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Working with Blue Cross Blue Shield of Texas

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Presentation on theme: "Working with Blue Cross Blue Shield of Texas"— Presentation transcript:

1 Working with Blue Cross Blue Shield of Texas

2 Presentation format: Type your question in the GoToMeeting “Questions” area located in the toolbar on your right side of the screen If time allows, the Moderator will answer the questions verbally at the end of the presentation There will not be a live Q&A session This webinar is being recorded and will be posted 30 minutes after the presentation at

3 Agenda Certifications Submission Deadlines
Understanding Your BCBS Producer Portal Quoting/Online Submission Dental Requirements Estimating Tax Subsidies Resources

4 Read your News from the Blues!

5 Questions I spoke with a provider yesterday that is in the BCBSTX HMO network, but they are not taking the Advantage HMO network. Therefore when you are online and doing a HMO provider search on BCBS and the provider is indicated to be in the HMO network it may not really be indicating that they will take the HealthCare Reform plans. Therefore if you enroll someone in an HMO network then they will have even more limited network than what is implied on the BCBS website.

6 On Exchange – Complete Option A Off Exchange – Complete Option B
Training ACA You ARE required to take the Marketplace Certification if you are working “On Exchange” (helping your clients apply for tax subsidies/cost sharing). You Are Not required to take the Marketplace Certification if you are working “Off Exchange” (clients are enrolling without tax subsidies/cost sharing). BCBSTX You ARE required to complete the Marketplace Matters training on the BCBS website if you are selling “On or Off Exchange” plans On Exchange – Complete Option A Off Exchange – Complete Option B Completing You ARE required to send in training forms to BCBS regardless of which option you are selling. All certification instructions can be found on our website at under Products/Individual Major Medical

7 Submission Deadlines 3/1/2014 4/1/2014 5/1/2014 Effective Dates
Apps must be submitted no later than 2/15/14 4/1/2014 Apps must be submitted between 2/16/14 and 3/15/14 5/1/2014 Apps must be submitted between 3/16/14 and 3/31/14 March 31st is the final deadline to submit business until November 15, 2014 for a effective date (QEP excepted).

8 Qualifying Events He loses minimum essential coverage, including through divorce. He gains a dependent or becomes a dependent through marriage, birth, adoption or placement for adoption or foster care. He becomes a citizen, national or lawfully present individual. He is eligible to enroll but didn’t because of a mistake, misrepresentation or inaction of an officer, employee or agent of the Marketplace. The plan he enrolled in substantially violated a material provision of its contract with the individual. He becomes newly eligible for premium tax credits or cost-sharing assistance. He becomes ineligible for premium tax credits or cost-sharing assistance. He makes a permanent move and has access to new health plans. He is a member of an American Indian tribe (American Indians can enroll in a plan or change plans one time each month). He demonstrates to the Marketplace that he has other extenuating circumstances that qualify him for special enrollment. When any of these situations happen, he will have 60 days to go to the Marketplace to enroll in a health insurance plan or change plans.

9 Short Term Major Medical
Critical Illness Hospital Indemnity Accident Need Answers for After Lock In? Here Are Your Solutions!

10 Based on full premium, not subsidized premiums
Commission 6% - Years 1-3 4% - Years 4 + Based on full premium, not subsidized premiums Payment BCBS will be releasing commissions for January 1, 2014 effective dates between February 18 – 20th

11 Snapshot Bonus Program
On 11/30/13 BCBS take a snapshot of your business for small group and individual business. On 5/1/2014 BCBS takes a 2nd snapshot of your business. The difference between the two snapshots will receive $50 per app up to $25,000.

12 Agent Assignment Confirmation Form
Fill out the Agent Assignment on all applications submitted to BCBS to make sure you are recognized as the Agent of Record Send your forms to

13 Now you are at Blue Access for Producers
Understanding Your Producer Portal Login to Click on Producer Tab Enter your Username and Password Now you are at Blue Access for Producers

14 Use Your Producer Portal To Access
Product and Forms Product Overviews, Comparison Charts, Dental Information Marketing and Sales Advertising Materials, Compensation Schedules Training and Administration Access the Market Place Matters Training Other Information Legislative Updates Provider Finder Commission Statements

15 Use your Quote and Enroll button to quote Off Exchange Applications
Use your Quote and Enroll button to quote Off Exchange Applications. You can save and your quotes when quoting Off Exchange. Generate a formal proposal and your clients can enroll from the you send. Online BAP

16 Individual Tools Use your Express Link Button when quoting On Exchange Applications. You will need to copy and paste your Express Link into a new internet browser if you are working on the quote. You can also your Express Link to your client and let them do the work

17 Individual Tools Use your Track Application Status button to track applications and find out the status of your clients.

18 Quoting and Enrollment
On Exchange

19 Key Points to Remember When Quoting On The Exchange Be Prepared Make sure your clients have all information needed to go to the Marketplace Names, Birthdates, Household Income, Social Security Numbers Make sure you have your FFM & NPN numbers to enter in Consumers Need To Create Their Own Usernames and Passwords Agents will be out of compliance if creating for their clients Make sure your client records their usernames and passwords as they will need them at a later date. Eligibility Results Make sure your clients either print or save the results letter for future use.

20 Put in your client information
Your Express Link Put in your client information

21 If you select yes you will then have the option to either get an estimate or get an official tax credit amount

22 If you select yes

23 This is for an estimate only

24 Amount of Estimate

25 If you select yes to get an official tax credit amount

26 You will need to create an account

27 You will get this screen to go to the exchange

28 The Marketplace

29 First page of the application

30 You will need to log into your email account and click the link to confirm your email

31 You will now log in

32 Select what type of coverage you need

33 Click Next

34 1st step

35 Market Place – More Information
Once identity questions are verified you will be prompted to enter household information and income amount. After all information is entered the eligibility results will be available Open the pdf to view the eligibility results and either save and or print the letter for your clients. They will need to keep this information for tax purposes. Find the Return to Issuers Website button to return to the BCBS website. After returning to the BCBS website tax subsidies and/or cost sharing will reduce the premiums and benefits in order for your client to determine which plan to enroll in.

36 Application Submission

37 Select your plan

38 Select a dental option

39 Page shows plan and premium

40 First page of the application

41 Applicant information

42 Additional Information

43 Or you can have the client sent a bill for the premium
Credit card option will take you to a 3rd party vendor (May charge $9.99 for this service in the future.) Or you can have the client sent a bill for the premium

44 Applicants signatures
There will be a button here that you will click to submit the application

45 Checking Status on your Business!
For Underwriting Status and other New Business forms Open your web browser and visit Click on the button labeled "Producer Services". Click on the button labeled "Register". Complete the simple form being sure to provide your Tax ID (SSN or EIN) and your BCBS writing number listed above in this . Once you have completed the form, click "Continue". You will receive a notice stating that you should check your to validate your account. Check your and look for a message. Follow the instructions contained in the , clicking the link to validate your account. After validating your account, you will receive a message stating that "You have successfully validated your address and account. Please log in." Click the "log in" link.


47 Dental Pediatric and Adult


49 Things to Know about Dental Plans
Pediatric dental is required to be offered on all ACA Plans. Consumers can add a stand alone dental plan from Blue Cross Blue Shield Dental follows the same open enrollment period as medical

50 Estimating Tax Subsidy

51 Calculating subsidies is very easy!

52 Use the Kaiser Family Foundation subsidy calculator!

53 Instant results Family of 4, $60,000 expected income in 2014,
Subsidies cover 41% of annual premium

54 Open the “Notes” when you scroll down this page

55 Scroll down further for important FAQs

56 Enrollment
Things To Know Provider Issues Providers not accepting plans get name and phone of providers office and send to Premium Payments EFT Pay By Mail Pay in Person Credit/Debit Card Option Check By Phone Payment Deadlines BCBSTX Clients have until 2/28/14 to pay their January and February Enrollment Clients that enrolled directly on the exchange can only make changes by contacting The Marketplace.

57 Important News From The Marketplace
System Maintenance Will Affect Feb. 15 Applications On Feb. 15, the Social Security Administration (SSA) is taking down its website for regularly scheduled systems maintenance activities. This will affect people applying for coverage on the site, since eligibility verification with the SSA is part of the application process. Applications for March 1 coverage will need to be submitted before 2 p.m. CT in order to find out if the applicant qualifies at the time of application. Any applications received after 2 p.m. will be processed beginning on Tuesday, Feb. 18.

58 The Brokerage Inc. - ACA Contacts
Belynda Diciaccio Cristin Hopkin-Bishop Dana Ragsdale Melissa Lopez

59 Other Resources BCBS Agent Support Line – 855-782-4272
Market Place Call Center – Market Place Agent Support – Medicaid – CHIP – 877-KIDSNOW

60 Find valuable tools in our Individual Health section at www
Find valuable tools in our Individual Health section at

61 Q & A To ask a question, type your question in the GoToMeeting Q&A box
If we cannot answer all questions with certainty, we will include the answer in our follow up, after additional research has been done All answers during this segment will be provided as a follow up to you via .

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