1. May Enrollment Knowledge Transfer

2. Overview 19 year-old age out 26 year-old age out
SEP changes for existing users
Washington Health Benefit Exchange
May 10, 2018

3. Age-Out Overview Aging out Scenario Actions
19 year old aging out of WAH for Kids – PA enrolled in WAH
19 year old needs to be updated as “not seeking coverage” on PA application
19 year old needs to complete a separate account and application to enroll in WAH for Adults (if eligible)
19 year old aging out of CHIP – PA enrolled in QHP (APTC or QHP eligible)
19 year old can choose to enroll in existing coverage with QHP, or
19 year old can complete a separate account and application and enroll in QHP for themselves
If the 19 year old is filing as single, the system will look at their income.
26 year old aging out of QHP with parents – PA enrolled in QHP
(Not Adult Disabled)
26 year old needs to create their own account and application to enroll in coverage as an adult
If Adult Disabled, tax filing status needs to be updated to Disabled Dependent on Household Member Page to remain eligible on current application
Washington Health Benefit Exchange
May 10, 2018

4. 19 Year-Old Age-Out Event
Program eligibility for Washington Apple Health for Kids ends on the last day of the 19th birthday month
Example: Applicant turns nineteen on September 24th, their WAH for Kids program eligibility ends September 30th
Follow the standard WAH renewal flow to indicate next steps
Added to Primary’s Qualified Health Plan (subsidized and non-subsidized)
Begin program eligibility for Washington Apple Health for Adults
Washington Health Benefit Exchange
May 10, 2018

5. 19 Year-Old Age-Out Event
Added to the Primary’s Qualified Health Plan
Updates APTC calculation
Must confirm plan selection to add person
Qualifying life event that allows currently enrolled QHP applicants to change plans during 60-day SEP window
Can remain on plan until age 26
Eligible for WAH for Adults
Households below 138% Federal Poverty Level
Create new application with the 19 year old as the Primary applicant
Same information, only change who is seeking coverage
WAH for Adults only allowed for the Primary Applicant or their Spouse; over 18 dependents will each need to have their own application.
Washington Health Benefit Exchange
May 10, 2018

6. Adult Children on Parent’s QHP to age 26
Adult children can remain on their parents’ QHP to age 26.
Adult children tax status CAN be a dependent of the PA or filing as Single.
Again, if the family and or the adult child will qualify for WAH – they will need their own application at age 19.
If filing as a Dependent of PA – the system looks at the adult child as part of the tax household and if eligible, provides a tax credit for the whole family.
If filing as Single and on their parents’ QHP, the system determines 2 tax credits. One for the adult child, and one for the family.
Washington Health Benefit Exchange
May 10, 2018

7. 26 Year-Old Age-Out Event
Program eligibility for QHP as DEP child ends on the last day of the 26th birthday month
Example: Applicant turns twenty-six on March 10th, their QHP DEP child eligibility ends March 31th
26 year-old needs to create their own account and application to enroll in coverage as an adult
Monthly HPF batch is ran 1st of each month to auto- terminate QHP/QDP coverage for the dependent
Washington Health Benefit Exchange
May 10, 2018

8. Special Enrollment Period Changes
Impacted Users: Individuals, account workers and privileged users
Customized and user friendly 'Special Enrollment' screen flow
Finish Later button added to Special Enrollment Approved screen & Plan Confirmation screen
*New* special enrollment period Qualified Health Plan enrollment restriction logic based off of customers reported Qualifying Life Event
Correspondence updates to Enrollment Deadline for Coverage (EE002), Eligibility Results (EE015) and Plan Selection Confirmed (EE019)
Washington Healthplanfinder will auto open special enrollment periods for customers who transition from Washington Apple Health (Medicaid) to Qualified Health Plan
New WAH to QHP indicators will be placed in enrollment files to carriers for quicker processing
Background: To comply with federal regulations for Special Enrollment Periods into a Qualified health plan
Washington Health Benefit Exchange
May 10, 2018

9. Pre 5.1 Overlap
If a customer was approved a Special Enrollment Period prior to 04/21/2018 and is still in that Special Enrollment Period – No plan restrictions irrespective of QLE
Anyone who is approved a Special Enrollment Period after 04/21/2018 will be subject to the new plan restriction logic determinant on QLE
Washington Health Benefit Exchange
May 10, 2018

10. Special Enrollment Questionnaire
Simplified check box style Special Enrollment Period Questionnaire
When a Qualifying Life Event is selected, more details may appear to further report that event
Washington Health Benefit Exchange
May 10, 2018

11. Special Enrollment Period Shopping Eligibility
Approval to Shop:
**Consumer will be required to check the attestation box prior to proceeding to EYO
Denial to Shop:
Selecting Finish Later will allow the consumer to come back to this screen
Cannot shop for a plan until attestation box has been selected and they select ‘Next’
Washington Health Benefit Exchange
May 10, 2018

12. Special Enrollment Across Years
If applying cross years could see dual result:
Washington Health Benefit Exchange
May 10, 2018

13. SEP Restriction Logic
Households will experience a unique shopping experience based on the Qualifying Life Event reported and plan restriction applied
Restrictions apply to QHP and QDP
Restrictions apply to most qualifying life event’s with a few exceptions
Restrictions apply based on QLE Type
Exceptions (not enrolled, QHP, QDP)
No restrictions
Washington Health Benefit Exchange
May 10, 2018

14. Plan Restriction Logic – Dependent Addition
Restriction Bucket
Business Rule
Scenario
Changes in Household Size
Birth, adoption, placement for adoption, foster care, court order, marriage
If client is enrolled in a Qualified health plan and their current enrolled plan is available, your client may enroll new dependents:
1. In their current plan
2. In a Catastrophic plan if eligible
Household enrolled in a qualified health plan reports a birth
Newly added member is eligible for tax credits
Household is not eligible for Catastrophic
Result = Child is added to existing Qualified health plan, no other Qualified health plan plans are available for shopping
* If enrollee changes plans, their deductibles and out of pocket expenses start over.
Washington Health Benefit Exchange
May 10, 2018

15. My Cart – Unable to Shop for Qualified Health Plan
If a customer is not allowed to shop for a new Qualified Health Plan that section of My Cart will be ‘locked’ and ‘grayed’ out
Washington Health Benefit Exchange
May 10, 2018

16. Plan Restriction – CSR Changes
Tier 1 = No Cost Sharing Reductions
Tier 2 = AI/AN 300% or below FPL
Tier 3 = AI/AN Above 300% FPL
Tier 4 = % FPL
Tier 5 = % FPL
Tier 6 = 200 – 250% FPL
Federal Poverty Level Guidelines Chart

17. Plan Restriction Logic – Cost Sharing Reduction Non Tier 1
Restriction Bucket
Business Rule
Scenario
Change in Program Eligibility or Amount of Financial Help
Tier 1 = not eligible for Cost Sharing Reductions
Tiers 2-6 = eligible for Cost Sharing Reductions
If your client’s CSR Tier Changes from Tier 1 to any Tiers 2 through 6, the following will apply:
If your client is not enrolled in a Silver plan and there are multiple plans available within their current metal level, your client may enroll in:
1. The same metal level
2. A Silver plan
3. A Catastrophic plan if eligible
If your client is not enrolled in a Silver plan and there is only one plan available within their current metal level, your client may enroll in:
1. The same plan if available
3. + or -one metal level
4. A Catastrophic plan if eligible #1
Household enrolled in a Qualified health plan reports a change in income
Household transitions from Cost Sharing Reduction tier 1 to Cost Sharing Reduction tier 6
Household is enrolled in a bronze plan
Result = Household can shop for plans within the same metal level or silver plans
level, silver plans or a catastrophic plan if available
(They may not go from Bronze to Gold or from Gold to Bronze. May move + or –1 metal level)
* If enrollee changes plans, their deductibles and out of pocket expenses start over.
Washington Health Benefit Exchange
May 10, 2018

18. Plan Restriction Logic – Cost Sharing Reduction Tier 1
Restriction Bucket
Business Rule
Scenario
Cost Sharing Reduction Tier Change
Tier 1 = not eligible for Cost Sharing
CSR Tier Change (Tier 1)
Non-Catastrophic and Multiple Plans Available
1. Same Metal Level
2. Can shop for Catastrophic if eligible
Non-Catastrophic and One Available
1. Same Plan if available
2. + or - 1
3. Can shop for Catastrophic if eligible #2
Household enrolled in a Qualified health plan reports a change in income.
Household transitions from Cost Sharing Reduction tier 6 to Cost Sharing Reduction tier 1
Household is enrolled in a bronze plan
Multiple bronze plans available
Result = Household can shop for plans within the same metal level
Washington Health Benefit Exchange
May 10, 2018

19. Plan Restriction Logic – Other
Restriction Bucket
Business Rule
Scenario
Other
Address change, loss of minimum essential coverage, change in citizenship or lawful presence, death, divorce, reconciliation of taxes, change in tax household
Non – Catastrophic and Multiple Available
1. Same Metal Level
2. Can shop for Catastrophic if eligible
Non – Catastrophic and One Available
1. Same Plan
2. + or - 1
3. Can shop for Catastrophic if eligible
Household enrolled in a Qualified health plan reports an address change
Household is no longer eligible for their current Qualified health plan based on the new address
Household is enrolled in a bronze plan
One new bronze plan is available at the current metal level
Household is not eligible for Catastrophic
Result = Household can shop at the same metal level or shop for silver plans
Washington Health Benefit Exchange
May 10, 2018

20. Plan Restriction Logic – Exceptions
As a reminder the 4th bucket Exceptions has no plan restrictions
The 2 types of Exceptions are:
Enrolled in a Catastrophic Plan regardless of Qualifying life event
Qualifying life event listed within the Exceptions bucket is reported
American Indian/Alaska Native
Domestic Violence
Washington Health Benefit Exchange
May 10, 2018

22. Q & A
The only way a 26 yr old can stay on the parents plans and as a dependent is if they are disabled?
If the WAH 19 yr old is still living with parents and NOT working, would they be required to include parents proof of income?
If the 19 or 26 yr old does not change, when they age out, are they automatically disenrolled when the system updates the first month in the HPF?
Does a child turning 19 and coming off a QHP qualify as an SEP for the parents?
Washington Health Benefit Exchange
May 10, 2018

23. Q & A
What happens if they don’t submit new application before the end of their birthday month?
Will the deductible start over again if it’s with the same carrier?
Since the new system update, HPF is showing a change of income as an SEP. Is this a system glitch?
If a household who has a QHP qualifies for SEP due to child aging out or income change, do they have to take any action to keep the plan they are/have been enrolled on?
Washington Health Benefit Exchange
May 10, 2018