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February 19, 2013 WebEx Release 3 Training and Review 1.

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Presentation on theme: "February 19, 2013 WebEx Release 3 Training and Review 1."— Presentation transcript:

1 February 19, 2013 WebEx Release 3 Training and Review 1

2 - 2 - Agenda Spanish Site and Notices (Release 3) Catastrophic Coverage (Release 3) Eligibility Date vs. Effective Date Review Enrollment and 15 Day Rule Review Special Enrollment Events Review Loss of Minimum Essential Coverage - Effective Coverage Dates Verification Documents and 90 Day Rule for QHP/APTC Review Change Reporting Review Online – Lawfully Present without an alien or certificate number review Worker Portal Override – Special Enrollment

3 The consumer portal will now be also available in Spanish. The consumer can click on the “Espanol” link on the top right view the consumer portal in Spanish. Scenario Spanish Site and Notices (Release 3) Topic

4 The following document contains a list of notices along with their descriptions that have been translated for Spanish speaking consumers Scenario Spanish Site and Notices (Release 3) Topic

5 A Catastrophic Health Plan meets all of the requirements applicable to other Qualified Health Plans, except that it doesn’t cover any benefits other than 3 primary care visits per year before the plan's deductible is met. The monthly premium amount for catastrophic plans are lower than for other QHPs. The out-of-pocket costs for deductibles, copayments, and coinsurance are usually higher on catastrophic plans. To qualify for a catastrophic plan, you must be under 30 years old OR get a "hardship exemption" because the Marketplace determined that you’re unable to afford health coverage. Overview What is Catastrophic Coverage? (Release 3) Topic

6 Catastrophic Plan: Bronze Plan: Scenario Catastrophic Plan Vs. Bronze Plan Topic

7 Before choosing a Catastrophic Plan consider: 1.Catastrophic Plans do not offer APTC and are not available as CSR’s (Cost Sharing Reductions). 2.Bronze plans, which are the least expensive of the metal levels, offer APTC. 3.Compare the annual deductibles and annual out of pocket maximum deductibles for each of the plans. 4.The consumer is also advised to compare the plan detail pdf for each plan before making a decision. Scenario Catastrophic Plan Vs. Bronze Plan Topic

8 Option 1: Consumer requests a hardship exemption before applying for catastrophic coverage on the Consumer Portal Requesting a Hardship Exemption upfront before completing the application Step 1: If an individual is over the age of 30 they are applying for a hardship exemption. One can select the Can I Opt Out? button on the Access Health CT home page Topic Steps Step 2: Submit an appeal as a hardship exemption in order to receive an exemption number. 8

9 Step 3: Once the consumer has received an exemption number, the individual can fill out the application and proceed to the shopping screen. In the Notice section the consumer can select “click here to enter your exemption certificate number” Step 4: Enter the exemption number on the Exemption Certificate page to then view the catastrophic coverage plans 9 Option 1: Consumer requests a hardship exemption before applying for catastrophic coverage on the Consumer Portal (continued) Topic Steps

10 Option 2: Consumer completes application first and then applies for hardship exemption (for catastrophic coverage) Completing the Application 1 st Step 1: The consumer can also opt to fill out the application first and apply for a hardship exemption from the Shopping page. The applicant can click on the link in the Notice section to apply for an exemption Topic Steps Step 2: Submit an appeal as a hardship exemption in order to receive an exemption number 10

11 Option 2: Consumer completes application first and then applies for hardship exemption (for catastrophic coverage) - continued Step 3: Once the consumer receives an exemption number, the individual can return to the Shopping Screen and enter the exemption number from the hyperlink in the Notice section. Topic Steps Step 4: Enter the exemption number on the Exemption Certificate page to then view the catastrophic coverage plans 11

12 How is a mixed household (some household members under 30 and some above 30) handled in the portal for catastrophic coverage? For households who have a mix of under 30 year olds and above 30 year olds, the exemption certificates are required only for the 30 or above year olds to enable catastrophic plans for the entire household. All the 30 or above year olds should have valid certificate numbers for catastrophic plan exemptions to shop and enroll into catastrophic plans Exemptions are provided for a plan coverage year. Exemptions do not overlap across years. Once an exemption is provided, it is valid until the end of the coverage year. An exemption provided on October 7 th 2014 expires December 31 st 2014 If the consumer wants an exemption to allow Catastrophic Plans for the next plan coverage year, he/she must reapply for exemptions during the next coverage year’s shopping process If a non-Catastrophic Plan was purchased and the consumer wishes to qualify for Catastrophic Plans outside Open Enrollment, the consumer must report a Special Enrollment-qualifying event and qualify for exemptions. Upon qualifying for exemptions, the consumer can report a special enrollment qualifying event to shop for catastrophic plans Catastrophic Coverage Considerations Topic

13 All communication between the consumer and Exemptions team (at Access Health CT) for exemptions of catastrophic plans is performed outside the AHCT system. There are no notices to the consumer from AHCT system for catastrophic plans. Verification is carried out based on the certificate numbers manually maintained by the Exemptions team. Upon loss of Exemption for catastrophic plans for a consumer, the Exemptions team will coordinate with the call center worker to disenroll the household from the Catastrophic Plan. Even if one person loses eligibility for a catastrophic exemption, the entire household is disenrolled from the catastrophic plan. Catastrophic Coverage Considerations Topic

14 In the Worker Portal, the Document Search Tab displays a record of all individuals that have provided a Catastrophic Exemption Number that have enrolled in a Catastrophic plan. Catastrophic Coverage Considerations Topic

15 Be mindful that the Filing Date, the Submit Date, the Eligibility Date, and the Effective Date may not be the same: Filing Date  Date that the consumer starts an application (New application or a Change Report) e.g. 1/14/2014 Submit Date  Date that the consumer clicks [Submit] after completing an application. e.g. 1/16/2014 Eligibility Date  Date that the consumer receives the eligibility determination. e.g. 1/16/2014 Effective Date  Date that a consumer begins to have effective coverage under their plan. e.g. 3/1/2014 Scenario Eligibility Date vs. Effective Date Review Topic

16 If an applicant applies before 3/31/14, they are still in the Open Enrollment Period and can start a new application or complete an unfinished application. Applicants who enroll in coverage on or before the 15 th of a given month will have a coverage effective date of the 1st of the upcoming month.  For example, if a brand new consumer applies on 01/10 and does not have a Qualifying Special Enrollment event, then this consumer’s coverage will be effective starting 02/01. Applicants who enroll in coverage after the 15 th of a given month will have a coverage effective date of the first of the following month.  For example, if a brand new consumer applies on 01/16 and does not have a qualifying Special Enrollment event, then this consumer’s coverage will be effective starting 03/01. Enrollment and the 15 day rule Review Scenario Topic

17 The Special Enrollment events are as follows: A household member had a loss of (MEC) Minimum Essential Coverage in the last 60 days A household member is going to lose Minimum Essential Coverage in the next 60 days A household member’s employer didn’t provide health coverage or the employer provided health coverage that wasn’t affordable or didn’t meet minimum value in the last 60 days. A household member’s employer isn’t going to provide health coverage or the employer will provide coverage that isn’t affordable or won’t meet minimum value in the next 60 days. A household member got married in the last 60 days. A household member gained eligible immigration status in the last 60 days. A household member moved in the last 60 days. A household member had been adopted or placed for adoption in the last 60 days. Special Enrollment Events Review Scenario Topic

18 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 Minimum Essential Coverage in the last 60 days or is going to lose MEC 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 Special Enrollment Events Review Scenario Topic

19 1.Applicant knows she will lose insurance 2/28 due to a job layoff. She applies for insurance on 2/23/14. What date will her new insurance be effective? 2.Applicant will lose insurance 3/31/2014. He applies for insurance on 3/3. What date will his new insurance plan be effective? Scenarios Practice Your Knowledge – What is the Effective Date? Topic

20 1.Applicant knows she will lose insurance 2/28 due to a job layoff. She applies for insurance on 2/23/14. What date will her new insurance be effective? ANSWER: 3/1 2.Applicant will lose insurance 3/31/2014. He applies for insurance on 3/3. What date will his new insurance plan be effective? ANSWER: 4/1 Scenarios Practice Your Knowledge – What is the Effective Date? Topic

21 7 th of the month  An Individual loses his minimum essential coverage on 4/6/2014 and applies for a new plan on 4/6/2014. When will his new effective coverage date begin? Scenario Loss of MEC - Effective Coverage Dates Topic

22 7 th of the month  An Individual loses his minimum essential coverage on 4/6/2014 and applies for a new plan on 4/8/2014. When will his new effective coverage date begin?  ANSWER: 4/1 if eligible for Medicaid (and up to 3 month prior if applicant qualifies for previous bills to be covered) and 5/1 if eligible for QHP  Note: Be careful when you answer the questions regarding Insurance coverage dates. Policy end date and coverage end date must be the same or an error is generated. In this case, end date is 4/6/2014. Scenario Loss of MEC - Effective Coverage Dates Topic

23 Step 1: Consumer lists the Loss of Coverage date as 04/06/2014. Note: The coverage end date and policy end date fields must match. Loss of MEC - Effective Coverage Dates Topic Steps Step 2: Consumer chooses Medicaid for one household member and a QHP for another household member (note difference between eligibility start date and effective coverage date) 23

24 Step 3: Consumer receives the following coverage effective date: Loss of MEC - Effective Coverage Dates Topic Steps 24

25  Individual loses their coverage on 4/18/2014 and applies for a new plan on 4/19/2014. When will their new effective coverage begin? Scenario Loss of MEC - Effective Coverage Dates Topic

26  Individual loses their coverage on 4/18/2014 and applies for a new plan on 4/19/2014. When will their new effective coverage begin?  ANSWER: 5/1 for both eligibility date and coverage effective date  Why? A household member that has a loss of Minimum Essential Coverage in the last 60 days or is going to lose MEC in the next 60 days, the Effective date will be the 1 st of the month following the date of event. Scenario Loss of MEC effective Coverage Dates Topic

27 Step 1: Consumer lists the Loss of Coverage date as 04/18/2014. Note: The coverage end date and policy end date fields must match. Loss of MEC - Effective Coverage Dates Topic Steps Step 2: Consumer chooses Medicaid for one household member and a QHP for another household member 27

28 Step 3: Consumer receives the following coverage effective dates: (Note: The portal no longer does the math for the consumer.) Loss of MEC - Effective Coverage Dates Topic Steps 28

29 Birth of a household member  Applicant reports of loss of minimum essential coverage on 04/30. The father also includes his son who was born on 03/18.  When will their new effective coverage begin? Scenario Loss of MEC - Effective Coverage Dates Review Topic

30 Birth of a household member  Applicant reports of loss of minimum essential coverage on 04/30. The father also includes his son who was born on 03/18. When will their new effective coverage begin?  ANSWER: Son will be eligible 3/18 and have coverage effective 3/18; father will be eligible 4/1 and have coverage effective 5/1 Scenario Loss of MEC - Effective Coverage Dates Review Topic

31 Step 2: Consumer chooses Medicaid for one household member and a QHP for another household member Step 1: Consumer lists the Loss of Coverage date as 04/30/2014 Loss of MEC - Effective Coverage Dates Topic Steps 31

32 Step 1: Consumer receives the following coverage effective dates. Note that the baby’s coverage effective date is retroactive to the date of the birth. Loss of MEC - Effective Coverage Dates Topic Steps 32

33 What happens if an individual does not report a birth or adoption within 60 days of the event? If an individual reports the change after 60 days of the event but within an open enrollment period: 15 day rule applies If an individual reports the change after 60 days of the event and open enrollment has ended: Individual must wait for the next open enrollment period. Applicant can file an appeal for exemption to ahCT Special Enrollment Events Review Scenario Topic

34 The 90 day rule for verification is handled differently for Medicaid and QHP/APTC. Medicaid: If an individual is eligible for Medicaid and does not provide verification documents within the 90 days the individual will be disenrolled. Since there is no open enrollment period for Medicaid the individual can then enroll again immediately. Scenario Verification documents and 90 day rule Review Topic

35 QHP/APTC: If an individual is eligible for QHP/APTC and does not provide verification documents within the 90 days the individual will be disenrolled. If the open enrollment period is no longer available, the individual will have to wait until the next open enrollment period or appeal to ahCT. If there was a Special Enrollment event which occurred, then the individual can report a change and report the Special Enrollment event to determine new eligibility. Scenario Verification documents and 90 day rule for QHP/APTC Review Topic

36 Applicant who is enrolled in a QHP with APTC reports a change and enrolls for a new QHP with APTC. Note that the monthly premiums do not take into account the tax credits. The full price of the monthly premium is displayed with the tax credit amount listed below. (The portal no longer does the subtraction to reflect the monthly premium minus the APTC amount resulting in the monthly premium minus the tax credit.) Scenario Change Reporting Review Topic

37 Step 1: Current enrollment page is displayed. (Prior to the change.) Step 2: Current enrollment Plan Summary page is displayed (When you actually select a plan.) 37 Change Reporting Review Topic Steps

38 Step 3: Coverage change page shows the current enrollment. Step 4: Eligibility determination page is displayed after the change is reported. 38 Change Reporting Review Topic Steps

39 Step 5: Next steps page shows the sections completed and sections to be completed along with current section. Click next. Step 6: Final confirmation show with the new premium amount. 39 Change Reporting Review Topic Steps

40 Step 7: New Premium amount shown. NOTE: Screen no longer displays the subtraction to indicate the difference between the monthly premium and APTC amount. Step 8: Next steps page shows the sections completed and sections to be completed along with current section. (buying a plan.) 40 Change Reporting Review Topic Steps

41 Step 9: APTC slider for the new amount is shown. Step 10: Confirming the new plan along with full premium and APTC amount shown. 41 Change Reporting Review Topic Steps

42 Step 11: Proceed to Account Home after final confirmation of the new plan. You must follow the screens all the way to the last screen and click the Proceed to Account Home button or the change will not take.. N. 42 Change Reporting Review Topic Steps

43 How do applicants who are lawfully present but do not have a certificate number apply on the exchange via the Consumer Portal? Without the certificate # and alien #, the system will not be able to electronically verify the naturalized citizenship. U.S. citizenship is verified by the Social Security Administration (SSA) through the Federal Data Hub and non-citizen immigration status is verified by the Department of Homeland Security (DHS) via the Hub. These two numbers are required by the Hub, and therefore are required on our screen. If lawfully present individuals do not have those numbers, their immigration status cannot be verified electronically. It must be verified manually by paper. Scenario Online - Lawfully present without an alien or certificate number Review Topic

44 Consumer Portal Select “I don’t know” on the Naturalized Citizenship section o The screen will not check the required fields and user will be able to proceed o The system will skip the Verification Lawful Presence process (VLP) o Proof of Citizenship will be added to Verification Checklist (VCL) o Consumer will be required to send in verification documents within 90 days Scenario Consumer Portal - Lawfully present without an alien or certificate number Topic

45 45 Consumer Portal – Naturalized Citizenship

46 Worker Portal Enter Certificate Number: N (The Naturalization Certificate and the Certificate of Citizenship number are between 7 and 12 numeric characters) and enter Alien Number if available. If not available, enter (The Alien Number is 9 numerical digits) o User will be able to proceed o The system will send the info to Hub/DHS for verification, but will be returned as “Not Verified” or “Pending” o The system will add Citizenship on the Verification Checklist o Consumer will be required to send in verification documents within 90 days Scenario Worker Portal - Lawfully present without an alien or certificate number Topic

47 If an appeal is approved by Access Health CT, a worker with special privileges can override the eligibility determination and manually select an eligibility based upon the following Special Enrollment criteria: Scenario Worker Portal Override (For Associates with Worker Portal Authority) Topic

48 Reason for opening Special Enrollment Household members enrollment/non enrollment in QHP was 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 Issuer substantially violated a material provision of its contract Individual was enrolled or disenrolled due to Exchange error Individual was enrolled or disenrolled due to Issuer error Individual was enrolled or disenrolled due to Federal error Scenario Override Special Enrollment (For Associates with Worker Portal Authority) Topic

49 Step 1: The worker clicks [Proceed] on the Override Eligibility modal screen. Step 2: Worker manually enters an eligibility determination and enters a reason for the override. 49 Override Special Enrollment (For Designated individuals with Worker Portal Access) Topic Steps

50 Step 3: The worker can open Special Enrollment by clicking [Open Special Enrollment]. Step 4: The worker can then select the reason for opening special enrollment, and then proceed to enrollment. 50 Override Special Enrollment (For Designated individuals with Worker Portal Access) Topic Steps


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