Patient Protection and Affordable Care Act (PPACA) - Section 14 - Quiz

Annual dollar limits on essential health benefits will not be permitted for plan years starting after January 1

2014

Modified Adjust Gross Income The new health reform law extends Medicaid coverage to what populations with Modified Adjust Gross Incomes (MAGI) below 133% of the federal poverty level?

All adults under age 65

The PPACA (Affordable Cost Act) allows young adults to stay on their parents employer plan only if:

All of these answers are true (They are not married, Financially dependent on their parents and in school)

Sally purchased a new individual health policy for herself and her 13 year old child who has a history of asthma on October 1, 2010. She is hospitalized for an asthma attack on December 1, 2010. The coverage can't be denied because:

All of these are reasons coverage cannot be denied (Hint: Policies issued after 3/23/10 cannot exclude pre-existing on children below age 19)

What is the primary criterion that qualifies an individual for premium tax credits through an exchange?

Income

What is the 80% MLR (Medical Loss Ratio), also referred to as the 80/20 rule imposed on insurers by the Affordable Care Act?

Insurers must spend at least 80 percent of the premiums they receive on medical expenses, health care and quality improvement; only 20 percent can be directed to other costs.

The Patient Protection and Affordable Cost Act (PPACA) does not:

Requires all health plans to cover preventive services without out-of-pocket expense

Which of the following is not one of the three major functions of the Federal law concerning Health Care Exchanges?

Serve as one of the places where federal tax credits may be used to purchase health coverage

Which of the following is designed to make health insurance more affordable and accessible to small business?

Small Business Health Options Program (SHOP)

For plan years beginning in 2015, individual eligibility for premium tax credits with an exchange requires all of the following except:

The individual must be eligible for minimum essential coverage

As of January 1, 2010 insurers must provide a rebate to enrollees if the insurer's medical loss ratio fails to meet:

The minimum requirements of 85% in large group and 80% in small group or individual market

All of the following qualify as providing minimum essential coverage EXCEPT:

a critical illness plan

The goal of reporting medical loss ratios is for more premium dollars to go to

clinical care

What employers are exempt from ACA's mandate to offer health insurance to their employees?

employers with fewer than 50 full-time employees (Beginning in 2016 small employers will be those of 0-99 employees)

What term is used to refer to the comprehensive set of minimum core benefits that all qualified health plans must provide?

essential health benefits (EHBs)

When compared to other tiered qualified health plans (QHPs) the catastrophic plan available through an exchange has:

higher out-of-pocket expenses for the insured

The functions of a health insurance exchange include all of the following EXCEPT:

license and regulate the activities of health insurance agents and producers

Starting in 2014, those without acceptable health insurance must:

pay a fee

What term refers to health plans that are certified and available through an exchange?

qualified health plans (QHPs)

What type of consumer are SHOP programs designed to serve?

small employers

Every qualified plan offered through an exchange is categorized according to a metal level: bronze, silver, gold or platinum. This metal tier/level is a reflection of:

the percentage of essential health benefits costs the plan will pay

When referring to individual exchange plans, the term cost-sharing includes all of the following except:

the plans premium