CEC Application and Enrollment Procedures 3 — Questions and Answers
Question 1: When an employee is newly hired, how many days do they typically have to enroll in employer-sponsored coverage without needing a qualifying event?
- 15 days
- 30 days
- 60 days (Correct answer)
- 90 days
Correct answer: 60 days
Under the ACA and most employer plan rules, newly eligible employees generally have a 60-day enrollment window upon becoming eligible.
Question 2: What is 'auto-enrollment' in the context of employer health plans?
- Employers automatically enroll new full-time employees in a default plan unless they opt out (Correct answer)
- Employees are automatically switched to a better plan each year
- Insurers enroll all applicants regardless of eligibility
- The government assigns plans to uninsured individuals
Correct answer: Employers automatically enroll new full-time employees in a default plan unless they opt out
Auto-enrollment means employers enroll newly eligible employees into a default health plan automatically, requiring an affirmative opt-out to decline.
Question 3: For Marketplace plans, when does coverage typically begin if a consumer enrolls between the 1st and 15th of the month?
- The same day
- The first of the following month (Correct answer)
- The 15th of the following month
- 60 days after enrollment
Correct answer: The first of the following month
Enrollments completed between the 1st and 15th of a month generally result in coverage effective the 1st of the following month.
Question 4: What does 'creditable coverage' mean in health insurance enrollment?
- Coverage that qualifies an enrollee for a tax credit
- Prior health coverage that counts toward satisfying waiting periods or pre-existing condition rules (Correct answer)
- A plan with no deductible
- Coverage that has been approved by the state insurance commissioner
Correct answer: Prior health coverage that counts toward satisfying waiting periods or pre-existing condition rules
Creditable coverage refers to previous health insurance that is at least as comprehensive as Medicare Part D or employer standards, used to avoid waiting periods.
Question 5: A Certified Enrollment Counselor discovers that a client provided incorrect income information on their application. What is the correct course of action?
- Ignore the error since enrollment is already complete
- Advise the client to report the correction to the Marketplace immediately (Correct answer)
- Submit a new application without correcting the old one
- Contact the insurer directly to change the income
Correct answer: Advise the client to report the correction to the Marketplace immediately
Incorrect income information must be corrected through the Marketplace to ensure accurate APTC amounts and avoid penalties at tax filing.
Question 6: Which federal program provides health coverage to eligible low-income adults, children, pregnant women, elderly adults, and people with disabilities?
- COBRA
- CHIP
- Medicaid (Correct answer)
- Medicare Part B
Correct answer: Medicaid
Medicaid is the joint federal-state program that provides comprehensive health coverage to eligible low-income individuals across multiple categories.
Question 7: What is the role of a 'navigator' versus a 'certified application counselor' in the enrollment process?
- They are identical roles with no distinctions
- Navigators receive federal funding and must provide unbiased assistance, while CACs are typically affiliated with organizations but serve similar enrollment functions (Correct answer)
- Navigators can sell insurance plans; CACs cannot
- CACs work only with Medicaid; navigators work only with Marketplace plans
Correct answer: Navigators receive federal funding and must provide unbiased assistance, while CACs are typically affiliated with organizations but serve similar enrollment functions
Navigators are federally funded, trained to provide neutral enrollment assistance, while CACs work through designated organizations; both help consumers but have different funding and oversight structures.
CEC Application and Enrollment Procedures 3
When an employee is newly hired, how many days do they typically have to enroll in employer-sponsored coverage without needing a qualifying event?