WebEx Training Friday, January 31 st

- 2 - Agenda Clarification on Employer Coverage Disenrollment/Reimbursement In-House Patients providing Documentation Error when changing household size Unable to change Requested Coverage Spanish Site and Notices 19 Year Old Household Size Reporting Other Health Insurance Medicaid Spenddown

If an individual has open enrollment for their employer in June (for 7/1 coverage) will the individual get penalized for not having insurance from 1/1-6/31? The IRS has decided to provide transition relief to people who didn’t enroll in a non-calendar year employer plan. If a plan goes from July 2013-June 2014, The consumer won’t have to pay the penalty for 1/2014 through 6/2014, even if you missed your plan’s open enrollment in To view a short Q&A regarding this notice click here: Answers-on-the-Individual-Shared-Responsibility-Provision. Answers-on-the-Individual-Shared-Responsibility-Provision The view the full notice containing information on this transition relief click here: Scenario Clarification on Employer Coverage Topic Correction

The consumer must give 14 days notice for disenrollment. Coverage will only be cancelled after the 14 th day, even if the 14 th day extends into the next month. The carrier may allow cancellation sooner, but are not required to shorten this period. If a consumer cancels their coverage mid-month, can they get a refund for the rest of the month? o The reimbursement policy is dependent on the carrier policy. The customer must reach out to the carrier’s customer service. Scenario Disenrollment/ Reimbursements Topic

How are hospitals handling in-house patients who are challenged with providing the qualifying documentation needed for QHP? The CAC must communicate with the spouse, power of attorney, or responsible family member, that the marketplace may be an option for this patient to obtain health insurance. The CAC must be careful to explain that a QHP is not retroactive. This means that any health costs that have been or are being accrued will NOT be reimbursed (unless they have Medicaid and they request retroactive coverage) All missing documentation (such as proof of income if it could not be validated) must be provided within 90 days of application. Lawfully present documentation is required at the time of applying. Scenario In-House Patients providing Documentation Topic

A known error occurs when trying to make changes to the number of people in the household via reporting a change. What should consumer do if they run into an error when adding or removing household members? In this instance, the best option for the consumer would be to call the call center and have a CCR complete the application from the Worker Portal. Once an application has been submitted, any changes to an application must be made via the “Report a change” link on the consumer’s Account Home page. Scenario Error when Changing Household Size Topic

If a consumer has started an application online and has indicated that a certain family member is not requesting coverage, but now wants to report a change and request coverage for that family member, the consumer is not able to make this change on their own. They must call the call center and have a Call Center representative indicate this change for them. Scenario Unable to Report a Change to Indicate that a Household Member is Applying for Coverage Topic

The consumer portal will now be also available in Spanish. The consumer can click the “Español” link on the top right to view the consumer portal in Spanish. Scenario Spanish Site and Notices Topic

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 Topic

Step 2: Navigate to the Household Address and Contact Information, select the checkbox to go paperless, and select Spanish as the preferred language. The same option is also available on consumer portal during the application process. Spanish Site and Notices (Option 1) Step 1: On the consumer’s Account Home page, click Start New Application in the Quick Links section. Topic Steps 10

Spanish Site and Notices (Option 2) Step 1: On the consumer’s Account Home page, click Change Account Settings in the Quick Links section. Topic Steps Step 2: Change the Preferred Language to Spanish and Select Yes to go paperless. 11

If a 19 year old who lives with their parent(s) is only applying for him or herself, must all household members be included on the application? If the individual is claimed as a dependent on the parents tax return, then all members of the parents tax household, including the 19 year old, must be included in the application. The parents (and any other person in the household) must be entered as not requesting coverage, and their income information and tax filing status will need to be included to determine the child’s eligibility determination. If the child is not being claimed on their parents tax return then he can file an application on his own and will have to file taxes for himself for 2014 in order to be eligible for tax credits. Scenario 19 Year Applying for Coverage Living in the Home Topic

When a consumer is applying for coverage and has other insurance, how must the applicant report their current insurance?  Consumer can enter their current insurance information through the following method: Scenario Current Health Insurance Topic

Step 2: The consumer enters their current health insurance information and pertinent coverage and policy end dates. Current Health Coverage (cont) Step 1: The consumer navigates to the Additional Questions – Current Health Insurance Coverage page, click [Add Health Coverage]. Topic Steps 14

Medicaid spenddown cases established on and after Aug. 1, 2013 had 6 month redetermination dates which were after Jan. 1, Since these consumers would not be eligible for Medicaid until their medical expenses equaled their excess income, they are currently INELIGIBLE for Medicaid. The system was not looking at the date field to determine Medicaid eligibility. As a result, the system, denied eligibility and generated an error message for those individuals. Solution: A system fix was implemented so that the system reads both the coverage end date and the policy end date. Both date fields must match. The Call Center did an outbound call campaign to 658 consumers and told them that the problem was being corrected. Eligibility was re-run on those affected consumers and they were given a retroactive coverage date. All phone calls to consumers will be completed by 1/31/14. Scenario Medicaid Spenddown Topic

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