CLAHS California Life, Accident and Health or Sickness Examination - Set 3 - Part 3

Test your knowledge of technical writing concepts with these practice questions. Each question includes detailed explanations to help you understand the correct answers.

Question 41: Under the Affordable Care Act, what limit may a plan place on the dollar value of an enrollee's essential health benefits?

A low annual dollar cap

A lifetime dollar cap

A one-time dollar cap per illness

No annual or lifetime dollar limit

Question 42: Among the metal tiers, which one has the highest actuarial value, meaning the plan pays the largest share of covered costs and the enrollee pays the least at the point of care?

Platinum

Bronze

Silver

Gold

Question 43: Among the metal tiers, which one generally carries the lowest monthly premium but the highest out-of-pocket costs when care is used?

Silver

Gold

Bronze

Platinum

Question 44: Two marketplace plans are in different metal tiers. Which statement about their benefits is correct?

Higher tiers cover more types of benefits

Lower tiers exclude emergency care

Only Platinum covers prescription drugs

Both cover the same essential health benefits

Question 45: Which Affordable Care Act term refers to the types of health coverage that satisfy the law's coverage requirement?

Essential health benefits

Minimum essential coverage

Qualified health plan

Actuarial value

Question 46: Which of the following, by itself, does NOT count as minimum essential coverage under the Affordable Care Act?

Employer-sponsored group coverage

Medicare

A stand-alone accident-only policy

An individual-market medical plan

Question 47: The small-employer arm of California's Exchange, where a qualifying small business can offer employees qualified health plans, is known as which of the following?

Covered California for Small Business

The California FAIR Plan

The California Earthquake Authority

The state guarantee association

Question 48: A small employer may qualify for the federal small-business health care tax credit only if it has fewer than how many full-time-equivalent employees and buys coverage through the small-business marketplace?

Fewer than ten

Fewer than fifty

Fewer than one hundred

Fewer than twenty-five

Question 49: Under the Affordable Care Act, a Navigator who helps consumers use the marketplace is prohibited from doing which of the following?

Helping a consumer enroll

Explaining coverage options

Selling insurance or recommending a plan

Determining eligibility for assistance

Question 50: Under the medical loss ratio rule, what must an insurer do if it spends less than the required share of premium on medical care and quality in a market segment?

Refund the excess to consumers

Keep the difference as profit

Raise premiums the next year

Report nothing to regulators

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