2024 INDIANA NAVIGATOR TEST
STUDY GUIDE EXAM WITH
CORRECT ANSWERS
Define IHCP - CORRECT ANSWERS-Indiana Health Coverage Program:
programs under Indiana Medicaid developed to address the medical needs of low income, aged, disabled, pregmant and other populations meeting the different eligibility criteria of each program. www.dfrbenefits.in.gov What programs fall under the Indiana Health Coverage Programs? - CORRECT
ANSWERS-Indiana Medicaid: Hoosier Healthwise, Childrens's Health
Insurance Program, Healthy Indiana Plan, Hoosier Care Connect, Traditional Medicaid, and Home and Community Based Waiver Services (HCBS) What are the 10 Essential Health Benefits (EHBs)? - CORRECT ANSWERS-1.ambulatory patient services/outpatient care
- emergency services
- hospitalization
- maternity and newborn care
- mental health and substance use disorder services, including behavioral
- prescription drugs
- rehabilitation and habilitative services and devices
- laboratory services
- preventative and wellness services and chronic disease management
- pediatric services, including oral and vision care
- small group 80% 1 / 3
health treatment
what is a state's benchmark plan? - CORRECT ANSWERS-a plan that sets the baseline requirement(s) of benefits that must be covered by other plans offered in the state Define Medical Loss Ratio (MLR). - CORRECT ANSWERS-the percent of premiums collected by an insurance company that must be spent on medical services and quality improvement; if not met by insurance company, individuals and small businesses covered will receive a refund What are the Medical Loss Ratio (MLR) requirements according to the ACA? - CORRECT ANSWERS-1. large group 85%
- individual 80%
programs that are not MEC: - CORRECT ANSWERS-Medicaid: optional family planning services, emergency Medicaid, tuberculosis services, outpatient hospital services
Not Medicaid: worker's compensation, vision benefits, coverage for
employer-provided onsite medical clinics, separate policies for coverage of only a specified disease What programs are MEC? - CORRECT ANSWERS-1. Government sponsored health coverage (QHPs, Medicare Pt. A or C, most Medicaid programs, CHIP, Refugee Medical Assistance, Veterans Admin. ;programs including TriCare and CHAMP VA, Dept. of Defense nonappropriated Fund Health Benefit Program, coverage for Peace Corps volunteers)
- any job based coverage
- qualifying individual market health coverage
- grandfatehred health plan
- coverage under a parent's plan
- most student health plans
- state high-risk pools
Define FFM - CORRECT ANSWERS-Federally-facilitated Marketplace: federally
developed and operated insurance marketplace that makes Qualified Health Providers, Premium Tax Credits, and Cost Share Reductions available to individuals and/or employers in accordance with the Affordable Care Act (ACA). Also referred to as www.healthcare.gov or an Exchange.Define Producer, Agent, Broker, Agency - CORRECT ANSWERS-an individual/entity licensed by the state/Indiana Dept. of Insurance (IDOI) as a health insurance producer to sell, solicit, or negotiate insurance (products) and are therefore unable to be certified as an Indiana Navigator or Application Organization due to receiving compensation for enrolling an individual in a plan. If they want to sell on the FFM, they must be federally certified through the CMS.Define Indiana Navigator - CORRECT ANSWERS-an individual certified by the state of Indiana to provide application assistance through the Federally
Facilitated Marketplace (FFM: QHPs, PTCs, CSRs) and/or the Indiana Health
Coverage Program (Medicaid, CHIP, HIP, HHW, Hoosier Care Connect)
Define AO - CORRECT ANSWERS-Application Organization: an entity that
must be certified and registered with the state of Indiana to assist Hoosiers with applications on the FFM and/or for IHCPs
Define CAC - CORRECT ANSWERS-Certified Application Counselors:
individuals (staff members or volunteers) who fulfill some of the same roles 2 / 3
as Navigators and are certified as Indiana Navigators through the IDOI; they are not responsible for outreach and education but they do provide free information to consumers about insurance programs and they help to facilitate the enrollment in health coverage.Define Non-Navigator Assistance Personnel - CORRECT ANSWERS-a role with the same certification requirements as a Navigator that complements Navigator programs in Partnership Marketplace states; not available in Indiana and other FFM Model states Define Navigator PE - CORRECT ANSWERS-Navigator Precertification
Education: education and training programs approved by the IDOI that must
be completed by individuals as part of the initial Indiana Navigator certification application process and prior to taking the Navigator Examination.
Navigator CE - CORRECT ANSWERS-Navigator Continuing Education:
education and training programs approved by the IDOI that must be completed by certified Indiana Navigators to satisfy their yearly two-hour Navigator CE requirement to renew their licensure.What is a Conflict of Interest Policy? - CORRECT ANSWERS-A state policy that establishes what may constitute an actual or potential Conflict of Interest (Financial Interest or Conflict of Loyalty) and disclosure and other requirements surrounding such conflicts by which all Indiana Navigators and AOs must comply.What is an example of a conflict of interest and what type is it? - CORRECT ANSWERS-Conflict of loyalty- an Indiana Navigator and/or an AO have a close relationship with a hospital that prefers a high payment rate plan What are the kinds of conflict of interests? - CORRECT ANSWERS-Direct financial incentive, indirect financial incentive, no additional financial incentive, and conflict of loyalty.
Define direct financial incentive. - CORRECT ANSWERS-A conflict of interest:
an individual receives compensation from a health insurance company for enrolling a consumer in a specific/stop-loss plan. Not allowed (ie agents or brokers)
Define indirect financial incentive. - CORRECT ANSWERS-Conflict of interest:
must be disclosed to IDOI and all consumers prior to assisting with coverage that an AO or Navigator holds stock in an insurance company and may indirectly benefit if consumer purchases a plan with the assistance of a Navigator.
- / 3