february 19, 2013 webex release 3 training and review 1

February 19, 2013 WebExRelease 3 Training and Review

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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

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


Topic

• The following document contains a list of notices along with their descriptions that have been translated for Spanish speaking consumers

Scenario


Topic

Spanish Notices

• 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

Catastrophic Plan:

Bronze Plan:

Scenario

Catastrophic Plan Vs. Bronze Plan

Topic

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

Option 1: Consumer requests a hardship exemption before applying for catastrophic coverage on the Consumer Portal

Requesting a Hardship Exemption upfront before completing the applicationStep 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.

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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

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Option 1: Consumer requests a hardship exemption before applying for catastrophic coverage on the Consumer Portal (continued)

Topic

Steps

Option 2: Consumer completes application first and then applies for hardship exemption (for catastrophic coverage)

Completing the Application 1st

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

StepsStep 2: Submit an appeal as a hardship exemption in order to receive an exemption number

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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

StepsStep 4: Enter the exemption number on the Exemption Certificate page to then view the catastrophic coverage plans

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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 7th 2014 expires December 31st 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

• 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.


Topic

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.


Topic

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

• 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 15th 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 15th 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

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.


Scenario

Scenario

Topic

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 1st

of the month following the date of event.

• A household member got married in the last 60 days: Effective date starting the

1st 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


Scenario

Scenario

Topic

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

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

7th 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

7th 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


Topic

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 DatesTopic

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)

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Step 3: • Consumer receives the following coverage effective date:


Steps

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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


Topic

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 1st of the month following the date of event.

Scenario

Loss of MEC effective Coverage Dates

Topic

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.


Steps


QHP for another household member

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Step 3: • Consumer receives the following coverage effective dates: (Note: The portal no longer does the math for the consumer .)


Steps

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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

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


QHP for another household member

Step 1: • Consumer lists the Loss of Coverage date as 04/30/2014


Steps

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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.


Steps

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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


Scenario

Scenario

Topic

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

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

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

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.)

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Change Reporting ReviewTopic

Steps

Step 3: Coverage change page shows the current enrollment.

Step 4: Eligibility determination page is displayed after the change is reported.

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Steps

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.

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Steps

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.)

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Steps

Step 9:APTC slider for the new amount is shown.

Step 10:Confirming the new plan along with full premium and APTC amount shown.

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Steps

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.

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Steps

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

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

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Consumer Portal – Naturalized Citizenship

Worker Portal

Enter Certificate Number: N99999999999 (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 999999999 (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

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

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

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.

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Override Special Enrollment (For Designated individuals with Worker Portal Access)

Topic

Steps

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.

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Override Special Enrollment (For Designated individuals with Worker Portal Access)

Topic

Steps