CAC Roles and Responsibilities Flashcards

A CAC is working at a community health center and a consumer discloses a sensitive medical condition during enrollment assistance. How should the CAC treat this information?

Answer: Keep it confidential and use it only to the extent necessary to assist with enrollment

CACs must treat all consumer health information as confidential and use it only for the purpose of providing authorized assistance.

What action should a CAC take if they encounter a consumer who appears to be a victim of Marketplace fraud by another assister?

Answer: Help the consumer correct their situation and report the fraud to appropriate authorities such as CMS

CACs are obligated to assist affected consumers and must report suspected fraud or abuse to CMS or other appropriate authorities.

Which of the following best describes a CAC's responsibility regarding consumers who are ineligible for Marketplace coverage?

Answer: CACs should inform them of their ineligibility and refer them to other available programs or resources

Even when consumers are ineligible for Marketplace plans, CACs must inform them and connect them to other resources such as Medicaid, CHIP, or community health programs.

A CAC's sponsoring organization asks the CAC to promote a specific health insurer's plans at community enrollment events. This request is:

Answer: A violation of CAC standards because CACs must remain neutral and not promote specific insurers

CACs must remain impartial and cannot promote specific insurers or plans, regardless of relationships between insurers and their sponsoring organizations.

What must a CAC do if a consumer's circumstances change significantly after enrollment (e.g., income change, loss of job)?

Answer: Advise the consumer that changes must be reported and assist them with submitting a life event update to the Marketplace

CACs must inform consumers of their obligation to report qualifying life events and assist them in updating their Marketplace applications accordingly.

A consumer approaches a CAC requesting help choosing the plan with the lowest premium. The CAC believes a plan with a slightly higher premium would better fit the consumer's medical needs. What should the CAC do?

Answer: Respect the consumer's choice while providing complete information about how both plans compare

CACs must respect consumer autonomy while ensuring they have complete, accurate information to make an informed decision.

Under what circumstance may a CAC complete and submit a Marketplace application without the consumer being present?

Answer: Only with the consumer's explicit authorization and only to the extent authorized

A CAC may only act on a consumer's behalf with explicit authorization and must limit actions to exactly what the consumer has authorized.