ACA Professional Ethics & Standards 2 — Questions and Answers
Question 1: A navigator assists a client who later discovers the plan enrolled them in does not cover their specialist's services. What is the navigator's primary ethical obligation in this scenario?
- Bill the client for additional consultation time
- Acknowledge the error, apologize, and help the client explore corrective options (Correct answer)
- Advise the client to sue the marketplace
- Refer the client to a licensed insurance agent only
Correct answer: Acknowledge the error, apologize, and help the client explore corrective options
Navigators must take responsibility for mistakes, communicate honestly, and actively assist clients in resolving problems caused by enrollment errors.
Question 2: Which of the following best describes the principle of 'non-maleficence' as applied to ACA enrollment assistance?
- Charging fair fees for services
- Avoiding actions that cause harm to clients (Correct answer)
- Maintaining confidential client records
- Referring clients to preferred insurance carriers
Correct answer: Avoiding actions that cause harm to clients
Non-maleficence means that enrollment assisters must avoid actions that could damage the client's health coverage, finances, or legal standing.
Question 3: An assister notices a colleague is recommending plans based on which insurer offers the best referral gifts. What is the assister's ethical duty?
- Ignore it since it is not their responsibility
- Report the conduct to their supervisor or compliance officer (Correct answer)
- Join the colleague to earn the same gifts
- Advise clients to choose any plan except those recommended by the colleague
Correct answer: Report the conduct to their supervisor or compliance officer
Ethical standards require that assisters report conflicts of interest or improper conduct that harm clients or violate program integrity.
Question 4: Under ACA ethics guidelines, when is it acceptable for a navigator to accept a tip from a grateful client?
- When the tip is under $20
- When the client insists and the navigator documents it
- Never; navigators may not accept compensation from clients (Correct answer)
- Only after the open enrollment period ends
Correct answer: Never; navigators may not accept compensation from clients
Navigators funded by federal grants are prohibited from accepting any payment, gifts, or tips from the clients they assist.
Question 5: A client shares that they are undocumented but has a citizen child who needs coverage. What is the ethically correct course of action?
- Decline to assist because the parent is ineligible
- Enroll the child in CHIP or Marketplace coverage without disclosing the parent's status unnecessarily (Correct answer)
- Report the parent's status to immigration authorities
- Require proof of citizenship before any assistance
Correct answer: Enroll the child in CHIP or Marketplace coverage without disclosing the parent's status unnecessarily
Eligible children may receive coverage regardless of their parents' status, and assisters must protect client confidentiality and serve all eligible individuals.
Question 6: Which practice best upholds the ethical standard of 'informed consent' in the ACA enrollment context?
- Enrolling clients quickly to save time
- Explaining all plan options, costs, and consequences before the client makes a decision (Correct answer)
- Selecting the lowest-cost plan on the client's behalf
- Obtaining a signed form after enrollment is complete
Correct answer: Explaining all plan options, costs, and consequences before the client makes a decision
Informed consent requires that clients fully understand their options, costs, and what they are agreeing to before any enrollment action is taken.
Question 7: A certified application counselor (CAC) works for a hospital. A client asks whether a specific plan covers the hospital's services. How should the CAC respond ethically?
- Recommend the hospital's preferred plan without mentioning the conflict of interest
- Disclose the hospital affiliation and provide objective information about all available plans (Correct answer)
- Refuse to answer and direct the client to call the insurer
- Only recommend plans that include the hospital to serve the client's best interest
Correct answer: Disclose the hospital affiliation and provide objective information about all available plans
CACs must disclose their organizational affiliation and any potential conflicts so clients can make independent, informed decisions.
ACA Professional Ethics & Standards 2
A navigator assists a client who later discovers the plan enrolled them in does not cover their specialist's services.
What is the navigator's primary ethical obligation in this scenario?