum of ____________? - correct 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? - correct answer ✔✔ California
Can individuals still be penalized when they file their federal tax returns for failing to have MEC
(Minimum Essential Coverage)? - correct 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: - correct 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? - correct answer ✔✔ Yes, additionally they must also become certified with
Covered California
Certified Insurance Agents (CIA) earn and are paid commissions for effectuated enrollments
with: - correct 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). - correct answer ✔✔ These
enrollment partners ARE NOT compensated by Covered CA.
Navigator Grant Program- CEC (Certified Enrollment Counselor) - correct answer ✔✔ Provides
outreach, education, enrollment assistance, and post-enrollment services to consumers on
behalf of Covered CA
What is considered SEP (Special Enrollment Period)? - correct answer ✔✔ Qualifying life events
such as birth or adoptions, marriage, moving to or within California, or loss of MEC (Minimum
Essential Coverage)
To ensure that consumer assistance is accessible to people with disabilities: - correct 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? - correct answer ✔✔
Until they reach age 26
What are not subject to copayments, coinsurance, or deductibles? - correct 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? - correct 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? - correct answer ✔✔ The amount a consumer must pay their health or
dental plan, usually paid on a monthly basis.
What is a deductible? - correct 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? - correct answer ✔✔ Out-of-pocket costs that the member pays for
covered services.
- coinsurance
- copayments
- deductibles
What is coinsurance? - correct answer ✔✔ A type of cost sharing in which a member pays for a
medical service after meeting a deductible.
What is considered Coinsurance? - correct answer ✔✔ A consumer's share of the cost of a
covered health care service, as a percentage.
What is a copayment (copay)? - correct answer ✔✔ The fixed dollar amount the member pays
for a covered health care service. Usually paid when the service is received.
California questions and answers
The ACA requires employers with FTE (Full-Time Equivalent) employees to offer coverage with a
minimum of ____________? - correct 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? - correct answer ✔✔ California
Can individuals still be penalized when they file their federal tax returns for failing to have MEC
(Minimum Essential Coverage)? - correct 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: - correct 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? - correct answer ✔✔ Yes, additionally they must also become certified with
Covered California
Certified Insurance Agents (CIA) earn and are paid commissions for effectuated enrollments
with: - correct 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). - correct answer ✔✔ These
enrollment partners ARE NOT compensated by Covered CA.
Navigator Grant Program- CEC (Certified Enrollment Counselor) - correct answer ✔✔ Provides
outreach, education, enrollment assistance, and post-enrollment services to consumers on
behalf of Covered CA
What is considered SEP (Special Enrollment Period)? - correct answer ✔✔ Qualifying life events
such as birth or adoptions, marriage, moving to or within California, or loss of MEC (Minimum
Essential Coverage)
To ensure that consumer assistance is accessible to people with disabilities: - correct 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? - correct answer ✔✔
Until they reach age 26
What are not subject to copayments, coinsurance, or deductibles? - correct 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? - correct 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? - correct answer ✔✔ The amount a consumer must pay their health or
dental plan, usually paid on a monthly basis.
What is a deductible? - correct 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? - correct answer ✔✔ Out-of-pocket costs that the member pays for
covered services.
- coinsurance
- copayments
- deductibles
What is coinsurance? - correct answer ✔✔ A type of cost sharing in which a member pays for a
medical service after meeting a deductible.
What is considered Coinsurance? - correct answer ✔✔ A consumer's share of the cost of a
covered health care service, as a percentage.
What is a copayment (copay)? - correct answer ✔✔ The fixed dollar amount the member pays
for a covered health care service. Usually paid when the service is received.
