CEC Application and Enrollment Procedures 2 — Questions and Answers
Question 1: A dependent child turns 26 mid-plan-year. When does their coverage under a parent's employer-sponsored plan end?
- Immediately on the birthday
- At the end of the month in which they turn 26 (Correct answer)
- At the end of the plan year
- 30 days after the birthday
Correct answer: At the end of the month in which they turn 26
Under the ACA, dependent children may remain on a parent's plan until the end of the month in which they turn 26.
Question 2: Which document is typically required to verify a qualifying life event for a Special Enrollment Period?
- Prior-year tax return
- Documentation such as a marriage certificate, birth certificate, or loss-of-coverage letter (Correct answer)
- Social Security card only
- Employer verification letter only
Correct answer: Documentation such as a marriage certificate, birth certificate, or loss-of-coverage letter
Applicants must provide supporting documentation that matches the qualifying life event, such as a marriage certificate or loss-of-coverage notice.
Question 3: An applicant selects a plan during Open Enrollment but fails to pay the first premium. What is the result?
- Coverage starts anyway and a grace period applies from day one
- The plan selection is voided and coverage never takes effect (Correct answer)
- The insurer must cover claims for 30 days
- The applicant is automatically enrolled in Medicaid
Correct answer: The plan selection is voided and coverage never takes effect
If the initial premium is not paid by the due date, the enrollment is cancelled and coverage never becomes effective.
Question 4: Under CHIP, what income threshold generally determines eligibility for children in most states?
- Up to 100% FPL
- Up to 138% FPL
- Up to 200% FPL or higher (Correct answer)
- Up to 400% FPL
Correct answer: Up to 200% FPL or higher
CHIP covers children in families with incomes too high for Medicaid, typically up to 200% FPL or higher depending on the state.
Question 5: What is the purpose of the 'effective date' in an enrollment application?
- It marks when the insurer received the application
- It is the date from which coverage benefits begin (Correct answer)
- It is the date the premium is due
- It indicates when the enrollment window opened
Correct answer: It is the date from which coverage benefits begin
The effective date is the specific date on which the enrollee's health coverage and benefits officially begin.
Question 6: A consumer reports a household income change of $10,000 during the plan year. What should an enrollment counselor advise?
- Wait until next Open Enrollment to update
- Report the change through a Special Enrollment Period on the Marketplace
- Report the change to the Marketplace immediately to adjust APTC and CSR eligibility (Correct answer)
- Contact the employer directly
Correct answer: Report the change to the Marketplace immediately to adjust APTC and CSR eligibility
Consumers must report income changes promptly so that advance premium tax credits and cost-sharing reductions can be recalculated to avoid year-end reconciliation issues.
Question 7: Which of the following is NOT a qualifying life event for a Special Enrollment Period in the Marketplace?
- Loss of job-based coverage
- Getting married
- Voluntarily cancelling a previous health plan (Correct answer)
- Moving to a new coverage area
Correct answer: Voluntarily cancelling a previous health plan
Voluntarily dropping coverage is not a qualifying life event; SEPs are triggered by involuntary loss or other life changes.
CEC Application and Enrollment Procedures 2
A dependent child turns 26 mid-plan-year.
When does their coverage under a parent's employer-sponsored plan end?