CEC Roles and Regulations 5 — Questions and Answers
Question 1: Under CMS regulations, how long must a CAC-designated organization retain records related to consumer assistance activities?
- 1 year
- 3 years
- 5 years (Correct answer)
- 10 years
Correct answer: 5 years
CMS requires CAC-designated organizations to retain records of their consumer assistance activities for a minimum of 5 years.
Question 2: A consumer is simultaneously eligible for both Medicaid and Marketplace coverage. What should the enrollment counselor do?
- Enroll the consumer in the Marketplace plan since it has more options
- Explain both programs objectively and help the consumer understand which they qualify for, noting Medicaid eligibility typically precludes premium tax credits (Correct answer)
- Enroll the consumer in both programs to maximize their coverage
- Refer the consumer only to the Medicaid agency without explaining Marketplace options
Correct answer: Explain both programs objectively and help the consumer understand which they qualify for, noting Medicaid eligibility typically precludes premium tax credits
Counselors must objectively explain both programs; consumers eligible for Medicaid are generally not eligible for premium tax credits, so accurate information is essential for an informed decision.
Question 3: Which of the following best describes the 'assister attestation' requirement when registering as a CAC?
- The consumer's signature confirming enrollment
- The CAC's agreement to comply with all applicable laws, regulations, and program requirements (Correct answer)
- The organization's attestation that it has no outstanding tax liabilities
- The insurer's confirmation that the CAC is authorized to enroll their plans
Correct answer: The CAC's agreement to comply with all applicable laws, regulations, and program requirements
Assister attestation is the formal agreement by CACs to abide by all applicable federal and state laws, regulations, and program standards as a condition of certification.
Question 4: What is the significance of a Special Enrollment Period (SEP) in the context of an enrollment counselor's role?
- It allows counselors to enroll in additional training programs
- It provides qualifying consumers a window to enroll in or change coverage outside the annual Open Enrollment Period (Correct answer)
- It extends the deadline for organizations to submit CAC recertification paperwork
- It is a period when insurers must accept all applicants regardless of health status
Correct answer: It provides qualifying consumers a window to enroll in or change coverage outside the annual Open Enrollment Period
SEPs allow consumers who experience qualifying life events (marriage, job loss, birth of a child) to enroll in or modify Marketplace coverage outside the standard Open Enrollment Period.
Question 5: Which of the following is a qualifying life event that triggers a Special Enrollment Period?
- Deciding you no longer like your current plan
- Losing job-based health coverage (Correct answer)
- Moving to a different apartment in the same zip code
- Receiving a raise that increases household income
Correct answer: Losing job-based health coverage
Losing job-based health coverage is a qualifying life event that triggers a 60-day Special Enrollment Period to enroll in Marketplace coverage.
Question 6: An enrollment counselor working for a Navigator organization receives a large gift basket from a local insurance broker who wants referrals. What should the counselor do?
- Accept the gift since it is from a broker, not an insurer
- Decline the gift and report the offer to their supervisor, as it represents a potential conflict of interest (Correct answer)
- Accept it but document the receipt in their records
- Ask the broker to donate the gift to a local charity instead
Correct answer: Decline the gift and report the offer to their supervisor, as it represents a potential conflict of interest
Accepting gifts from anyone seeking referrals creates a conflict of interest; the counselor must decline and report the offer to maintain impartiality and comply with assister standards.
Question 7: Under the ACA, what does 'meaningful access' require for consumers with disabilities seeking enrollment assistance?
- Providing a separate enrollment portal for consumers with disabilities
- Ensuring physical and communication accessibility so consumers with disabilities can fully participate in the enrollment process (Correct answer)
- Waiving premium payments for consumers with documented disabilities
- Automatically enrolling disabled consumers in the most comprehensive plan available
Correct answer: Ensuring physical and communication accessibility so consumers with disabilities can fully participate in the enrollment process
Section 504 of the Rehabilitation Act and ACA Section 1557 require that enrollment assistance be physically and communicatively accessible to individuals with disabilities.
CEC Roles and Regulations 5
Under CMS regulations, how long must a CAC-designated organization retain records related to consumer assistance activities?