Covered California Certified Enroller Practice Exam

What must AI/AN members obtain to avoid paying copayments or deductibles in their Covered California plan?

1. A referral from an Indian health care provider

2. A secondary insurance

3. A specific plan type

4. An eligibility letter

The correct answer is: A referral from an Indian health care provider

AI/AN (American Indian/Alaska Native) members likely need to obtain a referral from an Indian health care provider to avoid paying copayments or deductibles in their Covered California plan. This requirement is tied to provisions under the Affordable Care Act that enhance access to health services for indigenous populations, recognizing the role of tribal health providers in advocating for the health needs of AI/AN individuals. Referral from an Indian health care provider ensures that members are utilizing culturally competent care and that their health services meet eligibility criteria specific to AI/AN members. While secondary insurance could help in reducing out-of-pocket costs, it does not specifically address the waiving of copayments or deductibles as this approach does. A specific plan type might offer additional benefits tailored to AI/AN members, but it does not inherently provide a mechanism to avoid copayments or deductibles without the referral. An eligibility letter is a crucial document to verify status, but it alone does not provide the needed exemption from these costs. Therefore, the requirement for a referral directly links the exemption to the use of services typically offered through Indian health care providers, making it a vital step for AI/AN members seeking to minimize their healthcare expenses.