Market Place SHOP
How many years must informed consent documents be appropriately secured and retained?
10 years
Which of the following would be considered a vulnerability to a system's security?
Failing to install and regularly run an anti-virus program on a computer system
Agents and brokers must provide a Privacy Notice Statement to consumers in the Marketplace regarding the use and disclosure of PII.
true
When signing up for insurance, a consumer understands 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...
A rebate to refund the excess back to the consumer
For qualified health plan certification, a plan that uses a provider network must have an adequate provider network available to its enrollees. This network must include all of the following EXCEPT:
Adult oral and vision care providers
Which of the following is true about agent and broker compensation in the Marketplace?
Agents and brokers are compensated in accordance with their agreements with qualified health plan issuers and any state-specific requirements.
Which of the following are categories of EHB?
Ambulatory patient services Emergency services, hospitalization, and prescription drugs
In which of the following ways must non-grandfathered health plans limit cost sharing for enrolled individuals?
Annual cost-sharing limits cannot exceed specified amounts.
Which of the following are roles of agents and brokers in the Individual Marketplace and the SHOP?
Assist individuals with enrolling in QHPs through the Marketplace and employers with selecting and enrolling in SHOP coverage Assist qualified individuals in the Individual Marketplace in applying for APTC and CSRs for eligible plans
For an employer group to enroll in Small Business Health Options Program (SHOP) coverage, in many states, what percentage of the total number of full-time employees must participate and enroll in coverage?
At least 70%
Which of the following are elements to protecting information?
Availability: Defending information systems and resources from malicious, unauthorized users to ensure accessibility by authorized users Confidentiality: Protecting information from unauthorized disclosure to people or processes Integrity: Assuring the reliability and accuracy of information and information technology resources
Which of the following should NOT be included as part of written procedures for incident handling and breach notification?
Become a certified incident investigator
To become certified, a QHP must meet which of the following criteria?
Benefit design standards, including non-discrimination requirements and limits on 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
Agents and brokers operating in which kind of Marketplace or Program must enter into a Privacy and Security Agreement with the Centers for Medicare & Medicaid Services?
Both the Individual Marketplace and the Small Business Health Options Program (SHOP)
Which of the following are steps you can take as an agent or broker to help promote information security?
Change your password often Use a different password for each system or application Change your password immediately if you suspect it has been compromised
Before agents and brokers can begin assisting small group employers in a SHOP, they must...
Complete identity proofing Execute the SHOP Privacy and Security Agreement, which includes privacy and security standards Have the employer's authorization to work on its behalf
If a qualified employer chooses to offer its qualified employees a choice of Silver plans, which of the following is true?
Each of its qualified employees may choose a Silver plan that best fits his or her individual or family needs.
Which of the following data formats must be protected according to the Department of Health & Human Services' information policy?
Electronic, paper, and oral formats
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 is NOT one of the standards of conduct for agents and brokers who participate in the Marketplace?
Establish an exclusive referral relationship with Navigators and other Marketplace assisters in their service area
Which of the following are components of the Affordable Care Act?
Extension of dependent coverage of children up to age 26 Prohibition on charging consumers a higher premium based on health status or gender Prohibition on coverage limitations or exclusions based on pre-existing conditions
Which of the following is NOT an example of personally identifiable information?
Family composition
Which of the following is NOT true about Marketplaces?
HHS operates all Marketplaces.
Which of the following is NOT an eligibility requirement for the Small Business Health Care Tax Credit?
Have average annual employee wages above $60,000
To qualify for the Small Business Health Care Tax Credit, small employers must...
Have fewer than 25 FTE employees Contribute a uniform percentage (at least 50%) of the premium cost of employee-only insurance coverage on behalf of each employee enrolled in a SHOP QHP
Under the Affordable Care Act, guaranteed issue means that:
Health insurance issuers must accept any individual and employer who applies for an individual market or group market plan, subject to certain exceptions.
A consumer worries she may develop chronic asthma because she has a family history, but she knows she will not be denied health insurance coverage due to the guaranteed issue provision of the Affordable Care Act. Guaranteed issue means that...
Health insurance issuers that offer individual policies in a state generally must offer all of their available individual market plans to all eligible individuals in the state, and must accept all eligible individuals who apply for coverage.
For which of the following purposes can an agent or broker share PII about an individual?
Help an individual obtain an assessment of his/her Medicaid eligibility Assist an individual in obtaining a determination as to whether he/she qualifies for the premium tax credit through his/her state's Marketplace Select a QHP
Which of the following are examples of practices that an agent or broker must follow with respect to PII in the Marketplace?
Informing consumers of the collection and use of their PII Providing consumers with the opportunity to review and correct their PII Taking appropriate steps to safeguard the confidentiality of PII Reporting privacy breaches to the CMS IT Service Desk
Which statement best describes the operational meaning of the termination or suspension of an agent's, broker's, or web-broker's Marketplace Agreement(s) with the Centers for Medicare & Medicaid Services (CMS)?
It means the agent, broker, or web-broker is no longer registered with the Marketplace and is not permitted to assist with enrollments through the Marketplace.
Which of the following is NOT something all agents and brokers must do to assist their small business clients enroll in Small Business Health Options Program (SHOP) plans?
Maintain residence in the employer's service area
Which of the following would NOT be considered a privacy incident?
Overhearing a private conversation in the hallway
Each health plan offered in the Small Business Health Options Program (SHOP) must be a qualified health plan, which means it meets which of the following requirements?
Provides essential health benefits
In general, a health insurance issuer that does not spend at least 80% of its premium dollars on medical claims or quality improvement activities must provide:
Rebates to individuals and employers
Which of the following is NOT considered a privacy incident?
Receipt of an email phishing for personally identifiable information
Which of the following is an allowable use and disclosure of personally identifiable information (PII) specified in Appendix A in both Privacy and Security Agreements: the "Agreement Between Agent or Broker and the Centers for Medicare & Medicaid Services for the Individual Market Federally-facilitated Exchanges and the State-based Exchanges on the Federal Platform" and the "Agreement Between Agent or Broker and CMS for the Small Business Health Options Programs of the Federally-facilitated Exchanges and State-based Exchanges on the Federal Platform?
Requesting an individual's PII to obtain an assessment of his or her Medicaid eligibility
Which of the following are prohibited according to the specifications for prohibited uses and disclosure of PII?
Requesting information regarding the citizenship of an individual who is not seeking coverage for himself or herself on any application Requesting an SSN of an individual who is not seeking coverage for himself or herself on any application Requesting any individual's PII to discriminate or discourage the enrollment of individuals with significant health needs in QHPs
Passage of the Affordable Care Act incorporated which of the following health insurance market reforms?
Requirement for individuals to maintain minimum essential coverage for themselves and their spouse/dependents, qualify for an exemption from coverage, or make an individual shared responsibility payment when filing their federal income tax returns
Which of the following are controls that agents and brokers can apply to manage risk and protect consumer information?
Security awareness training Restricting access to systems that contain sensitive information
A 60-year-old military veteran seeking health insurance coverage:
Should first apply directly to the Veterans Health Administration (VHA) to determine eligibility for VHA benefits
Which of the following is a NOT a resource for agents and brokers to obtain more information and updates on the Small Business Health Options Program (SHOP)?
The Agreement Between Agent or Broker and the Centers for Medicare & Medicaid Services for the Small Business Health Options Programs of the Federally-facilitated Exchanges and State-based Exchanges on the Federal Platform
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
Bill and Barbara are married and have two children under age 18. They do not have minimum essential coverage (or any other form of coverage that helps to pay the cost of medical care) for any family member for any month during 2018 and no one in the family qualifies for an exemption. Which of the following are Bill and Barbara responsible for paying?
The individual shared responsibility payment for the months they and their children were uninsured when they file their 2018 income tax return, which is due in April 2019 The entire cost of any medical care they or their children receive during the year
What is the allowable maximum surcharge for non-grandfathered coverage for an individual who legally uses tobacco?
The maximum surcharge is one and a half times the non-tobacco user's rate.
Which of the following BEST describes information security?
The protection of information and information systems from unauthorized access, use, disclosure, disruption, modification, or destruction in order to provide confidentiality, integrity, and availability
Which of the following best describes information security?
The protection of information and information systems from unauthorized access, use, disclosure, disruption, modification, or destruction in order to provide confidentiality, integrity, and availability
A 34-year-old woman is looking for health insurance 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.
false
Any incident involving the loss or suspected loss of PII must be reported in accordance with health insurance issuer requirements.
false
The individual shared responsibility requirement under 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.
false
Under the intended approach for plan years beginning on or after January 1, 2018, if an employee or dependent's eligibility status changes mid-plan-year, the agent, broker, or employer would inform the SHOP Marketplace, and should do so through the applicable Marketplace account.
false
Your colleague Hank hands you a list with email addresses of potential clients who expressed interest in enrolling in a QHP through the Marketplace, and asks you to contact each of them to set up appointments. Since the list does not contain individual names, you can store and share this list as you wish because it does not contain the clients' PII.
false
A risk is the likelihood that a vulnerability will exploit a threat.
false. A risk is the likelihood that a threat will exploit a vulnerability. For example, a system may not have a backup power source, so it is vulnerable to a threat such as a thunderstorm. The thunderstorm creates a risk to the system. A threat is the potential to cause unauthorized disclosure, changes to, or destruction of an asset. A vulnerability is any flaw or weakness that can be exploited and could result in a breach or a violation of a system's security policy.
PII is defined as any information that can be used to distinguish or trace an individual's identity, either alone or when combined with other information that is ___________ a specific individual.
linked or linkable to
A Navigator may refer a consumer to general listings of agents and brokers for assistance if the consumer says he or she wants a specific QHP recommendation and agents/brokers are permitted to make plan recommendations under state law.
true
A breach is the loss of control, compromise, unauthorized disclosure, unauthorized acquisition, or any similar occurrence where (1) a person other than an authorized user accesses or potentially accesses personally identifiable information or (2) an authorized user accesses personally identifiable information for an other than authorized purpose.
true
Agents or brokers must decide to grant or deny an individual access to personally identifiable information pertaining to the individual within 30 days of receipt of the access request.
true
Agents, brokers, and web-brokers must be appropriately licensed in each state where they sell qualified health plans through the Marketplace.
true
An agent or broker may only collect, use, or disclose PII to the extent necessary to carry out the functions authorized in the Individual Marketplace Privacy and Security Agreement and the SHOP Privacy and Security Agreement.
true
An agent or broker must account for all disclosures of an individual's personally identifiable information (PII), except for disclosures made to members of the agent's or broker's workforce who have a need for the PII to perform their duties and disclosures needed to carry out the required functions of the agent or broker.
true
Consumer Operated and Oriented Plans are private, nonprofit, member-run health insurers.
true
Individuals under age 30 and individuals who qualify for a hardship or affordability exemption may purchase a catastrophic plan.
true
Information security is achieved through implementing technical, managerial, and operational measures designed to protect the confidentiality, integrity, and availability of information.
true
Maria had four full-time employees, on average, on business days during the preceding calendar year and will continue to have four full-time employees on the first day of her business' SHOP plan year. She will offer a SHOP health plan to all four. Her flower shop is her only business location or employee work site and is located in the service area of the SHOP where she is applying for and offering coverage. Maria qualifies to purchase a SHOP plan.
true
Security refers to the mechanisms in place to protect the confidentiality and privacy of personal information.
true
The Affordable Care Act requires qualified non-grandfathered health plans to provide certain recommended preventive health services without cost-sharing or deductible requirements.
true
The Department of Health & Human Services may impose a civil money penalty of not more than $25,000 per person or entity, per use or disclosure against any person who knowingly and willfully uses or discloses personally identifiable information in violation of section 1411(g) of the Affordable Care Act.
true
The Privacy Notice Statement must be written in plain language and provided in a manner that is accessible and timely to people living with disabilities and with limited English proficiency.
true
The total family premium generally includes per-member rates for all members, but limits per-member premiums for covered children to up to three dependent children under the age of 21.
true
To become certified as a QHP, a plan that has a provider 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.
true
Under the Affordable Care Act, group rates generally are based on the individual rates of the group's members.
true
Under the intended approach for plan years beginning in 2018 and beyond, employers enrolling in a Small Business Health Options Program (SHOP) qualified health plan or qualified dental plan would receive a bill from each issuer in which employees are enrolled and would pay their monthly premium directly to each issuer.
true
