Compliance & Consumer Protections Flashcards
6 cards from real ACA practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 6 Compliance & Consumer Protections flashcards as text
What is one key consumer protection under the ACA?
Answer: Insurers cannot deny coverage for pre-existing conditions
The ACA prohibits insurance companies from denying coverage due to pre-existing conditions, ensuring broader access to healthcare.
Which entity is responsible for enforcing ACA compliance?
Answer: Department of Health and Human Services (HHS)
The Department of Health and Human Services (HHS) ensures that ACA regulations are followed by insurers and healthcare providers.
What is the purpose of the ACA’s Medical Loss Ratio rule?
Answer: To ensure a majority of premiums fund healthcare services
The Medical Loss Ratio rule requires insurers to spend at least 80% of premium revenues on healthcare services and quality improvements.
How does the ACA protect consumers from surprise medical bills?
Answer: By requiring transparency in coverage and prohibiting surprise billing
The ACA requires insurers to provide clear explanations of coverage and prohibits unexpected out-of-network charges in emergency situations.
What does the ACA require insurers to include in all health plans?
Answer: Essential health benefits such as preventive care and maternity services
The ACA mandates that all health plans cover essential health benefits, including preventive care, maternity services, and mental health treatment.
How does the ACA ensure consumer access to accurate health plan information?
Answer: By requiring insurers to offer a standardized Summary of Benefits and Coverage
The ACA requires insurers to provide a Summary of Benefits and Coverage (SBC) that outlines plan details in a clear and understandable format.