CMS FFM Agent flashcards
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32 cards. Read the term and the definition here. The deck at the top of this page is optional.
- FFM registration
- The process by which an agent completes CMS identity proofing, signs the agent/broker agreement, and is authorized to assist consumers in the Federally-facilitated Marketplace.
- MLMS
- The Marketplace Learning Management System is the CMS platform where agents complete required annual Marketplace training modules and attest to completion.
- Annual training requirement
- FFM agents must complete Marketplace training each plan year before assisting consumers; prior-year completion does not satisfy the current year's requirement.
- FFM User ID
- The identifier issued to a Marketplace-registered agent after registration and training, used when assisting consumers through Marketplace eligibility and enrollment systems.
- Attestation
- A formal statement by the agent confirming completion of required training and commitment to comply with Marketplace registration and program requirements.
- SHOP module
- A supplemental MLMS training component required for agents who intend to assist small employers with Small Business Health Options Program enrollment.
- Privacy and security training
- A registration component that prepares agents to safeguard personally identifiable information and protected health information handled during Marketplace transactions.
- Registration termination
- CMS may suspend or terminate an agent's Marketplace registration if the agent's license lapses, is disciplined, or the agent violates program requirements.
- Lawful presence
- A Marketplace eligibility requirement that the consumer be lawfully present in the United States and reside in the Marketplace service area.
- Premium tax credit income range
- Eligibility generally requires household income between 100% and 400% of the federal poverty level for the applicable family size.
- Affordability test
- Employer coverage is affordable if the employee's required contribution for self-only coverage does not exceed the indexed percentage of household income.
- Special enrollment period
- A window triggered by a qualifying life event, such as marriage, birth, or loss of coverage, allowing enrollment outside Open Enrollment, generally within 60 days.
- Open Enrollment
- The annual period, typically November 1 through January 15 for the FFM, during which consumers may enroll in or change Marketplace coverage.
- Cost-sharing reductions
- Reductions in deductibles, copayments, and out-of-pocket limits available to consumers at or below 250% FPL who enroll in a Silver plan.
- Minimum essential coverage
- Coverage types that satisfy the individual coverage requirement, including Marketplace plans, employer plans, Medicare, Medicaid, and CHIP.
- SHOP eligibility
- Small employers, generally with 1-50 employees depending on state rules, may offer qualified health plans to employees through the Small Business Health Options Program.
- Single streamlined application
- The Marketplace application used to determine eligibility for Marketplace coverage, premium tax credits, Medicaid, and CHIP in one process.
- Qualified Health Plan
- A health plan certified by the Marketplace that meets benefit, network, and cost-sharing standards and is eligible for premium tax credits.
- Essential health benefits
- Ten required benefit categories, including hospitalization, prescription drugs, maternity care, and mental health services, that QHPs must cover.
- Metal tiers
- Actuarial value levels: Bronze about 60%, Silver about 70%, Gold about 80%, and Platinum about 90% of expected covered costs.
- Catastrophic plan
- A low-premium, high-deductible plan available only to consumers under age 30 or those who qualify for a hardship exemption.
- Summary of Benefits and Coverage
- A standardized document describing covered benefits, cost sharing, and coverage examples that must be provided to consumers considering a plan.
- Out-of-pocket maximum
- The annual cap on in-network cost sharing for essential health benefits; once reached, the plan pays 100% of covered EHB services.
- Network type
- The plan structure, such as HMO, PPO, EPO, or POS, that determines referral requirements and whether out-of-network services are covered.
- Formulary
- The list of prescription drugs covered by a plan, organized by cost-sharing tier, which consumers should check before enrolling.
- Advance premium tax credit
- A premium tax credit applied to monthly premiums during the year rather than claimed at tax filing; it must be reconciled on the tax return.
- Section 1557
- The Affordable Care Act nondiscrimination provision prohibiting discrimination in health programs receiving federal financial assistance and requiring language access.
- Protected characteristics
- Attributes such as race, color, national origin, sex, age, and disability that cannot be used to discriminate against consumers in Marketplace transactions.
- PII and PHI safeguards
- Requirements to protect personally identifiable information and protected health information from unauthorized access, use, or disclosure during enrollment assistance.
- Unauthorized enrollment
- Enrolling or switching a consumer's plan without consent, a deceptive practice that can result in registration termination and fraud liability.
- Eligibility appeal
- A consumer's right to challenge a Marketplace eligibility determination, including decisions on premium tax credits, Medicaid, or CHIP referral.
- State licensure
- An active state insurance license and appointment are required in addition to Marketplace registration to assist consumers in that state.