CACs CAC Roles and Responsibilities 2 — Questions and Answers
Question 1: A CAC discovers that a client provided incorrect income information on their Marketplace application. What is the CAC's primary obligation?
- Ignore it since the application is already submitted
- Advise the client to correct the information and submit an application update (Correct answer)
- Report the client to the IRS immediately
- Enroll the client anyway and note the discrepancy internally
Correct answer: Advise the client to correct the information and submit an application update
CACs must advise clients to provide accurate information and help them correct any errors on their applications.
Question 2: Which of the following activities is OUTSIDE the scope of a CAC's authorized role?
- Explaining Marketplace plan options to consumers
- Recommending a specific health plan based on the CAC's commission (Correct answer)
- Helping clients complete enrollment applications
- Providing information about tax credits and cost-sharing reductions
Correct answer: Recommending a specific health plan based on the CAC's commission
CACs are prohibited from accepting compensation from insurers or recommending plans based on financial incentives, as this conflicts with their duty to serve the consumer.
Question 3: A CAC is approached by a consumer who speaks limited English. What should the CAC do?
- Decline to assist and refer the consumer to an English-speaking navigator
- Assist the consumer using available language services or interpreter resources (Correct answer)
- Have the consumer bring a family member to translate without any additional steps
- Submit the application on the consumer's behalf without explaining the contents
Correct answer: Assist the consumer using available language services or interpreter resources
CACs must take reasonable steps to provide meaningful access to services, including using available language assistance resources.
Question 4: How long must a CAC retain records of consumer assistance activities?
- 6 months
- 1 year
- At least 3 years (Correct answer)
- 10 years
Correct answer: At least 3 years
CACs and their sponsoring organizations must retain records of consumer assistance activities for a minimum of three years.
Question 5: A consumer asks a CAC to help them understand the difference between a PPO and an HMO on the Marketplace. This request is:
- Outside a CAC's scope — only licensed agents may explain plan types
- Within a CAC's scope as part of providing educational information about plan options (Correct answer)
- Only permitted if the CAC holds an active insurance license
- Prohibited because it could be construed as plan recommendation
Correct answer: Within a CAC's scope as part of providing educational information about plan options
Explaining plan types and general differences between them is educational assistance that falls within a CAC's authorized scope.
Question 6: A CAC assists a client in enrolling in a Qualified Health Plan (QHP). After enrollment, the client calls with billing questions from the insurer. The CAC should:
- Handle all billing disputes directly with the insurer on the client's behalf
- Direct the client to the insurer's customer service or appropriate state resources (Correct answer)
- Re-enroll the client in a different plan to avoid the billing issue
- File a complaint with CMS on the client's behalf without their knowledge
Correct answer: Direct the client to the insurer's customer service or appropriate state resources
Post-enrollment billing issues are handled by the insurer; CACs should refer clients to the appropriate insurer or state resources.
Question 7: What is a CAC required to do before providing assistance to a consumer?
- Charge a nominal fee for their services
- Inform the consumer of the CAC's role, the free nature of services, and confidentiality policies (Correct answer)
- Obtain written authorization from CMS for each consumer assisted
- Verify the consumer's identity with a government-issued ID
Correct answer: Inform the consumer of the CAC's role, the free nature of services, and confidentiality policies
CACs must disclose their role, that their services are free, and how consumer information will be used before assisting.
CACs CAC Roles and Responsibilities 2
A CAC discovers that a client provided incorrect income information on their Marketplace application.
What is the CAC's primary obligation?