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WebEx Training Wednesday, January 29 th 2014 1. - 2 - Agenda Open Enrollment for Employee Sponsored Insurance Certification Number for Assisters Eligibility.

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Presentation on theme: "WebEx Training Wednesday, January 29 th 2014 1. - 2 - Agenda Open Enrollment for Employee Sponsored Insurance Certification Number for Assisters Eligibility."— Presentation transcript:

1 WebEx Training Wednesday, January 29 th

2 - 2 - Agenda Open Enrollment for Employee Sponsored Insurance Certification Number for Assisters Eligibility during Special Enrollment Income Question for Retroactive Medicaid Divorced/Widow Workaround Anonymous Browsing Worker Portal vs. Consumer Portal Applying on the Worker Portal Medicaid Eligibility vs. APTC Certified Application Counselor’s access to Navigator and In Person Assistor Website Income Year Display Error

3 How do assisters enter their certification number after the consumer application is complete? After eligibility is determined, during the enrollment process, the consumer is asked “Is anyone helping you with this application?” If the consumer chooses “No” then the application will proceed and there will be no option to input any assister information. If the consumer chooses “Yes”, the screen gives an option for the consumer to enter the certification/license number of the assister. (If this were a broker, he or she would enter the CT license number.) Assisters are also being asked to self report any application they helped complete, or, handed off to another entity. This will be manually tracked through their NIPA unit. Scenario Certification Number for Assisters Topic

4 Step 2: “Yes” will allow the assister to enter the assister certification number Certification Number for Assisters Step 1: Click Yes for is anyone helping you with application? Topic Steps 4

5 What does eligibility in a special enrollment period mean? A special enrollment period is a time outside of the open enrollment period. A new application or a person seeking to make a coverage or carrier change outside of the open enrollment period can only make such change when there is a qualifying life event as defined by Access Health. The first year, 2014, is a unique year, where open enrollment has been extended to 3/31/14. During this period, special enrollment events are still applicable to determine effective dates however are not needed to change plans or carriers or add new household members eligible to be on the same plan. Scenario Eligibility during Special Enrollment Topic

6 The Special Enrollment events are as follows: The Exchange must allow qualified individuals and enrollees to enroll in or change from one QHP to another as a result of the following triggering events: (60 day eligibility period) 1) A qualified individual or dependent loses minimum essential coverage; 2) A qualified individual gains a dependent or becomes a dependent through marriage, birth, adoption or placement for adoption; 3) An individual, who was not previously a citizen, national, or lawfully present individual gains such status; 4) A qualified individual's enrollment or non-enrollment in a QHP is unintentional, inadvertent, or erroneous and is the result of the error, misrepresentation, or inaction of an officer, employee, or agent of the Exchange or HHS, or its instrumentalities as evaluated and determined by the Exchange. In such cases, the Exchange may take such action as may be necessary to correct or eliminate the effects of such error, misrepresentation, or inaction; Eligibility during Special Enrollment cont’d Scenario Topic

7 The Special Enrollment events are as follows:(cont’d) (60 day eligibility period) 5) An enrollee adequately demonstrates to the Exchange that the QHP in which he or she is enrolled substantially violated a material provision of its contract in relation to the enrollee; 6) An individual is determined newly eligible or newly ineligible for advance payments of the premium tax credit or has a change in eligibility for cost-sharing reductions, regardless of whether such individual is already enrolled in a QHP. The Exchange must permit individuals whose existing coverage through an eligible employer-sponsored plan will no longer be affordable or provide minimum value for his or her employer's upcoming plan year to access this special enrollment period prior to the end of his or her coverage through such eligible employer-sponsored plan; 7) A qualified individual or enrollee gains access to new QHPs as a result of a permanent move; 8) An Indian, as defined by section 4 of the Indian Health Care Improvement Act, may enroll in a QHP or change from one QHP to another one time per month; and 9) A qualified individual or enrollee demonstrates to the Exchange, in accordance with guidelines issued by HHS, that the individual meets other exceptional circumstances as the Exchange may provide. Eligibility during Special Enrollment cont’d Scenario Topic

8 All Special Enrollment events follow the 15 day Rule except for the following: A household member has been born, adopted, or placed for adoption in the last 60 days: Retroactive to the date of the birth or adoption. A household member had a loss of Minimal Essential Coverage in the last 60 days or is going to lose Minimal Essential Coverage in the next 60 days: Effective date starting the 1 st of the month following the date of event.* A household member got married in the last 60 days: Effective date starting the 1 st of the month following the date of event.* Note: Events must be reported within 60 days of the trigger date otherwise these events follow the 15 day rule Eligibility during Special Enrollment cont’d Scenario Topic

9 Birth of a household member and loss of Minimal Essential Coverage A consumer reports a loss of Minimal Essential Coverage on 04/30 and enrolls in a plan the same day. The father also includes his son who was born on 03/18. When will their new effective coverage begin? Scenario Eligibility during Special Enrollment cont’d Topic

10 Step 1: Consumer lists the Loss of Coverage date as 04/30/2014 Step 2: Consumer chooses QHP with APTC for one household member and a QHP for another household member Eligibility during Special Enrollment cont’d Topic Steps 10

11 Step 3: Consumer receives the following coverage effective dates. Note that the baby’s coverage effective date is retroactive to the date of the birth. Since the father lost Minimal Essential Coverage on 4/30 his new coverage effective date is 5/1. Eligibility during Special Enrollment cont’d Topic Steps 11

12 When applying for retroactive Medicaid the system asks “Was your income in the last 3 months equal to this month’s income?.” If the consumer selects “no,” the system will ask for more information regarding the variable income over the last 3 months. If the consumer selects “yes,” the system will use the current month’s income and apply the same amount for the previous 3 months. Scenario Income Question for Retroactive Medicaid Topic

13 Step 2: If “Yes is selected the system will use the current months income and apply the same amount for the previous 3 months. Income Question for Retroactive Medicaid cont’d Step 1: When applying for retroactive Medicaid the system asks “Was your income in each of the last 3 months equal to this month’s income?.” Topic Steps 13

14 In the current divorce/widow workaround, at what point in the process will the divorced/widowed spouse be removed when the individual is added with an income of $0? The divorced/widowed workaround will not be necessary after the 2/2 release. We will highlight this change when the 2/2 update is reviewed next week. If the workaround is needed prior to the fix, the link below will demonstrate the steps required. Scenario Divorced/Widow Workaround Topic

15 Please help me to understand the purpose of Anonymous Browsing. Anonymous Browsing is valuable when a consumer is not sure what plan they would qualify for or not sure if they might be eligible for any financial assistance with affording health insurance premiums (APTC). The consumer can receive a quick determination without completing an entire application. It is also a good way to check the plan benefits so that the consumer can start comparing options or to remind them of the benefits of the plan they have already chosen. Scenario Anonymous Browsing Topic

16 What is the difference between the AHCT Worker Portal and the Consumer Portal? The Consumer Portal is the Access Health Website consumers use to determine eligibility for the applicant and for the consumer to complete an application. The Worker Portal is an administrative tool used to override or reset information entered by individuals while trying to complete an application. Only authorized users (such as call center representatives) are given access to this system. Scenario Worker Portal vs. Consumer Portal Topic

17 What happens if the consumer applies via the Worker Portal (e.g. Call Center or DSS) for Husky D and does not create an account on the Consumer Portal? If a consumer applies on the Worker Portal but does not create an account on the Consumer Portal they will receive notices regarding their application in the mail or via . If the consumer wishes to view their enrollment details they can create a User ID and then call the Call Center to link their existing application to their User ID. Scenario Applying on the Worker Portal Topic

18 A consumer applied on the exchange and the system found that he was eligible for HUSKY. If the consumer does not want to enroll in Medicaid, can the individual be eligible for a tax credit? The application will only determine if a consumer is eligible for a tax credit if the individual has failed Medicaid eligibility. If the individual is Medicaid eligible and does not want to enroll in Medicaid, then the consumer can purchase an unsubsidized Qualified Health Plan. (The option to select a QHP always is presented on the eligibility screen even if the applicant is eligible for Medicaid.) Scenario Medicaid Eligibility vs. APTC Topic

19 Can Certified Application Counselor’s (CAC’s) access the Navigator and In Person Assisters (NIPA) website? Yes, there is valuable information on the NIPA website that applies to both NIPA’s and CAC’s. The link to the website is below. There is no ID or Password required. Scenario Certified Application Counselor’s access to Navigator and In Person Assistor Website Topic

20 In several applications the income confirmation screen has displayed the years 2014 and 2015, when the income entered was for 2013 and A field level display issue has been encountered on the Annual Income page: This page asked the consumer for their 2013 and 2014 income information. After the consumer saves the information, the years on the screen changes to 2014 and 2015 income information. This is a known issue that is being resolved and does not affect the eligibility determination. Disregard this labeling change and avoid calling the Call Center. This fix will occur in the February 2 nd Release. Scenario Income Year Display Error Topic

21 About Deloitte Deloitte refers to one or more of Deloitte Touche Tohmatsu Limited, a UK private company limited by guarantee, and its network of member firms, each of which is a legally separate and independent entity. Please see for a detailed description of the legal structure of Deloitte Touche Tohmatsu Limited and its member firms. Please see for a detailed description of the legal structure of Deloitte LLP and its subsidiaries. Certain services may not be available to attest clients under the rules and regulations of public accounting. Copyright © 2014 Deloitte Development LLC. All rights reserved. 36 USC Member of Deloitte Touche Tohmatsu Limitedwww.deloitte.com/aboutwww.deloitte.com/us/about


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