ACA Professional Ethics & Standards 3 — Questions and Answers
Question 1: A client asks their navigator to use a slightly different income figure to qualify for a higher subsidy. What must the navigator do?
- Use the figure the client requests to maximize their benefit
- Refuse, explain that only accurate income must be reported, and use the correct figure (Correct answer)
- Ask the client to self-attest and take no further action
- Complete the application and note the discrepancy internally
Correct answer: Refuse, explain that only accurate income must be reported, and use the correct figure
Providing false income information to obtain premium tax credits is fraud, and assisters are ethically and legally obligated to use accurate data only.
Question 2: Which element is most critical when documenting an ACA enrollment assistance session for compliance purposes?
- The assister's personal opinion of the selected plan
- Date, services provided, and the client's verbal feedback
- A record of services offered, client decisions made, and any referrals provided (Correct answer)
- Only the final plan selected and the premium amount
Correct answer: A record of services offered, client decisions made, and any referrals provided
Complete documentation of services rendered, decisions made, and referrals given protects both the client and the assister and demonstrates program compliance.
Question 3: An assister's personal religious beliefs conflict with advising a client about a plan that covers services the assister objects to. What is the ethical standard?
- The assister may refuse to discuss those services
- The assister must provide complete, objective information or refer the client to another assister (Correct answer)
- The assister should recommend an alternative plan without explaining why
- The assister can skip those benefits during the explanation
Correct answer: The assister must provide complete, objective information or refer the client to another assister
Personal beliefs cannot limit the information provided to clients; if an assister cannot remain objective, they must refer the client to someone who can.
Question 4: Under HIPAA and ACA program standards, how long must a navigator typically retain client records?
- 6 months after the plan year ends
- At least 5 years, or as required by grant terms (Correct answer)
- Records need not be retained once enrollment is confirmed
- 3 years from the client's last contact
Correct answer: At least 5 years, or as required by grant terms
HHS grant requirements and best practices generally mandate retaining client assistance records for a minimum of five years.
Question 5: A client with limited English proficiency arrives without an interpreter. What is the ethically required response?
- Proceed in English and have the client sign an acknowledgment
- Use a bilingual family member present to translate all details
- Provide language assistance services or schedule a session with a qualified interpreter (Correct answer)
- Decline to assist until the client brings their own interpreter
Correct answer: Provide language assistance services or schedule a session with a qualified interpreter
Federal civil rights requirements mandate that assisters provide meaningful access to services for individuals with limited English proficiency through qualified language assistance.
Question 6: When a client's Special Enrollment Period (SEP) eligibility is questionable, what is the ethical approach?
- Enroll the client under any available SEP to ensure they get coverage
- Explain the qualifying events, let the client self-attest accurately, and document the basis for the SEP claim (Correct answer)
- Skip the SEP question and submit a standard application
- Advise the client to wait for Open Enrollment to avoid risk
Correct answer: Explain the qualifying events, let the client self-attest accurately, and document the basis for the SEP claim
Assisters must explain SEP rules accurately, ensure the client attests truthfully, and document the qualifying event rather than gaming the system.
Question 7: Which behavior by an assister would most directly violate the ACA's program integrity standards?
- Explaining the difference between HMO and PPO plans
- Steering clients toward a plan because the assister's family member is a provider in that network (Correct answer)
- Discussing premium tax credit calculation methods
- Explaining cost-sharing reductions to a client
Correct answer: Steering clients toward a plan because the assister's family member is a provider in that network
Using personal relationships to steer clients toward specific plans is a conflict of interest that violates ACA program integrity and ethical standards.
ACA Professional Ethics & Standards 3
A client asks their navigator to use a slightly different income figure to qualify for a higher subsidy.
What must the navigator do?