Which of the following are examples of what an agent must review with a consumer prior to completing an enrollment application?

• A. The agent's personal financial information.
• B. The plan's network characteristics and how using out-of-network providers may impact coverage and costs, covered benefits and limitations, and plan related costs such as monthly premium and copayments/coinsurance for services received.
• C. The consumer's family medical history.
• D. The plan's marketing materials only.

Answer: (B)

Understanding how a plan works before enrolling is essential. Agents must walk a consumer through how the plan’s network operates and how choosing in-network versus out-of-network providers affects coverage and costs. This includes clear explanations of what benefits are covered, any limitations or restrictions, and the actual plan-related costs the consumer will face, such as the monthly premium and copayments or coinsurance for services received. Providing this information helps the consumer make an informed decision and avoids unexpected charges after enrollment.

Personal financial information about the agent isn’t something the consumer needs to review as part of enrollment, and a consumer’s family medical history isn’t relevant to selecting a plan. Marketing materials alone won’t give the full picture of costs and coverage, so they aren’t sufficient on their own.