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ACA Certification with verified answers latest update
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ACA Certification with verified answers latest update
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ACA CertificationYoung Adult Coverage - correct answer ✔✔Under the Affordable Care Act, health plans that cover
children must make coverage available to children up to age 26. Young adults can join or remain on a
parent's plan even if they are:
Married (coverage does not extend to married child's spouse)
Not living with a parent
Not attending school
Not financially dependent on a parent
Eligible to enroll in their employer's plan (starting in 2014)
Guaranteed Issue - correct answer ✔✔The Affordable Care Act requires health insurance issuers to offer
all of their individual market and group market plans to any applicant in the state. It also requires health
insurance issuers to accept any individual who applies for those policies, as long as the applicant agrees
to the terms and conditions of the policy, including the payment of premiums. This provision is called
"guaranteed issue."
Guaranteed Renewability - correct answer ✔✔Additionally, the Affordable Care Act requires health
insurance issuers to offer to renew or continue in force coverage at the option of the policyholder. This is
called "guaranteed renewability."
Pre-existing Conditions - correct answer ✔✔Effective for all health plans with plan years beginning on or
after January 1, 2014, the Affordable Care Act prohibits health insurance issuers from limiting or
excluding coverage related to pre-existing health conditions, regardless of the age of the covered
individual. For persons under age 19, this provision became effective for policy years beginning on or
after September 23, 2010.
Generally, a pre-existing condition is any health condition or illness that was present before the coverage
effective date, regardless of whether medical advice or treatment was actually received or
recommended.
,Clinical Trials - correct answer ✔✔The Affordable Care Act prohibits health insurance issuers from:
Precluding participation of qualified individuals in an approved clinical trial
Denying, limiting, or placing additional conditions on the coverage of routine patient costs for items and
services furnished in connection with participation in an approved clinical trial
Discriminating against qualified individuals on the basis of their participation in an approved clinical trial
Medical Loss Ratio - correct answer ✔✔Is a basic financial measurement that shows how much of the
premium dollars a health insurance issuer spends on health care expenses, as opposed to profits or
administrative costs. As of 2012, a health insurance issuer that does not spend enough of its premium
dollars on health care services must provide rebates to insured individuals or policyholders.
Two Types of Martketplaces (exchanges) - correct answer ✔✔The Individual Marketplaces for individual
consumers and their families such as Kate, the self-employed interior decorator
The SHOP Marketplaces for small business owners such as Tony, the owner of the small Italian
restaurant
Functions of Marketplace - correct answer ✔✔Certifying health plans to participate in a Marketplace as
QHPs
Determining individuals' eligibility for enrollment in a QHP
Determining individuals' eligibility for premium tax credits and cost-sharing reductions
Determining or assessing individuals' eligibility for enrollment in Medicaid and/or the Children's Health
Insurance Program (CHIP)
Facilitating individuals' enrollment in a QHP
Carrying out certain plan oversight functions, including monitoring QHP issuers for continuing
compliance with certification requirements
Facilitating employers' applications and employee enrollments in coverage through SHOP
Some states will establish their own Marketplaces; however, if a state does not choose to establish its
own Marketplace, HHS will establish a Federally-facilitated Marketplace.
Qualified Health Plan - correct answer ✔✔Coverage, at a minimum, of a comprehensive package of
benefits, known as essential health benefits, or EHB
Benefit design standards, including non-discrimination requirements and limits on cost-sharing
, Network adequacy standards
Essential Health Benefits - correct answer ✔✔Reflect appropriate balance among the 10 EHB categories
Do not discriminate based on age, disability or expected length of life
Take into account the health care needs of diverse segments of the population
10 EHB Categories - correct answer ✔✔Ambulatory patient services(dr. visits)
Mental health and substance abuse, including behavioral health
Rehabilitative and habilative services and devices
Laboratory services
Emergency services
maternity and newborn care
Prescription drugs
Pediatric services, including oral (pkg or stand alone)
Preventive and wellness services and chronic disorder services
CO-OP Health Plan (Consumer operated & oriented plan) - correct answer ✔✔Private nonprofit health
insurer
directed by their customers and designed to offer individual and small business more affordable,
consumer-friendly and high quality health insurance options.
Multi State Plans MSPs - correct answer ✔✔Will be available to families or small business that reside or
operate in more than one state and will be available in all states 2014
Stand Alone Dental Plan - correct answer ✔✔Adult dental is not an EHB but can be purchased as stand
alone dental plan through marketplaces.
Five Levels of Coverage - correct answer ✔✔The five levels of generosity are called catastrophic, bronze,
silver, gold, and platinum in ascending order of generosity. These levels, sometimes referred to as "metal
levels" provide several benefits:
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