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

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

2014. For plan years starting after January 1, 2014, annual dollar limits on essential health benefits will not be permitted.

Modified Adjust Gross Income 19=64 The new health reform law extends Medicaid coverage to what population with Modified Adjust Gross Incomes (MAGI) below 133% of the federal poverty level?

All adults under age 65

Group insurance policies are issued to the following trusts except:

Associations that insure at least 5 members.

Group insurance in which the employees contribute 100% of the premium are called:

Contributory. When an employee pays any portion or all of the premium the plan is called contributory

COBRA qualifying events for spouses would be all of the following except:

Death of covered child

Under the COBRA, a qualifying event ensures that an employee who is covered can:

Elect to continue coverage as is. COBRA allows continuation of coverage

Which of the following is eligible for the health care tax credit for small employers?

Employers that have fewer than 25 full-time equivalent employees and pay wages averaging less than $50,000 per employee per year

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

In school. They are not married. Financially dependent on their parents. All of these answers are true

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

Income

What is the 80% MLR, 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.

All of the following could be reasonable accommodations for an ADA qualified employee except:

Job restructuring, modifying work schedules, and increased compensation.

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

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

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:

Sally's policy year began after September 23, 2010 when the laws rule on pre-existing conditions took effect. Sally purchased the policy after the 3/23/10 enforcement mandating pre-existing conditions for minors be covered The child is below age 19 All of these are reasons coverage cannot be denied.

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 businesses?

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. The goal of reporting medical loss ratios is for more premium dollars to go to clinical care and less to administrative costs and profits.

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

employers with fewer than 50 full-time 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