Module 1 Study Questions
What was the adult penalty for not complying with the individual mandate in 2017?
$695; 2.5% household income; national average premium for a QHP Bronze that would cover thenm
When do applicants get notices or letters?
Approval, Denial, Termination of coverage, suspension of coverage, Change in Medicaid category
How can a consumer protect themselves from fraud and abuse when choosing to ask someone for help?
Ask if they are certified by Indiana as a Navigator or Health Insurance agent or broker; Visit the IDOI website; Ask to see a copy of their certificate or license
What is an Authorized Representative?
Assist w/ IAHC; receive notice of application determination; appeal decision; report changes; complete redeterminations; receive appointment notices; support ongoing health coverage needs
What activities are required for AO during pre-certification education?
Attest that all Indiana Navigators have completed the precertification education
Who else needs to submit the COI Disclosure Form with the AO one for app?
Authorized Submitter
What are the responsibilities of an Indiana Navigator?
Become certified by the IDOI to assist consumers with applicatios for FFM (QHP, PTC, CSR) and IHCP
What is a Conflict of Loyalty?
Business or family/personal interest that keeps the Indiana Navigator or AO from acting in the best interest of the consumer
What ways are consumer's personal information protected?
By protecting against threats to confidentiality, security breach or improper disclosure; Disposing or destroying information so that it is unidentifiable and unusable; Collecting only the minimum amount of info necessary; Not giving information to anyone unless requested by the consumer or their AR
What is the list of locations provided by AO's used for?
By the county on the Indiana Healthcare Reform website
What 4 types of information must be reported?
Household size; Household income; Household location; citizenship status
What 2 places can consumers apply for health coverage?
IAHC (dfrbenefits.in.gov) or FFM (healthcare.gov)
If the consumer disagrees with the QHP complaint decision, who can they comnplain to?
IDOI
What agency oversees complaints?
IDOI
Where can an AO get information about state registration?
IDOI
Where can an indiana Navigator get information about state certification?
IDOI
Where can an insurance agent/broker get information about state licensure?
IDOI
Who regulates plans on the FFM?
IDOI
Where is the decision for PE made?
Immediately
What is the Affordable Care Act?
In 2010 Federal Health Insurance Marketplace and the option for states to expand Medicaid to adults up to 138%
How should a Navigator report a COI to a consumer?
In writing prior to assisting them
What is the IACH?
Indiana Application for Health Coverage- may be submitted to DFR for consideration
What is IHCP?
Indiana Health Coverage Program - Covers programs under Medicaid and apps can be accessed via dfr
What consumer assistants serve Hoosiers?
Indiana Navigators; Application Organizations; Authorized Representatives; Producers
What is a Producer?
Individual or business licensed by the state to sell, solicit, or negotiate insurance products; receives compensation from a health insurance carrier and is prohibited from becoming an Indiana Navigator
What is a Navigator?
Individuals who are certified with the IDOI to provide application assistance through the FFM or IHCP
Federal Health Insurance Marketplace?
Individuals with income over FPL can purchase insurance through the Marketplace (up to 400% FPL)
How can you check the status of an IAHC?
Must be applicant or AR; go to DFR website- enter last name, case number, dob, last four of the SSN
What additional steps does someone approved with PE need to take?
Must complete a full IHCP app; also, only allowed to get PE 1x/rolling 12 mo period or 1x/pregnancy
How does a Producer sell on the FFM?
Must have health producer license w/ IDOI and complete FFM registration and training
What activities are required for AO's during the Certification Exam?
N/A
What is a Non-Navigator?
N/A in Indiana; Developed to complement Federal Navigator program while staying distinct and separate. Same standards and requirements apply as for Federal Navigators. They provide consumer education and support
What information is needed for a PE app?
Name, Address, Phone number, SSN, Number of household members, household income
What Navigator items must be included on an IAHC?
Name, Certification Number, Name of AO, AO Registration Number
Can PE decisions be appealed?
No
What is the state's role inb ACA?
Observe federal guidelines; maintaines oversight of state-regulated insurance products
Where can you find an EBP?
Off marketplace
What is the Privacy, Security and Confidentiality Agreement meant to do?
Protect consumer's personal information; and reporting a breach
Who should a complaint be filed with for FFM coverage that did not pay as expected on a service?
QHP
PE applications can be done by whom?
QP- Qualified Provider
What is QHP?
Qualified Health Plan
What is a QHP?
Qualified Health Plan- Provides MEC, Covers EHBs; Meets AV standards; Meets provider network standards
What can an AR do on an ongoing basis?
Report changes, complete redeterminations, receive appointment and redetermination mailings
What consequences are there for Navigator or AO violations of laws/regulations?
Reprimand; Civil Penalty (fine); Suspension of certification; Revocation of certification; Cease & Desist
What happens when an AO or Navigator has a pattern of incomplete, inaccurage applications for Health coverage discovered via internal tracking?
Sent to IDOI for investigation
What is the Federal Gov't's role in Indiana ACA?
Sets guidelines; sets up and runs marketplace
What is a Federal Navigator?
They provide unbiased & accurate education, outreach and insurance enrollment assistance on a marketplace. They receive CMS funding & certification. They must apply & be selected to receive cooperative agreement funds from CMS, complete the CMS training and certification requirements; THEN.also complete the certification and registration requirements of Indiana AO's and Navigators
What is the goal of the ACA?
To increase the number of individuals w/ health insurance coverage
What is the role of an Indiana Navigator?
To provide consumers with fair, accurate and impartial health coverage application assistance
How and in what time frame are notifications sent?
US Mail; within 24 hours of decisions
How long is an AR valid?
Until modified by applicant or AR
If a new COI pops up between renewals, when should it be reported?
Within 30 days
Where can a consumer re-enroll in the marketplace?
healthcare.gov
What can an AR do during the app process?
sign the app, provide proof of information; receive notification of app decisions, speak on behalf of applicants at hearings
Where can an AO check the status of their application?
www.sircon.com
What are the 10 EHBs?
Ambulatory; Emergency; Hospitalization; Maternity & NB; Mental health and substance abuse; RX; Rehab and habilitative; Lab; Preventive and wellness; Pediatric including dental and vision
State Privacy & Security Agreements?
All IN Navigators must comply w/ this policy which defines what constitutes a consumer's personal information and a security breach or improper disclosure of information
What does PE do?
Allows uninsured or underinsured individuals and families obtain temporary coverage quickly; Allows providers to be reimbursed for services covered by the benefit package immediately after PE approval
What are 2 things that AO's and Navigators must tell consumers about?
1. Actual or potential COI's in writing; 2. Roles, responsibilities and limitations of Navigators
What are the Ethical Standards for Indiana Navigators?
1. Commitment to Clients; 2.Informed Consent & Authorization; 3. Self-Determination; 4. Competence; 5.Cultural Competence; 5. Conflicts of Interest; 6. Privacy & Confidentiality; 7. Professional Conduct; 8. Access to records; 9.
Initial AO Registration steps?
1. Complete online AO app & pay non-refundable app fee and online processing fee. 2. Review the COI and submit COI Disclosure Form; 3. Review & submit the AO Privacy and Security Agreement; 4. Provide a contact list of each location of the AO including name, address, phone, email, website and main contact person
What are the 6 steps for Initial Indiana Navigator License?
1. Complete online application & pay non-refundable app fee; 2. Submit criminal background check; 3. Review COI policy & submit COI Disclosure form; 4. Review then submit Privacy & Security Agreement; 5. Complete Navigator precertification education; 6. Pass Navigator certification exam.
What are the 3 steps to renew the AO license?
1. Complete the online AO renewal application and submit non-refundable renewal and online processing fee; 2. Submit Name, Address, Phone, Email, Website & Contact Person for each location; 3. Submit new COI form if it has changed
How quickly is eligibility determined?
45 days or 90 days if disabled
When does a reminder to renew the license get emailed?
60 days prior to certification expiration date
How much time is allowed for a complaint to be processed?
72 hours
What is an indirect financial incentive COI?
AO staff or board member holds stock in an insurance company and may indirectly benefit if Indiana Navigator helps consumer purchase a plan from that company
What activities are required for an AO during the online application?
Affirm all Indiana Navigators are eligible , w/o COI's or disqualifying criminal histories and to pay non-refundable fee
What is a Certified Application Counselor?
CAC-Assist consumers through unbiased and accurate education and application assistance. They do not receive federal grant awards to act as CAC organizations and are not required to provide public education and outreach services to the same extent as Federal Navigators. They receive training and certification from CMS. Individuals must do so through a federally-designated organization. They must also be registered as AO's or Indiana Navigators to serve Hoosiers
Who determines the open enrollment period for FFM?
CMS
Centers for Medicare & Medicaid Services
CMS - Federal agency w/in HHS that administers Medicare, works w/ state govt's to administer Medicaid & oversees FFM
Where can a consumer get general information about ACA?
CMS, FFM
What do Navigators need to report to IDOI?
Change of addres; an administrative or criminal action; change in COI; Security breach; removal of Navigator or AO
What is the process to renew a Navigator license?
Complete 2 hours of PE; Complete online renewal app & submit non-refundable renewal fee & online processing fee; Submit new COI form
How do you become an AR?
Complete and submit AR form that is barcoded to match IAHC... submit together
What do Federally-Designated consumer assistants who serve Hoosiers need to do?
Complete federal training and certification; Complete Indiana Navigator certification
How do you become a Producer?
Complete licensing requirements for IDOI; sign agreements with one or more insurance companies to sell; receive compensation from insurance companies
What activities are required for AO's during the annual re-certification?
Complete online renewal app; Pay non-refundable renewal fee; update Navigator associations w/in 30 days of any changes
When should a breach of privacy, security or confidentiality be reported, and to whom?
Consumer must be notified w/in 10 business days; IDOI must be notified w/in 5 business days
How do you purchase a plan on the FFM?
Contact a licensed health insurance agent or broker, or shop for coverage directly through insurance conmpanies
What criteria do QHPs meet?
Cover EHBs, Be accredited; Meet network adequacy; Meet non-discrimination standards; Meet transparence requirements
What can health plans place dollar limits on under ACA?
Coverage that is not considered EHBs
Who sends notifications?
DFR
What are the 3 main functions of the marketplace?
Determining eligibility; Accepting QHP selections; Monitoring QHP Issuers
What does an Indiana Navigator need to report on their COI?
Direct or Indirect Financial incentives; Conflict of Loyalty
Navigator Precertification Education
Education and training programs approved by the IDOI that must be completed as part of the initial Indiana Navigator certification application process and prior to the Navigator examination
Navigator Continuing Education
Education and training that must be completed by certified Indiana Navigators to satisfy their yearly 2 hr CE requirement.
How is the IAHC information verified?
Electronic data sources, sometimes paper documentation if there are inconsistencies or no electronic data
How can the BG, COI, Privacy & Security forms be submitted?
Electronically to the online application at the time of the application or through a link in the confirmation email
What is EHB?
Essential Health Benefit
Who should you contact if you have questions about ACA?
FFM
Where can a consumer get information about disability resources?
FFM; Area Agencies on Aging; Division of Disability and Rehabilitative Services
Where can a consumer get language resources?
FFM; DFR
What agency provides monitoring and oversight?
FSSA
Where can authorized representatives get information on state registration?
FSSA
What are the 4 types of Federally Designated Consumer Assistants
Federal Navigators; Certified Application Counselors; Non-Navigator Assistance Personnel; Producers
What is the FFM?
Federally Facilitated Marketplace - Marketplace that makes QHP's (Qualified Health Plans available to individuals or qualified employers under the ACA- available at healthcare.gov
Who needs to be certified as an Indiana Navigator?
Federally funded, federally-selected Navigators; Federally-designated CAC's; Medicaid Enrollment Center staff or volunteers; Licensed insurance producers who do not sell health insurance plans or receive compensation from health insurance issuers; Staff or volunteers of other organizations
What is a Federal Navigator?
Federally trained and certified consumer assistant to provide FFM education & enrollment assistance; must also be certified as Indiana Navigator w/ IDOI
Who needs to be certified as an Indiana Navigator or AO?
Federally-funded & certified Federal Navigators; Federally-designated CAC's; Medicaid Enrollment Center staff or volunteers; Staff or volunteers who help with insurance affordability program applications
What new groups of people were covered under ACA?
Former Foster Children/ Children 6-18
What types of compensation can AO's or Navigators receive?
Goods or other advertisement with a value of less than $100/year per insurance issuer
What health insurance plans are the only exception to the ACA requirements?
Grandfathered plans
Department of Health & Human Services
HHS-Federal govt's principal health agency. Manages the FFM; establishes training, certification, monitoring
What is a Direct Financial Incentive COI?
Health Insurance broker or agent receives direct compensation from health insurance or stop loss insurance issuer for enrollment in specific plans
Where can consumers file complaints?
Health Insurance company; IDOI; FFM
What individual factors can not be used to approve or deny coverage through the ACA?
Health status, family health history, age, gender
Where can a Navigator find assistance with Cultural Competence?
Healthcare.gov; Area Agencies on Aging; DFR
What types of oversight does the FSSA provide?
Internal tracking of apps for quality
What is the Patient Protection Affordable Care Act?
Law that provides fundamental reforms to the US healthcare and health insurance systems.
What is MEC?
Minimum Essential Coverage
What is an AO?
Organizations with employees and/or volunteers assisting Hoosier consumers with either FFM apps (QHP's and Cost lowering programs) or with the IHCP
What is the COI Policy?
Policy that establishes that Financial or Loyalty COI must be disclosed and other requirements
What activities prohibit someone from becoming an Indiana Navigator?
Suspended license for insurance agent or broker; Indiana Navigator or equivalent; Convicted of a disqualifying felony or other crime as determined by the Commissioner of Insurance; Admission or conviction of unfair trade practice or fraud in the insurance business; Has a state income or child support obligation that has not been paid
Where do you apply for PE?
The Indiana Medicaid provider healthcare portal
