CACs - Certified Application Counselor Ethics and Impartiality Questions and Answers 1 — Questions and Answers
Question 1: A CAC's roommate is an insurance agent who receives commissions for enrolling individuals in specific Qualified Health Plans. The roommate offers the CAC a cash 'finder's fee' for every consumer the CAC refers to them who successfully enrolls. What is the CAC's primary ethical obligation?
- Accept the fee but disclose the arrangement to the consumer and the CDO.
- Decline the offer as it represents a clear conflict of interest and is prohibited. (Correct answer)
- Accept the offer, since the arrangement is with a roommate and not directly with an insurance issuer.
- Refer consumers only if the roommate's plans are genuinely a good fit for their needs.
Correct answer: Decline the offer as it represents a clear conflict of interest and is prohibited.
Certified Application Counselors are strictly prohibited from receiving any direct or indirect consideration or payment from health insurance issuers or agents in connection with the enrollment of individuals. This scenario represents a prohibited conflict of interest that would compromise the CAC's required impartiality. The only correct action is to decline the offer.
Question 2: Which of the following statements best defines the ethical principle of impartiality for a Certified Application Counselor?
- Recommending the health plan with the lowest premium to save the consumer money.
- Suggesting the plan offered by the most well-known insurance company in the state.
- Providing fair, accurate, and unbiased information on all available health coverage options to empower the consumer's choice. (Correct answer)
- Assisting only those consumers who are likely to qualify for financial assistance.
Correct answer: Providing fair, accurate, and unbiased information on all available health coverage options to empower the consumer's choice.
Impartiality requires CACs to provide comprehensive, unbiased information about all of a consumer's health coverage options so the consumer can make an informed choice. It is unethical to steer consumers toward a specific plan based on a single factor like cost, brand recognition, or eligibility for subsidies. The CAC's role is to educate, not to recommend or decide for the consumer.
Question 3: A consumer is overwhelmed by the number of plan choices and says to the CAC, "This is too much for me. You're the expert, just pick the best silver plan and sign me up." Which of the following is the most ethical response?
- Comply with the consumer's request in the interest of providing efficient service.
- Explain that the CAC is prohibited from choosing a plan, and offer to use Marketplace tools to compare a few options side-by-side based on the consumer's stated priorities. (Correct answer)
- Select the silver plan with the lowest deductible and complete the enrollment.
- Refuse to assist the consumer further until they are willing to make their own selection.
Correct answer: Explain that the CAC is prohibited from choosing a plan, and offer to use Marketplace tools to compare a few options side-by-side based on the consumer's stated priorities.
A core ethical duty of a CAC is to help consumers make their own informed decisions, not to make decisions for them. Choosing a plan for a consumer, even when asked, violates the principle of impartiality and exceeds the CAC's authorized scope of work. The proper action is to guide the consumer in using comparison tools to help them make their own choice.
Question 4: A CAC works for a hospital that is a CDO. The hospital's marketing department asks the CAC for a list of consumers who were successfully enrolled in Marketplace plans to send them a welcome packet and information about hospital services. Ethically, what must the CAC do?
- Provide the list, as the marketing materials are beneficial to the consumers.
- Provide the list but only for consumers who selected a plan affiliated with the hospital.
- Refuse the request, explaining that PII collected for enrollment purposes cannot be used for marketing without explicit, written consumer consent for that specific purpose. (Correct answer)
- Ask the consumers for verbal permission before adding them to the marketing list.
Correct answer: Refuse the request, explaining that PII collected for enrollment purposes cannot be used for marketing without explicit, written consumer consent for that specific purpose.
Personally Identifiable Information (PII) collected to assist with a Marketplace application is protected and can only be used for that purpose. Using this information for a secondary purpose, such as marketing, is a violation of the CAC's privacy and confidentiality obligations unless the consumer has provided explicit, written consent for that secondary use.
Question 5: A consumer is very happy with the assistance they received and insists on giving the CAC a $25 restaurant gift card as a thank you. According to the standards of conduct for assisters, what is the appropriate action?
- Politely decline the gift, explaining that assisters are prohibited from accepting payments or gifts of any amount from consumers. (Correct answer)
- Accept the gift, since its value is small and does not create a significant conflict of interest.
- Accept the gift on behalf of the CDO and turn it over to a supervisor.
- Suggest the consumer mail the gift card to the CDO's main office instead.
Correct answer: Politely decline the gift, explaining that assisters are prohibited from accepting payments or gifts of any amount from consumers.
Federal standards of conduct prohibit CACs from soliciting or accepting any gifts, payments, or other consideration from consumers for their assistance. This is a strict rule to prevent conflicts of interest and the appearance of impropriety. The only correct action is to politely decline the gift, regardless of its value.
Question 6: A Certified Application Counselor Designated Organization (CDO) is creating a new radio advertisement. Which of the following phrases would be inappropriate and violate the principle of impartiality?
- "Our certified counselors offer free, unbiased help with your Marketplace application."
- "We'll get you enrolled in the best, most affordable health plan, guaranteed!" (Correct answer)
- "Need help understanding your health insurance options? Schedule a free appointment today."
- "We provide fair and accurate information to help you find the right coverage for your family."
Correct answer: "We'll get you enrolled in the best, most affordable health plan, guaranteed!"
The phrase "We'll get you enrolled in the best, most affordable health plan, guaranteed!" is inappropriate because it makes a subjective promise ('best'), implies a bias towards a single factor ('most affordable'), and suggests the CDO, not the consumer, is making the choice. This violates the core principle of impartiality. All outreach materials must accurately reflect the fair and unbiased nature of the assistance provided.
CACs - Certified Application Counselor Ethics and Impartiality Questions and Answers 1
A CAC's roommate is an insurance agent who receives commissions for enrolling individuals in specific Qualified Health Plans.
The roommate offers the CAC a cash 'finder's fee' for every consumer the CAC refers to them who successfully enrolls.
What is the CAC's primary ethical obligation?