Ethics and Impartiality Flashcards

A CAC's roommate is an insurance agent who receives commissions for enrolling individuals in specific Qualified Health Plans. The roommate offers the CAC a cash 'finder's fee' for every consumer the CAC refers to them who successfully enrolls. What is the CAC's primary ethical obligation?

Answer: Decline the offer as it represents a clear conflict of interest and is prohibited.

Certified Application Counselors are strictly prohibited from receiving any direct or indirect consideration or payment from health insurance issuers or agents in connection with the enrollment of individuals. This scenario represents a prohibited conflict of interest that would compromise the CAC's required impartiality. The only correct action is to decline the offer.

Which of the following statements best defines the ethical principle of impartiality for a Certified Application Counselor?

Answer: Providing fair, accurate, and unbiased information on all available health coverage options to empower the consumer's choice.

Impartiality requires CACs to provide comprehensive, unbiased information about all of a consumer's health coverage options so the consumer can make an informed choice. It is unethical to steer consumers toward a specific plan based on a single factor like cost, brand recognition, or eligibility for subsidies. The CAC's role is to educate, not to recommend or decide for the consumer.

A consumer is overwhelmed by the number of plan choices and says to the CAC, "This is too much for me. You're the expert, just pick the best silver plan and sign me up." Which of the following is the most ethical response?

Answer: Explain that the CAC is prohibited from choosing a plan, and offer to use Marketplace tools to compare a few options side-by-side based on the consumer's stated priorities.

A core ethical duty of a CAC is to help consumers make their own informed decisions, not to make decisions for them. Choosing a plan for a consumer, even when asked, violates the principle of impartiality and exceeds the CAC's authorized scope of work. The proper action is to guide the consumer in using comparison tools to help them make their own choice.

A CAC works for a hospital that is a CDO. The hospital's marketing department asks the CAC for a list of consumers who were successfully enrolled in Marketplace plans to send them a welcome packet and information about hospital services. Ethically, what must the CAC do?

Answer: Refuse the request, explaining that PII collected for enrollment purposes cannot be used for marketing without explicit, written consumer consent for that specific purpose.

Personally Identifiable Information (PII) collected to assist with a Marketplace application is protected and can only be used for that purpose. Using this information for a secondary purpose, such as marketing, is a violation of the CAC's privacy and confidentiality obligations unless the consumer has provided explicit, written consent for that secondary use.

A consumer is very happy with the assistance they received and insists on giving the CAC a $25 restaurant gift card as a thank you. According to the standards of conduct for assisters, what is the appropriate action?

Answer: Politely decline the gift, explaining that assisters are prohibited from accepting payments or gifts of any amount from consumers.

Federal standards of conduct prohibit CACs from soliciting or accepting any gifts, payments, or other consideration from consumers for their assistance. This is a strict rule to prevent conflicts of interest and the appearance of impropriety. The only correct action is to politely decline the gift, regardless of its value.

A Certified Application Counselor Designated Organization (CDO) is creating a new radio advertisement. Which of the following phrases would be inappropriate and violate the principle of impartiality?

Answer: "We'll get you enrolled in the best, most affordable health plan, guaranteed!"

The phrase "We'll get you enrolled in the best, most affordable health plan, guaranteed!" is inappropriate because it makes a subjective promise ('best'), implies a bias towards a single factor ('most affordable'), and suggests the CDO, not the consumer, is making the choice. This violates the core principle of impartiality. All outreach materials must accurately reflect the fair and unbiased nature of the assistance provided.