CEC Roles and Regulations 4 — Questions and Answers
Question 1: Which of the following activities is WITHIN the scope of a Certified Application Counselor's permitted role?
- Selling supplemental insurance policies to Marketplace consumers
- Helping consumers understand their eligibility for premium tax credits (Correct answer)
- Negotiating premium rates with health insurance issuers on behalf of consumers
- Providing legal advice about coverage disputes
Correct answer: Helping consumers understand their eligibility for premium tax credits
Explaining eligibility for premium tax credits and cost-sharing reductions is a core permitted function of Certified Application Counselors.
Question 2: What is a 'Federally Facilitated Marketplace' (FFM) in the context of ACA enrollment?
- A marketplace operated entirely by a state government
- A marketplace operated by HHS on behalf of states that did not establish their own (Correct answer)
- A private exchange run by insurance companies
- A Medicare enrollment portal
Correct answer: A marketplace operated by HHS on behalf of states that did not establish their own
The FFM is the health insurance marketplace operated by the federal government (HHS/CMS) for states that chose not to or were unable to establish their own state-based marketplace.
Question 3: Under ACA assister regulations, what is the primary purpose of the 'no wrong door' policy?
- To ensure consumers can enroll in any plan regardless of network
- To allow consumers to apply for coverage through multiple pathways and be referred to the appropriate program (Correct answer)
- To prevent consumers from being turned away from emergency rooms
- To guarantee same-day enrollment approval
Correct answer: To allow consumers to apply for coverage through multiple pathways and be referred to the appropriate program
The 'no wrong door' policy ensures consumers can access coverage assistance through multiple entry points (Medicaid, CHIP, Marketplace) and be seamlessly referred to the right program.
Question 4: Which of the following statements about a State-Based Marketplace (SBM) is accurate?
- SBMs must use the same technology platform as healthcare.gov
- SBMs can set their own assister certification requirements beyond federal minimums (Correct answer)
- SBMs are not permitted to have their own Navigator programs
- SBMs cannot offer plans from more than three insurance carriers
Correct answer: SBMs can set their own assister certification requirements beyond federal minimums
State-Based Marketplaces have flexibility to establish their own assister requirements as long as they meet or exceed federal minimum standards.
Question 5: An enrollment counselor is working with a limited English proficient (LEP) consumer. What is the counselor's obligation under federal civil rights laws?
- The consumer must bring their own interpreter
- The counselor must provide meaningful access, including language assistance services, at no cost to the consumer (Correct answer)
- The counselor may decline to assist if no staff interpreter is available
- The counselor only needs to provide written materials in English
Correct answer: The counselor must provide meaningful access, including language assistance services, at no cost to the consumer
Under Title VI of the Civil Rights Act and ACA requirements, organizations receiving federal funds must provide meaningful access to LEP individuals, including free language assistance.
Question 6: What is the role of the 'designated organization' in the CAC program?
- To set premium rates for Marketplace plans
- To train, oversee, and be accountable for the CACs they employ or have working on their behalf (Correct answer)
- To provide legal representation for CACs in consumer disputes
- To negotiate contracts between CACs and insurance issuers
Correct answer: To train, oversee, and be accountable for the CACs they employ or have working on their behalf
Designated organizations are responsible for training their CACs, ensuring compliance with program standards, and maintaining accountability for all CAC activities conducted under their designation.
Question 7: Which scenario best illustrates 'unauthorized practice of law' that an enrollment counselor must avoid?
- Explaining the difference between a deductible and an out-of-pocket maximum
- Advising a consumer on whether they have legal grounds to sue their insurer for a denied claim (Correct answer)
- Helping a consumer calculate their household income for eligibility purposes
- Informing a consumer about the open enrollment period dates
Correct answer: Advising a consumer on whether they have legal grounds to sue their insurer for a denied claim
Advising consumers on legal rights or grounds for litigation constitutes the practice of law, which enrollment counselors are not licensed to provide.
CEC Roles and Regulations 4
Which of the following activities is WITHIN the scope of a Certified Application Counselor's permitted role?