CERTIFIED ENROLLER EXAM - COVERED CALIFORNIA | 167 QUESTIONS | WITH
COMPLETE SOLUTIONS.
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 Covered CA
,CERTIFIED ENROLLER EXAM - COVERED CALIFORNIA | 167 QUESTIONS | WITH
COMPLETE SOLUTIONS.
What is considered SEP (Special Enrollment Period)? - (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: - (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.
, CERTIFIED ENROLLER EXAM - COVERED CALIFORNIA | 167 QUESTIONS | WITH
COMPLETE SOLUTIONS.
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
- deductibles
What is coinsurance? - (ANSWER)A type of cost sharing in which a member pays for a medical service
after meeting a deductible.
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.
COMPLETE SOLUTIONS.
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 Covered CA
,CERTIFIED ENROLLER EXAM - COVERED CALIFORNIA | 167 QUESTIONS | WITH
COMPLETE SOLUTIONS.
What is considered SEP (Special Enrollment Period)? - (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: - (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.
, CERTIFIED ENROLLER EXAM - COVERED CALIFORNIA | 167 QUESTIONS | WITH
COMPLETE SOLUTIONS.
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
- deductibles
What is coinsurance? - (ANSWER)A type of cost sharing in which a member pays for a medical service
after meeting a deductible.
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.
