CACs - Certified Application Counselor CAC Roles and Responsibilities Questions and Answers 1 — Questions and Answers
Question 1: A Certified Application Counselor (CAC) is approached by a consumer who is unsure which health plan to select. The consumer asks the CAC to recommend the 'best' plan for their needs. Which of the following is the most appropriate action for the CAC to take?
- Review the consumer's medical history and recommend a specific plan.
- Provide fair, accurate, and impartial information about the available plans so the consumer can make an informed choice. (Correct answer)
- Refer the consumer to a specific insurance agent they know personally.
- Enroll the consumer in the plan with the lowest premium.
Correct answer: Provide fair, accurate, and impartial information about the available plans so the consumer can make an informed choice.
Certified Application Counselors are required to provide information and services in a fair, impartial, and culturally competent manner. Their role is to help consumers understand their options and facilitate enrollment, not to recommend or select a specific plan on their behalf. Recommending a plan, referring to a specific agent, or choosing a plan based on a single factor like cost would be a violation of this core responsibility.
Question 2: Which of the following activities falls outside the scope of a Certified Application Counselor's authorized functions?
- Assisting a consumer with completing an application for health coverage.
- Explaining the differences between a PPO and an HMO plan.
- Providing legal advice regarding a coverage denial appeal. (Correct answer)
- Informing a consumer about their eligibility for insurance affordability programs.
Correct answer: Providing legal advice regarding a coverage denial appeal.
While CACs are responsible for assisting with applications and educating consumers about health coverage options and affordability programs, they are not authorized or qualified to provide legal advice. Offering legal counsel on matters like appeals is a prohibited activity and falls within the purview of a licensed legal professional.
Question 3: A CAC works for a local hospital that has been designated as a Certified Application Counselor Designated Organization (CDO). The CAC's cousin sells health insurance for a specific issuer. What is the CAC's primary responsibility regarding this relationship?
- Ignore the relationship as it is with a family member, not the CAC directly.
- Only refer consumers to their cousin if the consumer specifically asks for an agent.
- Disclose this potential conflict of interest to both the consumer and their CDO. (Correct answer)
- Quit their role as a CAC to avoid any potential conflict.
Correct answer: Disclose this potential conflict of interest to both the consumer and their CDO.
CACs have a duty to disclose any potential conflicts of interest to both the applicants they assist and their designated organization. This ensures transparency and maintains the integrity of the impartial assistance they are required to provide. Failing to disclose such a relationship could compromise their duty to act in the best interest of the consumer.
Question 4: During an enrollment event, a CAC collects personally identifiable information (PII) from several consumers on paper forms. What is a key responsibility of the CAC regarding this information?
- Leave the forms on their desk until they have time to enter the data.
- Ensure the information is stored and transmitted securely, according to privacy and security standards. (Correct answer)
- Share the information with colleagues who might also be able to help the consumers.
- Enter the information into their personal, password-protected laptop for convenience.
Correct answer: Ensure the information is stored and transmitted securely, according to privacy and security standards.
CACs and their organizations must adhere to strict privacy and security standards to protect consumer's PII. This includes developing and utilizing secure methods for collecting, storing, and transmitting sensitive information. Leaving documents unsecured or using personal devices would be a violation of these standards.
Question 5: A consumer who primarily speaks Spanish requests assistance from a CAC who is not fluent in Spanish. What is an appropriate step for the CAC to take in this scenario?
- Attempt to assist the consumer using translation apps, even if they are not fully accurate.
- Inform the consumer they cannot help and suggest they find a Spanish-speaking friend.
- Provide assistance in a manner that is accessible, which may include using qualified interpretation services. (Correct answer)
- Give the consumer the application and hope they can figure it out.
Correct answer: Provide assistance in a manner that is accessible, which may include using qualified interpretation services.
A core responsibility of a CAC is to provide information in a manner that is accessible, which includes accommodating individuals with limited English proficiency. The CAC should seek out resources like qualified interpreters or refer the consumer to another assister who can communicate effectively in their language to ensure they receive accurate and understandable help.
Question 6: Which of the following best describes the relationship between a Certified Application Counselor (CAC) and a Certified Application Counselor Designated Organization (CDO)?
- The CAC is an independent contractor who partners with a CDO.
- The CDO is a federal agency that directly employs all CACs.
- The CAC is a staff member or volunteer certified and overseen by the CDO. (Correct answer)
- The CAC and CDO are interchangeable terms for the same role.
Correct answer: The CAC is a staff member or volunteer certified and overseen by the CDO.
In the Federally-facilitated Marketplaces, CDOs are organizations (like hospitals or community health centers) designated to oversee CACs. These organizations are responsible for certifying that their individual staff members or volunteers meet the standards and training requirements to act as CACs.
CACs - Certified Application Counselor CAC Roles and Responsibilities Questions and Answers 1
A Certified Application Counselor (CAC) is approached by a consumer who is unsure which health plan to select.
The consumer asks the CAC to recommend the 'best' plan for their needs.
Which of the following is the most appropriate action for the CAC to take?