CEC Roles and Regulations 3 — Questions and Answers
Question 1: Under Marketplace regulations, enrollment counselors are required to complete training and be recertified on what basis?
- Every five years
- Annually (Correct answer)
- Once upon initial certification, no renewal needed
- Every three years
Correct answer: Annually
Enrollment assisters including CACs and Navigators are required to complete annual recertification training to maintain their active status.
Question 2: A consumer asks an enrollment counselor to recommend the 'best' health plan for them. What is the appropriate response?
- Recommend the plan with the lowest premium
- Recommend the plan with the most benefits
- Provide objective information and help the consumer choose based on their own needs (Correct answer)
- Refer the consumer to an insurance agent for any plan recommendations
Correct answer: Provide objective information and help the consumer choose based on their own needs
Enrollment counselors must remain neutral and provide objective information to help consumers make their own informed decisions rather than directing them to a specific plan.
Question 3: Which regulation prohibits a Navigator from being an agent or broker or receiving compensation from a health insurance issuer?
- The Health Insurance Portability and Accountability Act (HIPAA)
- 45 CFR § 155.210 (Correct answer)
- The Employee Retirement Income Security Act (ERISA)
- The Fair Labor Standards Act (FLSA)
Correct answer: 45 CFR § 155.210
45 CFR § 155.210 establishes Navigator standards, including the prohibition on being a licensed agent/broker or receiving issuer compensation to prevent conflicts of interest.
Question 4: What action must an enrollment counselor take before accessing a consumer's Marketplace account on their behalf?
- Obtain verbal consent only
- Obtain written or documented consent from the consumer (Correct answer)
- Notify the state insurance commissioner
- Request permission from their supervising organization
Correct answer: Obtain written or documented consent from the consumer
Enrollment counselors must obtain documented consumer consent before accessing or making changes to a consumer's Marketplace account.
Question 5: Which of the following is an example of a conflict of interest that an enrollment counselor must avoid?
- Assisting consumers from multiple income brackets
- Accepting gifts or payments from a health insurance issuer for enrolling consumers in their plans (Correct answer)
- Explaining the difference between HMO and PPO plan types
- Helping consumers understand their Explanation of Benefits
Correct answer: Accepting gifts or payments from a health insurance issuer for enrolling consumers in their plans
Accepting gifts or compensation from insurers in exchange for directing consumers to their plans is a conflict of interest prohibited under assister regulations.
Question 6: When must an enrollment counselor notify their designated organization or supervising entity of a potential conflict of interest?
- Only if the conflict results in a consumer complaint
- Immediately upon identifying the potential conflict (Correct answer)
- At their annual recertification
- Only if the conflict involves more than $500 in value
Correct answer: Immediately upon identifying the potential conflict
Enrollment counselors must disclose potential conflicts of interest to their organization immediately upon discovery, not wait for a complaint or annual review.
Question 7: A consumer who was assisted by an enrollment counselor later files a complaint that the counselor shared their health information with an unauthorized party. Which agency would most likely investigate this complaint on the federal Marketplace?
- The Federal Trade Commission (FTC)
- The Office for Civil Rights (OCR) at HHS
- CMS or the applicable state agency overseeing Marketplace assisters (Correct answer)
- The Social Security Administration (SSA)
Correct answer: CMS or the applicable state agency overseeing Marketplace assisters
CMS oversees assister conduct on the federally facilitated Marketplace, and consumer complaints about assister misconduct would be investigated by CMS or the relevant state agency.
CEC Roles and Regulations 3
Under Marketplace regulations, enrollment counselors are required to complete training and be recertified on what basis?