washington healthplanfinder business manual€¦ · v7 updated to reflect changes for 2015...

Washington Healthplanfinder Business

Manual

Version 7.0

June 1, 2015

Washington Healthplanfinder Business Manual Exchange Version 7.0

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Table of Contents 1.1 Intended Users ................................................................................................................................4 1.2 Guide Purpose ................................................................................................................................5

2 Washington Healthplanfinder Business Introduction........................................................................6

2.1 Overview .........................................................................................................................................5 2.2 Washington Healthplanfinder Business System Process...................................................................................................................................................6 2.3 Affordable Care in Washington State..............................................................................................6 2.4 Standard Benefits............................................................................................................................7 2.5 Washington Healthplanfinder ..........................................................................................................7 2.6 Estimate Possible Small BusinessTax Credits .................................................................................8 2.7 Small Business Market Healthplanfinder Initial Enrollment ............................................................9

3 Employer Account Creation................................................................................................................13

3.1 Creating Employer Account......... ..................................................................................................13 3.1.1 Company Information Basic…………………………...................................................................14 3.1.2 Set Up Your Account..................................................................................................................16 3.1.3 Employer Attestation ...................................................................................................................16 3.1.4 Employees …………………………...................................................................................................16 3.1.5 Authorization Security Code ........................................................................................................19 3.1.6 Company Information ..................................................................................................................19 3.1.7 Employee Roster .........................................................................................................................20 3.1.8 Employer Questionnaire ………………………

.............................................................................26

4 Employer Plan Selection ....................................................................................................................29

4.1 Plan Selection process..................................................................................................................31 4.1.1 Design Your Plan.................................................................................................................31 4.1.2 Explore Your Options ..........................................................................................................31 4.1.3 Compare Plans ....................................................................................................................33 4.1.4 Estimated Summary ............................................................................................................34 4.1.5 Employer Next Steps ...........................................................................................................35

5 Final Plan Confirmation Process.......................................................................................................36

5.1 Purchase Coverage ......................................................................................................................36 5.1.1 Final Application Summary ..................................................................................................36 5.1.2 E-Sign Page.........................................................................................................................38 5.1.3 Plan Payments ....................................................................................................................39

5.1.4 Employer Final Confirmation ...............................................................................................41

6 Employe r Dashboard ...........................................................................................................................42

6.1 Empl oyer Dashboard Tabs ...........................................................................................................42

6.1.1 Account Home Page............................................................................................................42

6.1.2 Billing and Payments Tab ....................................................................................................44

6.1.3 Prorated Premium Calculation (Mid-month Enrollment and Disenrollment) ........................44

6.1.4 Retroactive Premium Adjustments ......................................................................................45

6.1.5 Company Information Tab ...................................................................................................47

6.1.6 Employee Roster Tab ..........................................................................................................48

6.1.7 Action Center tab .................................................................................................................54

7 Annual Group Plan Renewal...............................................................................................................55

7.1.1 Renewal into the Same Single Plan Option ........................................................................58 7.1.2 Renewal into a Different Single Plan ...................................................................................58 7.1.3 Renewal into a Metal Level Plan (Same or Different Level)................................................58


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7.2 Group Disenrollment .....................................................................................................................58 7.3 Employee Disenrollment ...............................................................................................................65 7.4 COBRA..........................................................................................................................................65

8 Washington Heathplanfinder Business Premiums...................................................................................................................................................65

8.1 Employee Roster Factors..............................................................................................................66 8.2 Anonymous Browsing Tool… ........................................................................................................66 8.3 Total Group Premiums ..................................................................................................................66

9 Employee Account Creation ..............................................................................................................68

9.1 Account Creation...........................................................................................................................68 9.1.1 Confirm your Identity ...........................................................................................................68 9.1.2 Create User Account ...........................................................................................................70 9.1.3 You and Your Household ....................................................................................................71

10 Employee Plan Selection ...................................................................................................................74

10.1 Plan Selection ...............................................................................................................................74 10.1.1Employee Explore Your Options .........................................................................................74 10.1.2Compare Plans ....................................................................................................................76 10.1.3 E-sign ................................................................................................................................77 10.1.4Employee Summary & Final Smmary...................................................................................77

11 Employee Dashboard .........................................................................................................................80

11.1 Employee Dashboard Tabs ..........................................................................................................80 11.1.1Account Home Page............................................................................................................80 11.1.2Me and My Household Tab .................................................................................................81 11.1.3Coverage History .................................................................................................................83 11.1.4Action Center Tab................................................................................................................84

11.2 Change Reporting .........................................................................................................................85 11.2.1Qualifying Events.................................................................................................................85

11.3 Retroactive Enrollment.............................................draf.t .....................................................................88 11.4 Retroactive Disenrollment……………………………………………………………………………….88 11.5 Employee Renewals……………………………………………………………………………………...89

12 Brokers.................................................................................................................................................90

12.1 Broker Account Set-up ..................................................................................................................90 12.2 Selecting a Broker .........................................................................................................................90 12.3 Employer without an Account .......................................................................................................91 12.4 Broker Search Results ..................................................................................................................92 12.5 Broker Dashboard -Account Home Page......................................................................................94

Broker Account Home Tab .......................................................................................................................95

12.6 Broker Dashboard- My Clients tab ................................................................................................96 12.7 Broker Confirmation and eSignature.............................................................................................97 12.8 Broker Compensation ...................................................................................................................99

13 Consumer Help....................................................................................................................................99

14 Correspondence..................................................................................................................................99

15 Glossary .............................................................................................................................................100


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Washington Heathplanfinder Business Program Guide Revision History

DATE

REVISION NUMBER

REVISION DESCRIPTION

04/15/2013

V1

Final Draft

05/24/2013

V2

Final Draft

08/09/2013

V3

Final Draft

10/01/13

V3

Updated with manual processes

10/15/13

V4

Added Employer Questionnaire information and sample form

10/21/13

V5

Updated Figure 1. HBE System Tracks and reformatted sections

11/20/13

V6

Updated Employer of 1 work around

8/26/2014

V7

Updated to reflect changes for 2015

7/16/2015 V8 Updated to reflect changes for 2016

1.1 Intended Users

The Washington Healthplanfinder Business Guide is intended for Exchange users and Healthplanfinder privileged users, and employers. This guide has enrollment and ongoing account administration through Washington Healthplanfinder Business.


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1.2 Guide Purpose

Intended user

Purpose

HBE Staff

High level system overview on the process and flow of Washington Healthplanfinder Business.

Carriers

High level system overview on the process and flow of Washington Healthplanfinder Business.

Brokers and Navigators

High level system overview on the process and flow of Washington Healthplanfinder Business Includes specifics about setting up the employer and employee accounts as well as manual workarounds to be aware of as they work with employers, set up their accounts, and enroll the groups in coverage.

Employers

High level system overview on the process and flow of Washington Heathplanfinder Business. Includes manual workarounds which they need to be aware as they set up their account, and maintain or change employees’ and dependents coverage.

2 Washington Healthplanfinder Business (formerly SHOP) Introduction

2.1 Overview

The Affordable Care Act (ACA) establishes American Health Benefit Exchanges (Exchanges) to provide individuals and small business employees with access to affordable health insurance coverage options beginning January 1, 2014. An Exchange is an entity that both facilitates the purchase of Qualified Health Plans (QHP) by qualified individuals and provides for the establishment of a Small Business Health Options Program (SHOP), consistent with Affordable Care Act 1311(b) and 45 CFR 155 subpart H. Exchanges will provide competitive marketplaces for individuals and small employers to directly compare and purchase private health insurance options based on price, quality, and other factors. Exchanges are integral to the ACA’s goal of prohibiting discrimination against people with pre-existing conditions and insuring all Americans.

Washington State’s Health Benefit Exchange system is called the Washington Healthplanfinder. The plans offered to employers within the Washington State SHOP in Washington Healthplanfinder must be compliant with the regulatory requirements pursuant to 45 CFR 155 Subpart H.

The ACA has defined standardized benefit categories, which are required to be offered in all plans certified as Qualified Health Plans (QHPs), which includes any plans an insurer intends to offer small employers in SHOP. Each participant enrolled in a plan through SHOP will have all 10 of these standardized benefit categories, called “essential health benefits”.

Once a healthcare plan passes the regulatory review from the Office of the Insurance Commissioner (OIC) the Exchange will conclude its certification process for a plan to become a QHP. Only plans certified by the Exchange board as QHPs are allowed to be offered in Washington Healthplanfinder.


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2.2 Washington Healthplanfinder Business System Process

There are three main tracks in the Healthplanfinder system to set up a Washington Healthplanfinder business account for an employer group. The fourth track outlines HBE to handle manual processes. This guide provides a recap of the requirements in each step of the process. Track 1 below displays the steps required by an employer. Track 2 below displays the steps required by an employee. Track 3 below displays the steps required to partner with a broker. Track 4 displays functions that require manual processing by an Account Worker.

StartEmployer

Crates Account

Employee Creates Account

Employer Adds/Removes Broker/

Navagator

Employer Creates

Employee Roster

Employer Selects Plan

& Contribution

Employer Reviews Plan

Summary, Confirmation & Plan Payment

End, Carrier Receives

Enrollment, Disenrollment,

Change Info

Employer

Employees

Employer Manages Account

HBE Account Worker

Employee Selects a

Plan

Employee Reviews Plan Summary &

Confirmation

Employee Manages Account

Manual WorkaroundsCOBRA Process/Events, Disabled Adult Dependents, Identifying TEFRA Eligible, Employee Termination/Death, Loss/Gain

Medicare/CHIP for Dependent, Employer of 1, Send 60 Day Age Out Disenrollment Notice, Employer Questionnaire Process

Employer Confirms Plan and

Sends Link

2.3 Affordable Care in Washington State

Small businesses will be offered a choice of plans in Washington Healthplanfinder, which meet certain benefits and cost standards.

In 2014 and 2015, small businesses with up to 50 employees can participate in the Exchange. (Employers initially participating in the Exchange with less than 50 employees who expand their business during the year beyond 50 employees will be allowed to continue participation in the Exchange after their expansion.)

In 2016, small businesses with 1(other than owner) to 100 employees can participate in the Exchange, expanding the health-care pool even further.


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Washington States Employers are eligible to enroll in Washington Healthplanfinder Business in 2015 if they meet the following criteria:

Employer is located within the state of Washington or has Washington based employees Employer is offering coverage to all full-time employees Employer group includes up to 50 employees.

2.4 Standard Benefits

Each healthcare plan offered in the Healthplanfinder will include the 10 essential health benefits defined by the ACA. The 10 essential health benefit categories include:

Ambulatory Services Emergency Services Hospitalization Services Mental Health Services Prescription Drug Rehabilitation and Habilitative Services Laboratory Services Preventative and Wellness services, including Chronic Disease Management Maternity and Newborn Care Pediatric Services, including Oral and Vision

2.5 Washington Healthplanfinder

An employer visiting the Washington Healthplanfinder site for the first time to learn about coverage options for its business is initially taken to the site’s Home page.

On the Home page the employer selects the “Cover Your Employees” button to get started.


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Healthplanfinder Home page

2.6 Estimate Possible Tax Credits

If an employer offers coverage for employees through the Exchange it may qualify for a tax credit. The small business tax credit is only offered to small businesses that purchase health insurance through the Exchange.

In 2014 and 2015, small businesses with less than 25 full-time equivalent employees, with an average

annual pay of less than $50,000, may qualify for a small business tax credit of up to 50% of the employer’s share of the premium cost (up to 35% for non-profits) to help offset the cost of the insurance.

You can access the small business calculator here - http://www.irs.gov/uac/Small-Business-Health-Care-Tax-Credit:-Questions-and-Answers.com The link goes to the Internal Revenue Service (IRS) website where an employer can calculate projected savings as a result of qualifying for a tax credit. This selection will estimate a possible tax credit amount by using an online calculator.

Please note: All tax credits for small businesses are handled outside of the Washington Healthplanfinder system. Employers should consult their legal or tax advisor for any further questions regarding this tax credit.

http://www.irs.gov/uac/Small-Business-Health-Care-Tax-Credit:-Questions-and-Answers.com

http://www.irs.gov/uac/Small-Business-Health-Care-Tax-Credit:-Questions-and-Answers.com


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2.7 Enrollment for New Employers

Washington Healthplanfinder Business has an ongoing open enrollment period for new employers coming to the Washington Healthplanfinder.

New employers coming to the Healthplanfinder during the year will utilize the following enrollment time frame:

Employers have between 1-30 days to create an account, select a plan or metal level, and initiate employee Open Enrollment.

raEmployer indicates that they wish to have early enrollment coverage effective date – by selecting the earlier

coverage effective date on the Employee Roster screen

Employees have up to 30 days to elect/waive coverage and e-sign.

Employers have between 1-15 days to complete the application by confirming plan selection and making the initial premium payment.

o If the employer submits the final application (including payment) prior to 4:59 PM PST on the 15th

of the month, the coverage period starts on the 1st of the next month.

Example: March 15th application completion results in April 1st coverage period start date.

o If the employer/employee submits the application (including payment) from 5:00 PM PST on the 15th of the month up to 4:59 PM PST on the 15th to the next month, the coverage period starts on the 1st of the second following month.

Example: March 16th application completion results in May 1st coverage start date.

There is not an earlier coverage option for Open Enrollment (OE) initiated on the 15th day of months with 31

days (Jan, March, May, July, Aug, Oct, Dec)*


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Employer initiates Employee OE by sending out the Healthplanfinder Enrollment link to all employees being

offered coverage

o If the Employer does not ask the system to send out the OE link – then they will have to manually copy

the link from the Account Home Page on Healthplanfinder and email to Employees outside of

Healthplanfinder

All Employees designated ‘Election for Coverage’ status must select a plan and e-sign by the earliest possible

14th day of the month (1 day before the earliest payment due date. Changes indicated on the Employee roster

screen are updated in a nightly batch)

Employers must pay by 4:59 PM PT on the first available 15th of the month

o If the Employer fails to pay by the first available 15th of the month for early coverage, the Employer

group will automatically set to the default timeline where the first payment will be due the first 15th of

the month following the 30 day Employee OE (30 days from when the employer sent out the link)

Employer/Employees will receive coverage on the 1st day of the following month from which the payment was

made, in the case of the example the first day of coverage would be February 1st, 2015


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*OE initiated on months with 31 days do not have an earlier coverage option because the end of the open enrollment period (30

days from when the employer sent out the link) will fall on the 14th of the next month, this means that the latest and earliest

date the Employer can make a payment in the system will be the next day (15th) by 4:59 PM PT

Employer Early Coverage Timeline Example Open Enrollment Start Date: 1/5/2016

System Premium Due Date: 1/15/2016 or 2/15/2016

Coverage Effective Start Date*: 2/1/2016 or 3/1/2016

*Coverage Effective Start Date is defaulted to 3/1/2016 (later date); however, Employer is allowed to select

earlier coverage start date (2/1/2016). The System Premium Due Date will shift accordingly. If deadline is not

met for earlier coverage start date, application will proceed with 3/1/2016 coverage start date, as specified in

the Standard Coverage Timeline Chart.

*Note: for all timelines, when counting days in the system, begin the count on the day after the current day

Example:

If current date is 1/5/2016, first day counted is 1/6/2016

Employer Initiates Open Enrollment

•Employer selects earlier Coverage Effective Start Date and initiates Open Enrollment by sending out HPF link on 1/5/2016

Open Enrollment

•Employees must select plan and e-sign by 1/14/2016 to be eligible for 2/1/2016 Coverage Effective Start Date

Employer Completes payment

•Employer has until 4:59 PM Pacific Time on 1/15/2016 to make the first premium payment for 2/1/2016 Coverage Effective Start Date.


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3 Employer Account Creation

To create an employer account, select the “Cover your Employees” button on the Washington Healthplanfinder Landing page. The following information needs to be gathered in advance of creating the employer account: www.wahealthplanfinder.com

FEIN FEIN or Federal Employer Identification Number is also known as Federal Tax Identification Number. This 9 digit code is used by businesses in order to classify and identify them as a tax payer, for banking services and other official and legal purposes. A link to the FEIN application on the IRS website is provided for Employers in the Healthplanfinder.

Unique Email Address For each type of account set up in the system a user will need a unique email address.

For example, the additional information needed below indicates the following email addresses are needed:

Employer Account requires a unique email address associated with the employer’s business. Employee roster requires a unique email address associated with the employer as a member of the

group’s coverage.

Company and Owner Information

o Company information needed includes (*indicates required fields): *Federal Employer Identification Number (FEIN), *Company Name, *Business Address, *City, *State, *Zip, *Business Phone Number, Business Fax number.

o Employer’s personal (owner) information needed include(*indicates required fields) : *First

name, * Last name, *Middle name, *Date of birth, *Social Security Number (SSN), *Email address.

Employee Roster Information

o The employee roster should include a complete list of all full time employees, in addition to the employer. The roster information to be provided includes the following:

o Employee details needed include (listed in order, * indicates required fields, fields in red can only

be updated by an Account Worker once submitted):*First Name, *Last Name, *Middle Name, *Date of Birth (DOB), *the employees ZIP code & County, *Social Security Number (SSN), *Email address, *Participation Status in the plan (elect coverage, waive coverage, non-participation, exempt from individual mandate (this is for American Indians or those on Medicare)), *FTE Status (FT or PT), *Tobacco use (Yes or No)

o If employees are allowed to add dependents, for each dependent employers provide the

following details (listed in order, * indicates required fields, fields in red can only be updated by an Account Worker once submitted):*Dependent DOB, *Dependent relationship,*Tobacco use (Yes or No)

http://www.wahealthplanfinder.com/


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3.1 Creating Employer Account

The employer account is set up on the following main pages:

Company Information - basic

Account Creation

Authorization Required Security Code

Company Information - detailed

Employee Roster

3.1.1 Company Information - Basic

Basic information is entered into the first company information page.

The information needed includes (*indicates required fields): *Company name, *Federal Employer Identification Number (FEIN)

A link to the FEIN application on the IRS website is provided for employers who do not have an FEIN. FEIN or Federal Employer Identification Number is also known as Federal Tax Identification Number. This 9 digit code is used by businesses in order to classify and identify them as a tax payer, for banking services and other official and legal purposes. Self-employed individuals should enter their 9 digit SSN “##-#########” in the FEIN field.

Employers can still continue with the account set-up if they do not have an FEIN. However, the enrollment process will not start until an FEIN number is provided. Employers must submit an FEIN for verification within 30 days to complete the enrollment.


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Employer Creating a Healthplanfinder Business Account

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3.1.2 Account Creation

The primary owner’s personal information is entered into the account creation page. Information needed includes (*indicates required fields): *First name, * Last name, Middle name, *Date of birth, *Social Security Number (SSN), *Email address.

The final account creation includes setting up a user identification number (ID) and password and agreeing to the Terms and Conditions of Use.

3.1.3 Employer Attestation

When employers create an account the employer must “attest” to meeting the following, which are the requirements to participate in Washington Healthplanfinder Business:

1. The company is a small business of up to 50 employees. 2. The company is offering health coverage to all full-time employees. 3. The company is biased in Washington or has a work site located in Washington.

3.1.4 Employees

Attestation number 1 above which requires small businesses to have up to 50 employees (2015) is different than the IRS tax requirement qualifying the small business for the tax credit; refer to Section 2.6, Estimate Possible Tax Credits.

In 2015, an employer with up to 50 employees is eligible to participate in the Washington Healthplanfinder Business. Recent federal guidance gave state-based exchanges the ability to use their state methods for continuing employees for SHOP eligibility purposes before 2016, to align with state small group markets.


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Employer Creating Log-In Information

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3.1.5 Authorization Security Code

Once an employer account has been created, the employer will see the “Additional Authorization Required” security page.

Federal regulation requires privileged users such as; employers, brokers, etc. to have a one-time password. This is an extra step due to the access employers (or their assigned representatives) have to privileged security information in the employer account, such as employee SSNs. This means each time an employer (assigned Broker, Navigator, or Administrator) logs into their account, they will get an email with a 5 digit code which allows them access to the account.


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3.1.6 Company Information

The detailed company information provided includes the following information (* indicates required fields): *FEIN, *Company Name, *Business Address, *City, *State, *Zip, *County, *Business Phone Number, Business Fax number.

Employer Entering Business Contact Information

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3.1.7 Employee Roster

3.1.7.1 Roster Information

Employers need to determine if they are going to offer coverage only to employees OR if coverage will be offered to employees and their dependents. If dependents are also being covered, the roster will also include the employee’s dependent information.

Please note: Once you have offered your employees coverage you will not be able to go back and change the roster to include dependents if you didn’t initially include them in the group.

Employers are required to offer coverage to all full-time employees and must meet the threshold for employee participation and contribution to enroll in Washington Healthplanfinder Business. As such, employers are required to include all full-time employees in the employee roster.

Employers need to make sure they include themselves in the employee roster to receive coverage under their employer group plan.

Employers should include any individuals currently covered through COBRA on the employee roster, but should not include individuals who are in a COBRA election period and have not yet elected COBRA coverage. Please refer to Section 3.3.7.7, COBRA Individuals.

Employers should only include part time employees in thdraf t e roster when offering them coverage through the employer plan. All employees on the roster will be included in the participation calculation.

If you are an employer with a Wellness program for your employees, please refer to Section 3.3.7.5, Wellness program. If you are a self-employed businesses with “1” employee in the business (the owner) refer to Section 3.3.7.6, Self Employed Business of “1”.

Employee Roster (Indicates required fields, fields in red can only be updated by an Account Worker once the roster has been submitted):

Employee First Name Employee Last Name Employee Middle Initial Employee Date of Birth Employee SSN Employee Email Address Employee Employment Status (FT or PT) Employee Zip Code Employee County Employee Tobacco Status (Y or N) Employee Participation Status (refer to

Section 3.3.7.2 below)

Please note: Email is a required field in the system for all employees in the roster. Employers need to include themselves in the employee roster to receive coverage under their employer group. If they add themselves to the roster, our system requires them to provide a unique email address separate from the email address provided for the Employer account. Employees will also be required to have an email address in the system.

If you allow dependents to be covered in your plan the following dependent information is needed (* indicates required fields, fields in red can only be updated by an Account Worker once the roster has been submitted): *Dependent date of birth, Dependent Relationship to Employee (Spouse or Child), * Dependent Tobacco status (Y or N)


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3.1.7.2 Employee Participation Status

The employer is responsible for determining the “participation status” of each employee before submitting the employee roster. The employee participation status affects whether or not the employer meets conditions for employee participation.

Participation status options include:

“Election For Coverage” if your employee will receive coverage through your company. This should also be selected for an individual currently covered through COBRA.

“Waiver For Coverage” if your employee will be receiving coverage from another group- sponsored insurance (e.g., under their respective spouse’s coverage) or has VA, Medicare, Medicaid, Tricare coverage..

“Non Participation” the employee decides to not participate in group insurance for reasons other than the above two statuses. Please note: Employees in this status affect the employer meeting the participation threshold. Refer to Section 5.1.1, Final Application Summary for the specific threshold participation requirements.

If the participant information provided is wrong or if the employee makes changes to their participation status during open enrollment, the plan costs previously estimated will be incorrect. The employer is responsible for any extra costs associated with the plan rating changes.

3.1.7.3 Tobacco Use

“Tobacco use” is defined as the use of a tobacco product or products four or more times per week within no longer than the past 6 months by legal users of tobacco products age 21 and older and includes all tobacco products. Tobacco use is defined in terms of the time since the individual’s last use of a tobacco product. The Federal definition in 147.102 includes "except that tobacco use does not include religious or ceremonial use of tobacco."

Employers with employees participating in an employer sponsored wellness program that use tobacco should refer to Section 3.3.7.5, Wellness Program.

3.1.7.4 Manual Entry or Uploading the Employee Roster

Employers are given the option of adding the employees manually OR uploading the employee roster information in an Excel template.

If employees only are included in your plan:

and you upload your roster from the spreadsheet template; only employee information appears in the template. Dependent information is not included.

If employees and dependents are included in your plan: and you manually enter your roster; the roster page expands allowing you to add both employee

and dependent information. and you upload the roster from the spreadsheet template; the template includes information needed

on both employees and dependents.


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Once the employee roster has been added to the Healthplanfinder system, verify the information and then click the “Submit Employee Roster” button to save your roster in the system. Once the employee roster is submitted, the Washington Healthplanfinder is ready to retrieve available qualified health plans (QHPs).

Please note: Employers should not navigate away from this page without clicking the “Submit Employee Roster” button; otherwise any employee data already entered will be lost.

3.1.7.5 Wellness Program

When adding employees to the roster, enter employees participating in an employer-sponsored wellness program as non-tobacco users. Per the regulations, these employees will not be charged premiums for tobacco use.

A surcharge for tobacco use cannot be added retroactively if the individual was found to not be participating in the wellness program. However, issuers could retroactively charge for tobacco use if they discover tobacco use was misrepresented during the application process.

3.1.7.6 Self Employed Business of “1” – (2015 Only)

In the State of Washington, employer groups of “1” are eligible for small-group coverage if the business is a self- employed individual for which 75% of their revenue is derived from the business. The exception is for an agricultural business, in which case 51% of revenue must be derived from the business.

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Self-employed individuals who meet this eligibility criterion must follow certain procedures to successfully upload the employee roster in the Healthplanfinder. This “workaround” is required as the current design of the employee roster requires a minimum of “2” employees to be entered in order to upload into the system (based on earlier interpretations of federal regulations) until 2016.

As such, employer groups of “1” must follow the steps below:

1. Enter themselves as an employee on the roster. Enter their demographic information, including first

name, last name, and middle initial, date of birth, social security number, e-mail address, employment status, zip code / county, enter “Election for Coverage” as the participation status, and the tobacco status.

2. Enter a second “employee” record in the roster and include all the same information as above with the exception of the first and last name as noted below AND the participation status:

Enter “Duplicate” for the second employee record’s First Name Enter “Duplicate” for the second employee record’s Last Name Select “Waiver of Coverage” for the Participation Status

This process will allow an employer group of “1” to successfully upload the employee roster, while at the same time meeting the SHOP employee participation requirement of 100% (by having the second “dummy” employee being a waiver of coverage).


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3.1.7.7 COBRA Employees and Dependents

Employees/Dependents currently receiving COBRA coverage should be included in the Employee Roster with a Participation Status of “Election for Coverage.” These individuals will select a plan and enroll in the same manner as an active employee. Premiums for those with COBRA coverage will be included in the Employer invoice, and it will be the Employer’s responsibility to collect the correct amount from these individuals. Employers must inform the Healthplanfinder of any COBRA enrolled individuals listed on their roster so this information may be passed on to the Carrier.

Employers are responsible for providing COBRA notices to employees and dependents who experience a qualifying COBRA event, and for providing current plan information to those individuals. Employers should notify the Exchange of any individuals to whom they have provided a COBRA notice who are in a COBRA election period. However, these individuals should NOT be listed on the Employee Roster until they elect COBRA coverage.

At Initial Enrollment; renewal Washington Healthplanfinder Business will provide Employers with an Employer Questionnaire which will include a section where the Employer can provide information on both COBRA Elected and COBRA Eligible individuals. The Washington Healthplanfinder Business support staff will forward the completed questionnaire to appropriate carrier(s).

In early 2016, a system enhancement will add questions relating to COBRA compliance and Medicare Second Payer compliance as part of the initial enrollment and Renewal workflows. This will eliminate the need for the employer to fill out an extra form to answer these questions and allow the Health Benefit exchange to provide the Carrier with this information in a timelier manner.

3.1.7.8 Selecting a Designated Employer Administrator (DEA)

Designated Employer Administrators can assist an employer with managing their account. They have the same account privileges as the employer on the account, except for the ability to remove or reassign the DEA role. Employers have an option of selecting an administrator prior to submitting the group roster. The DEA must be an employee on the employer’s roster.

Employers need to notify the employee selected as the administrator that they have assigned them as an administrator. Employer will need to provide them with the group URL from the employer’s home page. The link will take the employee to a page where they will select the role to sign in as – employee or administrator. They will need to select the administrator role, which has unique account privileges separate from the employee role. Setting up the administrator account will require them to provide a unique email address.

3.1.7.9 In the Event of an “Employee or Dependent Death”

In the event of death of an Employee or Dependent, contact a Washington Health Benefit Exchange Account Worker. The Account worker will process the death to ensure coverage ends the day of death

Death of an employee will trigger disenrollment of all household members. Death of a dependent within a household triggers disenrollment of only the dependent.


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Employer Creating an Employee Roster (Manually)


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Employer Creating an Employee Roster (Excel Template)


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3.1.8 Employer Questionnaire The Employer Questionnaire is sent out to an Employer after they have made their initial payment for coverage. It elicits the following information from the Employer: TEFRA/MSP/COBRA eligibility and requirements, and information regarding individuals who have elected COBRA or are eligible for COBRA.

Employer Questionnaire Form


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4 Employer Plan Selection

4.1 Plan Selection process

All plans offered include the 10 essential health benefits. The plan selection process consists of the following: Design Your Plan Explore Your Options Compare Plans Estimated Summary Employer Next Steps

4.1.1 Design Your Plan One plan option:

The single plan option allows employers to select a specific plan to be offered to employees (and dependents, if the employer opts to offer dependent coverage).

Employee choice option:

Allow employers to select a specific metal level of Washington Healthplanfinder Business plans allowing employees to select any plan offered within the metal level selected. Metal level options may include the following:

o Bronze level plans provide lower monthly payments, but higher costs when receiving services. o Silver level plans provide higher monthly payments than Bronze, but lower costs than a Bronze

plan when receiving services. o Gold level plans provide higher monthly payment than Silver, but lower costs than Silver or

Bronze when receiving services. o Platinum level plans provide the highest monthly payment, but lowest cost when receiving

services.

The employer’s contribution percentage value towards the employee’ s premium can be set anywhere between 50% and 100%. The system default is set at the minimum of 50%. (Reminder - employer offering coverage to employees through the Exchange may be qualified for a tax credit.) o The employer's contribution percentage may be less than 50% if Open Enrollment is initiated

between November 15 and December 15, annually starting in 2014.

The employer’s contribution percentage towards dependents’ premiums can be set anywhere between 0% and 100%. The system default is set at the minimum of 0%.

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The employer’s contribution percentage should be set at an amount that will allow the employer group to meet the enrollment threshold required. If the contribution is too low, employees may not enroll and/or coverage may be determined to be “unaffordable”. If this occurs, the employer should consider increasing its contribution amount.

Please note: Indicating dependents are included in an employer plan does not require contributions toward dependents’ premiums, nor does it affect the “affordability” of coverage.

The Design Your Plan page in Washington Healthplanfinder Business provides two separate ways for an employer to purchase insurance:


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Employer Designing the Coverage Approach draf t


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4.1.2 Explore Your Options

The system retrieves plans for the employer based on the plan option selected (single or a metal level plan option) and displays them on the Explore Your Options page. All the plans shown are certified by the Washington Health Benefit Exchange board, and located in the employer and/or employee geographic area.

The employer has the ability to filter and sort the plans using a variety of options in the left-hand menu of the page. From this page, the employer can find out more information about a plan, go back and select a plan using a different option, or select a plan from the options displayed and continue the enrollment process.

Plans are displayed for comparison in descending order by premium costs. Employers can compare up to 3 plans at a time.

Employers can explore the options by changing and updating the contribution percentage(s) or by selecting from the different filters in the left-hand menu. An employer can view more information on a single plan by selecting the More Information link to view the Summary of Benefits and Coverage (SBC) PDF from the insurer.


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Employer Selecting the “Employee Choice Option”


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4.1.3 Compare Plans

To compare plans, the employer can select the “Add to Compare” link on their desired plan for up to 3 plans and then click View the Comparison.

The Washington Healthplanfinder will direct the employer to the Compare Plans page where specific benefit categories from the selected QHPs can then be viewed side by side. After comparing the plan benefits on this page, the employer can either go back to explore more options OR may click the “Select This Plan” button next to a chosen plan and continue the enrollment process.

If the Employer chooses a metal tier they will only be looking at plans in the same metal level, and therefore not need to compare plans

Plan Comparison


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4.1.4 Estimated Summary

Once the employer contribution percent is defined and a plan offering is selected an employer can view the estimated plan costs on the Estimated Summary page. Costs are displayed based on the group participation entered by the employer in the employee roster.

If a single plan option was selected, employers are able to view an overall summary of the selection,

including the employer’s chosen plan and contribution amount. This page shows a set dollar amount when the single plan model is selected.

If the metal-level plan option was selected, employers view an estimated range of premiums for the contribution amount. The range of costs shows the lowest total plan costs to the highest potential plan costs. The actual costs will vary based on the specific plans in that metal level selected by employees in the group.

To accept the monthly contribution estimates shown in the summary, select the Next button. Otherwise, the employer can go back to make changes in their plan selection and continue exploring options.

Employer Estimated Summary Pg.


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4.1.5 Employer Next Steps

Open Enrollment for the plan is initiated when the employer clicks the “Next” button on the Estimated Summary page and opens the Employer Next Steps page.

The enrollment window for the employer to set up an account, select a plan option and open enrollment for employees is up to 30 days. The Employers application status will indicate “Employee Action Pending” during the Open Enrollment period.

On the Employer Next Steps page, the employer has the ability to send the employee OE link (enrollment link) to its employees, allowing them to begin purchasing health insurance through Washington Healthplanfinder Business.

Please note: After the initial roster is completed, whenever an employer adds additional employees to the roster, they will have to send the unique employer enrollment link directly to the employees being added. The employer enrollment link can be found on the Employer Dashboard home page.

If an employer is only allowing employees (and not dependents) to be covered in the plan and a single plan option is offered, then with employee approval employer may complete the account and enrollment selections on their behalf.

If an employer allows dependents to also be covered in the plan, employees must login to the Washington Healthplanfinder to complete their user account and enrollment selections.

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The next step in the process is the employee receiving communication and accessing Washington Healthplanfinder through the unique employee enrollment link, allowing them to begin purchasing health insurance through Washington Healthplanfinder Business. To follow this next step, skip to the Employee Account Creation section.

5 Final Plan Confirmation Process

5.1 Purchase Coverage

The final confirmation process an employer will follow to purchase insurance and trigger their Washington Healthplanfinder Business Enrollment consists of the following pages:

Final Summary E-Sign Payment Employer Final Confirmation

5.1.1 Final Application Summary

Once the conditions for employee participation have been met, the employer will be notified by a correspondence that participation has been met to complete the application process.

Participation conditions include: If employee participation is at least 75% for groups of 4 or more and 100% for employer groups of 3 or

fewer at any time during the open enrollment period (30 days). o The employee participation rate may be less than 75% if Open Enrollment is initiated between

November 15 and December 15, annually starting in 2014.

When the employer logs into Healthplanfinder, after participation is met, they will now see the option to “Complete My Application” from Quick Links. This will take the employer to the Final Application Summary page so the employer can view the final summary of the employee and dependent coverage (if offered).

Based on employee changes made; adding or removing dra f t

household members and/or participation changes, the final total premium costs displayed may be different than what was previously provided. The final summary pg.will provide the “Total Premium Cost,” “Total Employer Cost”, and “Total Employee Cost.”

To confirm coverage the employer selects Continue to the E-sign page.

Due to the slight possibility of differences in the final costs, the employer is also given the option of discontinuing the current application by selecting to “Cancel My Application”. If the employer selects this link, it can re-open the plan shopping process starting with the Design Your Plan page.


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Employer Final Summary


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5.1.2 E-Sign Page

The E-sign page is an electronic signature certifying the Washington Healthplanfinder Business application.

After signing and clicking on the “Next” button the employer is taken to the Payment details page.

Employer eSignature (Before Payment)

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5.1.3 Plan Payments

Next, the employer makes the initial Total Premium payment for the first month’s coverage.

For a group’s initial enrollment, payment must be made by 4:59 PM PST on the 15th, coverage is effective the 1st

of the next month.

Please note: Failure to complete the payment portion can result in cancellation of the application and the employer will need to restart the process from the Explore Your Options page.

For initial payment, the employer may use only credit card or electronic check to pay via Washington Healthplanfinder. Once this initial payment has been made, employers can set up recurring auto-payments for the premium.

Ongoing plan payment methods available include credit/debit card and electronic check payment. Refer to the Billings and Payment tab section of this document for billing and payment time frames.

No partial premium payment is allowed. If the employer has outstanding past due invoices, the carrier will be unable to confirm enrollment for

the next year open enrollment until the employer pays the outstanding invoice. The employer group only receives coverage for which the employer has paid. If the employer fails to pay

before the end of the grace period, the group will be disenrolled retroactive to the beginning of the month. The employer is able to re-enroll the group any time in the future.

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Review Initial Payment Details – Employer


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5.1.4 Employer Final Confirmation

After successfully making the initial Premium payment, the employer will be directed to the Employer Final Confirmation page. On this page, the employer can see an overview of the account, roster, plan, and payment information and proceed to the Employer dashboard to access any account management functionality.

At this time, Healthplanfinder submits the initial enrollment and payment files notifying the carriers, the employer, and the employees of the enrollment completion.

The Carrier will receive a Group Set Up EDI file and an 834 enrollment EDI file 2 to 3 business days from when the employer has made initial payment.

The Carrier will receive the EDI files in the order displayed above.

The enrollment status then becomes “Active” and displays “Enrolled” for employees on the Employee Dashboard page.

Employer Final Confirmation


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6 Employer Account Dashboard

An employer with an active account will have the ability to perform a variety of administrative tasks related to the employer account via the “Employer Dashboard”. The dashboard will serve as the employer’s access to their employer account. This is the first page seen after successfully logging into their Washington Healthplanfinder Employer Account.

6.1 Employer Dashboard Tabs

Employers have 5 tabs from their Employer Dashboard:

Account Home

Billing and Payments

Company Information

Employee Roster

Action Center

6.1.1 Account Home Page

When an employer first logs into their account, they see the -Account Home page. draf t

The following is accessible from the Account Home Page:

The employer-specific enrollment link (that is sent to employees for initial enrollment) is displayed on the home page.

The Quick Links section of the home page provides the employer a quick and direct way to access a number of actions.

The Message Center section on the page displays recent correspondence sent regarding the employer’s account. Unread messages are displayed in bold on the page.

Please note: Employers who have indicated that email is the preferred communication may need to check their email spam filters to ensure emails from wahhealthplanfinder.org are properly received.


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Employer Dashboard – Account Home page

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6.1.2 Billing and Payments Tab

The Employer Dashboard – Billings and Payments tab provides payment history and current invoices. The employer can pay invoices or manage recurring payments by selecting the options on this page.

Invoices for ongoing coverage are generated around the 15th of each month and due by 4:59 PM PST on the last day of the month. The employer’s invoice generated will be for the “Total Group Premium” for the Employer Account. No partial payments will be accepted. All Washington Heathplanfinder Business payments must be made electronically through the Employer’s Washington Healthplanfinder account.

Please note: Employers are responsible for collecting the employee portion of the premium from each employee as well as COBRA premiums from individuals who have elected COBRA coverage.

Non-delinquent payment due dates: the last day (4:59 PM PST) of the month, for coverage period

starting 1st of next month If payment has not been received, a Payment Delinquency notice is sent the first of the month of

coverage. The grace period for delinquent payments: 1st of the month of coverage through the 10th of the month of

coverage. If the employer has not paid by 4:59 PM PST on the 10th of the month of coverage, the system initiates

the employer groups termination retroactively back to the last day of that month. A termination file generates overnight and is passed to the carrier on an Enrollment Termination file The employer group only receives coverage for which it has paid (through the end of the prior month).

May 31st = Payment due date June 1st = Payment delinquency notice is sent June 1st – 10th = Delinquency period June 11th = Group termination is processed back to May 31

Employer Tips When adding an employee, the premium for that new employee is invoiced with the next month’s invoice. When removing an employee, any credit generated from the termination are displayed on the next

month’s invoice. Employers receive a single invoice for multiple plans under an employee account even if coverage is

provided through different carriers.

6.1.3 Prorated Premium Calculation (Mid-month Enrollment and Disenrollment)

Premiums will be prorated when a mid-month enrollment takes place due to birth, adoption, or disenrollment due to death. The retroactive premium adjustment for these events uses a typical proration rounding rule.


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Premium pro-rating example: Premium without Child is $100, premium with Child is $110 and the Child was born March 3rd.

Old Plan Pro-rated premium

Since the baby was born on March 3rd, the old plan is effective only for 2 days. March 1st and March 2nd.

Premium per day for Month of March = $100.00/31 = ~ $3.225806 (taken out to 6 decimals) Therefore, total premium for 2 days (March 1st and 2nd) = 3.225806 * 2 = ~ $6.45 (rounded at the

end to 2 decimals)

New Plan Pro-rated premium Premium per day for Month of March = $110.00/31 = ~ $ 3.548387 (taken out to 6 decimals) Therefore, total premium from March 3rd to March 31st (29 days) = 3.548387*29=~ $102.90

(rounded at the end to 2 decimals)

Total = $ 109.35

6.1.4 Retroactive Premium Adjustments

Employers receive an invoice the 15th of the month for the next month’s coverage. The invoice the employer receives includes changes made from the 1st through the 15th of the month with the exception of retroactive premium adjustments.

There is a possibility of mid-month retroactive premium adjustments in Small Business Market for special enrollment events. The employee has 60 days to report all special enrollment events. Birth, adoption or placement for adoption and lossdr af t of minimum essential coverage have a retroactive adjustment back to the effective date of the change.


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Employer Dashboard - Billing and Payments Tab

Employers may view adjustments applied to the monthly invoice


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6.1.5 Company Information Tab

The Company Information tab allows the employer to view and update company, personal and user account information. Employers can also add or a broker/navigator or remove a broker/navigator previously added on this tab.

Employer Dashboard – Company Information


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6.1.6 Employee Roster Tab

The Employee Roster tab gives an employer the ability to update the Employee Roster, adding and removing employees, viewing employee’s plan choices, and assigning a designated employee administrator.

Updates or changes to the Employee Roster need to be done manually once the initial employee roster is submitted. Changes made to an employee or dependent in the roster may trigger special enrollment periods for the employee. Keep in mind, changes to the roster may affect the next month’s invoice generated.

6.1.6.1 Adding a New Employee

New employees who are hired by an employer after the initial enrollment will utilize the 30 day employee open enrollment time frame. Employers should keep in mind any probationary periods as well as the open enrollment time frame before adding the employee to the roster to ensure the correct coverage effective date you have defined for your business. Employers will add new employees eligible for coverage to the group by selecting the “Add Employee” button on the Employee Roster tab.

If an Employer adds a new employee to their employee roster on April 11th, starting their 30-day open

enrollment period. The employer will need to email the employee the link so the employee can create an account and select a plan if the employer is not selecting the plan for them. The open enrollment period for the new employee ends on May 11th.

Employees who complete the process quickly benefit by receiving coverage sooner than those who do not.

Example:

If the employee selects a plan quickly (April 12th), then the new employee would begin receiving coverage May 1st.

If the employee selects a plan after Invoice for next month's coverage is generated (April 16th), then coverage is effective starting June 1st.

Employer Adds Employee

An employee or dependent may be added to the roster after completion of the employer’s account. Employers

will add new employees eligible for coverage to the group by selecting the “Add Employee” button on the

Employee Roster tab. The employer will need to manually copy the Enrollment URL from their account home

and email the employee the group link. The employee will then create an account and select a plan if the

employer is not selecting the plan for them.

The only time that an employer has the ability to complete the employees’ enrollment is when the

employer is not offering coverage to dependents AND if the employer has selected a single plan.

Employee Selects Plan and E-signs by 4:59 PM PT on the 15th (Example)

The added employee must create an account and e-sign before 4:59 PM PT on the 15th of the month prior

to their planned coverage start date (The first day of the following month from which the payment was

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Example:

Add Employee Date: 1/5/2015

Account created and e-signed by: 1/15/2015

Coverage Effective Start Date: 3/1/2015

Employee Does NOT Select Plan and E-sign by 4:59 PM PT on the 15th (Example)

If the added employee creates and e-signs after the 4:59 PM PT on the 15th of the month, the employee will

NOT receive coverage for the planned coverage start date (The first day of the following month from

which the payment was made), but will instead receive coverage one month after the planned coverage

start date.

Example:

Add Employee Date: 1/5/2015

Account created and e-signed by: 1/16/2015

Coverage Effective Start Date: 2/1/2015

Employee is Added to Employer Group

•Employee is added to employer group

Employee Creates Account and E-signs

•Employee must select plan and e-sign by 4:59 PM PT on 1/15/2015 to be eligible for 2/1/2015 Coverage effective start date

Employee Receives Coverage

•Employee receives coverage starting 2/1

Employee is Added to Employer Group

•Employee is added to employer group

Employee Creates Account and E-signs after 4:59 PM PT on 1/15/2015

•Employee selects plan and e-signs after the 4:59 PM PT deadline on the 15th.

Employee Receives Coverage

•Employee receives coverage starting 3/1/2015


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Employer Removes Employee/Dependent

An employee or dependent can be removed from the roster after completion of the account set-up process.

Employers may need to remove employees from the group when a separation of service occurs. However, if the

separation constitutes a qualifying COBRA event, the Employer should contact a Washington Health Benefit

Exchange Account Worker ([email protected] ) to process the event in Healthplanfinder.

When there are no COBRA implications, Employers may remove an employee by logging into their account and

going to the Employee Roster tab. Locate the employee in the roster and select the Remove link for that employee.

Employer Removes Employee’s Link from Employee Roster Tab by 4:59 PM PT on the 15th (Example)

The employer must remove the terminated employee’s link in the employee roster tab before 4:59 PM PT

on the 15th of the month during the employees final month of coverage

Example:

Term Employee Date: 1/5/2015

Employee Link Removed from Employee Roster Tab: 1/15/2015

Coverage Effective End Date: 1/31/2015

Employer Does NOT Remove Employee’s Link from Employee Roster Tab by 4:59 PM PT on the 15th

(Example)

If the terminated employee’s link in the Employee Roster tab is not removed by 4:59 PM PT on the 15th of

the month, the employee will continue to receive coverage for the following month.

Employee is Terminated from Employer Group

•Employee is terminated from employer group

Employee is Removed From Employee Roster Tab after 4:59 PM PT on the 15th

•Employer removes employee's link from employee roster tab after 4:59 PM PT on 1/15/2015

Employee's Coverage Ends

•Employe's Coverage ends 1/31/2015

mailto:[email protected]


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Example:

Term Employee Date: 1/5/2015

Employee Link Removed from Employee Roster Tab: 1/16/2015

Coverage Effective End Date: 2/28/2015 (2/29/2015 for leap year)

Employee Adds Dependent to Employee’s Account

Employees adding a dependent follow the same timeline as an employer adding an employee (complete by 4:59 PM PT on the 15th for changes to be effective starting the beginning of month after the payment month)

Employee logs on to their employee account home screen and selects the “Me and My Household” tab.

Employee selects the “Update Household Information” link.

Employee selects “Add Dependent” link.

Employee fills in dependent’s information.

Employee provides reason for addition (birth, adoption, marriage, etc.) and a date of the event

o If the event involves a child the employee has 60 days to open special enrollment from the date of

the event.

Birth

Adoption

Placement for adoption

o The employee has 30 days to report the even for the following events:

Loss of employer sponsored MEC

Other (reviewed by Account Worker)

o In the event of marriage, the employee has 50 days to open special enrollment from the date of the

event.

Employee Removes Dependent from Employee’s Account

Employees removing a dependent follow the same timeline as an employer removing an employee (complete by 4:59 PM PT on the 15th for changes to be effective at the end of the payment month)

Employee logs on to their employee account home screen and selects the “Me and My Household” tab.

Employee selects the “Update Household Information” link.

Employee selects “Remove Dependent” link.

Employee provides a reason for the removal and date of the event.

The employee has 30 days to open special enrollment from the date of the event:

Employee is Terminated from Employer Group

•Employee is terminated from employer group

Employee is Removed From Employee Roster Tab After 4:59 PM PT on the 15th

•Employer removes employee's link from employee roster tab after 4:59 PM PT on 1/15/2015

Employee's Coverage Ends

•Employe's Coverage ends 2/28/2015


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o Death

o Divorce

o Other

6.1.6.2 Removing an Employee

Employers may need to remove employees from the group when a separation of service occurs. However, if the separation constitutes a qualifying COBRA event, the Employer should contact a Washington Health Benefit Exchange Account Worker to assist with processing the event.

When there are no COBRA implications, Employers may remove an employee by logging into their account and going to the Employee Roster tab. Locate the employee in the roster and clicking the Remove button for that employee.

6.1.6.3 Employee Changes

The Washington Heathplanfinder will allow special enrollment in an Employer plan based on a qualifying change in circumstance. The Exchange will allow qualified employees (and dependents if covered in the group) to enroll in an Employer plan or change coverage options as a result of a qualified life event.

6.1.6.4 D e s i g n a t e d Employee Administrator

The system allows employers to designate an employee administrator to help manage their account. An employer can designate an administrator on the Employee Roster tab. The administrator will need a unique business email account assigned for the Administrator role.

If an employer decides to designate an employee administrator, the employee administrator must be part of the employee roster. This role will have a separate user account from the employee’s personal account.

A designated employer administrator can access the Employer Dashboard on behalf of the employer and make updates and changes to the account, including the employee roster. Employers and employee administrators receive notifications of any updates or changes made to account information.


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Employer Dashboard – Employee Roster


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6.1.7 Action Center tab

The Action Center tab gives an employer the ability to upload any necessary documentation for verification purposes. Employers can view documents previously submitted and documents that the Healthplanfinder has received and that are awaiting action.

Employer Dashboard – Action Center


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7 Annual Plan Renewal

The system will trigger an annual renewal notice to the employer the 1st of the month 90 days prior to the end of the employer group’s coverage period. Employers will need to log into the system to determine if they want to renew the current plan or enroll into a different plan for the next year 60 days prior to the enrollment coverage end date.

The coverage effective date for renewal will follow the rules below, once employees have made their selection:

If the employer group submits the application (including payment) by the 15th of the month coverage ends, the coverage period will start on the 1st of the next month. This ensures employees will not have a lapse of coverage.

o Example: June 15th completed and paid enrollment will result in July 1st coverage start date.

If the employer submits the employer group‘s application (including payment) after the 15th of the

month coverage ends, the coverage period will start on the 1st of the following month. Employees would be responsible for any claims occurring during that month.

o Example: June 16th application completion will result in August 1st coverage start date.

2015 Renewal Timeline – Standard Process

Renewal Link is populated on Employer’s “Employee Roster” page 90 days prior to the end of the

Employer’s current coverage period.

Employer will receive a correspondence of renewal 90 Days prior to the Employer’s renewal coverage

date. The correspondence will be electronic and displayed on the Employer’s Message Center on their

Healthplanfinder dashboard. If the employer chose to receive correspondences by US Mail they will also

receive the renewal notice by mail. (The Employer will be notified not to select the renew link until 60

days prior to the end of their plan coverage. This workaround will be fixed in the September 2015

release)

Once the Employer has clicked renewal and updated enrollment options (if they wish to) they will send

out the Healthplanfinder Enrollment link to Employees.

o The employer will need to manually copy and paste the link into an email and send outside of the

Healthplanfinder.

o In the current system design the employer must send out the link on the first day of the month

prior to the effective coverage month for their employees to have a full 30 days to select a plan

and e-sign.

o 30 days from the first day of the month prior to the coverage month employees will no longer be

able to select a plan and e-sign as the system will time them out.

The Employees’ have between 1-30 days to select a plan and e-sign starting the first day of the month

prior to the coverage month.

o The employer must also send the link out to their employees no later than the first day of the

month prior to the end of their current coverage.


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Employer premium payment is due by 4:59 PM PT on the 15th of the month of the renewal month.

Employer Enrollment Link Timeline: Example

Renewal link generates 90 days prior to coverage start date: 10/1/2015

Renewal coverage start date: 01/1/2016

Date employer must send link for employees to receive 30 days to select a plan: 11/1/2015

Employee selection and e-sign period times out: 12/1/2015

Employer Enrollment Link Timeline, Employer Sends Link After Recommended

Time: Example

Renewal link generates 90 days prior to coverage start date: 10/1/2015

Renewal coverage start date: 01/1/2016

Date employer sends link to employees: 11/25/2016

Employee selection and e-sign period times out: 11/30/2015

Employer Receives Renewal Notification

•Employer recieves a notification that they will be able to renew their plan coverage in 30 days

Employer Sends Employees Renewal Link

•Employees have up to 30 days to select a plan and E-sign

Employee Selection and E-Sign Period Times Out

•Employees will no longer be able to select a plan or E-sign after this date, regardles of then the link was sent out

Employer Sends Employees Renewal Link

•Employer sends Link on 11/25/2015 giving employees 5 days to select plan and E-sign

Employees do not all finish plan selection period by 11/30/2015

•Employer sends Link on 11/25/2015 giving employees 5 days to select plan and E-sign

Employer can not move forward in renewal process

•Employer recieves a letter stating that they have not met participation threshold. Employer group will have a gap in coverage and will need to re apply for coverage following the standard Open Enrollment timeline


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2015 Renewal Timeline – Employer Does Not Meet Deadline

The Employer’s Renewal link on the Employee Roster Page will disappear and in its place a “Complete My

Application” link will generate.

The Employer will click on the Complete My Application link and be required to re select health plans and

send the link to the Employees.

o Because the employer did not make payment by 16:59 PT on the 15th of the month prior to their

renewal coverage month, the Employer group will have a gap in coverage until payment is made

following the standard Open Enrollment timeline rules.

Employer Renewal, Employer Does Not Meet Payment Deadline Process: Example

Intended Renewal Coverage Date: 1/1/2016

Payment Made: 12/16/2015

Effective Coverage Date: 2/1/2016

Employer Does Not Make Payment

•Employer does not Make payment by 12/15/2015

Gap in Coverage

•Employer group will not recieve coverage for 1/1/2016

Employer Follows OE Timeline

•Employer will follow Standard Open Enrollment Timeline and pay by 1/15/16 for 2/1/16 coverage


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High Level Timeline

7.1.1 Renewal into the Same Single Plan Option

The employer clicks the “Renew” button on the Company Information tab to renew the existing plan option. Enrollment is renewed under the same plan with the same insurer that currently provides coverage. The Estimated Summary page will display a re-quoted estimate for coverage for the currently enrolled members of the employer group.

7.1.2 Renewal into a Different Single Plan

Changing plans will trigger a disenrollment from the group’s current plan at the end of the coverage period. The employer will need to select a new single plan.

The Estimated Summary page will display a re-quoted estimate for coverage for the currently enrolled members of the employer group.

7.1.3 Renewal into a Metal Level Plan (Same or Different Level)

Employees must individually select to renew into the same plan or in a different plan within the metal level chosen by the employer. Based on the selection, the system will then disenroll/enroll and renew based on each employee’s choice.

7.2 Group Disenrollment

An employer may disenroll the employer group at any time during the year. The employer indicates disenrollment through the dashboard functionality by clicking the “Disenroll My Group” button on the Company information tab.

10/1/2015 1/1/201611/1/2015 12/1/2015

1/1/2016

Renewal Coverage Start Date

12/15/2015

Renewal Premium Due Date

11/30/2015

Last Day Of Employee Selection and e-Sign Period

(30 days After Beginning of Plan Selection Period)

11/1/2015

Recommended Date For Employer to Send Link To Employees,

System Starts 30 Day Countdown for Plan Selection Period

(30 Days Before Premium Due Date)

10/1/2015

Initial Renewal Notification Sent Out


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The following will also result in employer disenrollment:

An employer fails to pay for the coverage and does not make payment during grace period (this will trigger automatic disenrollment at the close of the grace period).


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When selecting the ‘Disenroll’ radio button, the following message is displayed:


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Selecting ‘Disenroll’ and clicking ‘Next’, takes the Employer back to the Employee Roster page. The disenroll button is

not displayed, but no other clues exist that the disenrollment just occurred:


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Disenroll Employee Correspondence:


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Disenroll Employer Correspondence:


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After Correspondence batch jobs ran (overnight), Disenrollment correspondence was present on Employer’s dashboard:

If group disenrollment is initiated, correspondence is sent to the employer and employees indicating that group will be disenrolled from coverage. Disenrollment is effective the “last date of coverage” as follows:

If the disenrollment is initiated on or prior to the 15th of the current month, the employer group

disenrollment will occur at the end of the current month.

o Example: June 15th disenrollment will result in June 30th coverage end date.

If the disenrollment is initiated on or after the 15th when the invoice has been generated and the invoice has not been paid, the employer group disenrollment will occur at the end of the current month.

o Example: June 16th disenrollment and the invoice haven’t been paid by the end of the month, will

result in a June 30th coverage end date.

If the disenrollment is initiated after the 15th when the invoice has been generated and the invoice was paid, the employer group disenrollment will occur at the end of the following month.


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o Example: June 16th disenrollment and the invoice was paid before the end of the month, will result

in a July 31st coverage end date.

7.3 Employee Disenrollment

Depending on the household makeup of the employee, changes made may or may not affect the following month’s premiums.

Employees who change from enrolled to waiving coverage Employees who are removed from the group du

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e to a separation in employment Employees who have a dependent(s) disenroll from household coverage

Correspondence of the disenrollment is sent to the employee and to the employer to notify them of the enrollment change. (Please note: Refer to Section 11.2, Employee Change Reporting for specifics.)

7.4 COBRA

Former Employees or Dependents who have elected COBRA coverage will be included on the Employer’s Roster, and premiums for these individuals will be included in the Employer’s invoice. It is the Employer’s responsibility to pay the amount invoiced and collect the appropriate amount from the COBRA covered individual. Information identifying all COBRA covered and eligible individuals should be provided to the Exchange so this information may be passed to the Carrier. The COBRA notification process will need to occur outside of the SHOP and be a direct transaction between employers and COBRA eligible individuals with a COBRA administrator at the employer’s option.

The Department of Labor (DOL) offer helpful COBRA material, such as the frequently asked questions: http://www.dol.gov/ebsa/faqs/faq-consumer-cobra.html

According to the DOL, employers with 20 or more employees are required to offer COBRA to covered employees who terminate from employment or lose coverage based on a qualifying event (these are noted by event in Section 11.2, Employee Change Reporting). Any such qualifying event experienced by a covered employee must be reported to a Washington Health Benefit Exchange Account Worker so the termination of coverage is handled correctly in Healthplanfinder. Employees have up to 60 days to elect COBRA coverage. The employer or a third party COBRA administrator hired by the employer will need to distribute required COBRA notices, facilitate election of COBRA, and notify the Exchange when an election for COBRA coverage is made.

8 Washington Healthplanfinder Business Premiums

Washington Healthplanfinder Business will provide both the premium rates and employee or primary subscriber contribution amounts. This section describes how the premium rates will be calculated. In all instances the employer is ultimately responsible for creating benefit plan documents, collecting primary subscriber contributions, and payment of the total monthly premium.

There are a few special cases where the amount that Washington Healthplanfinder Business calculates for the primary subscriber will need to be adjusted by the Employer. One situation is when an individual is receiving COBRA coverage, and therefore is listed as an Employee on the Employer’s Roster. The Employer is responsible for calculating and collecting the correct amounts owed to them by individuals receiving COBRA coverage for premiums included in the Employer’s invoice. The other situation requiring special attention is when an Employee has a Disabled Adult Dependent. The Adult Dependent will be listed as an Employee on the roster, so the Employer will need to make adjustments to the Employee contribution for this account if the contribution percentage differs between Employees and Dependents. Also, the Employee will be responsible for both the

http://www.dol.gov/ebsa/faqs/faq-consumer-cobra.html


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Adult Dependent “Employee” account and the primary subscriber Employee account. The employee roster entered into Washington Healthplanfinder is used to determine eligibility and enrollment of employees and their dependents in Washington Healthplanfinder Business. The employer is responsible for determining the participation status of each subscriber and dependents before creating the employee roster. If an employee makes any changes during enrollment selection, causing a difference from the participation indicated on the roster, the employer is responsible for any associated costs or savings resulting from total premium changes.

The premium rates quoted apply to the employer group’s entire 12-month coverage period, no matter when a new employee or dependent comes into the groups plan. If a new employee enrolls into an employer’s group plan, the original rate table used for the employer groupdraf t for that plan year will be used to determine the premium rate for the new employee and any dependents.

Each month the premium invoice statement will include a list billing of all active employees and dependents for the group. The premiums listed for each enrolled member are based on the rates effective for each employer’s unique plan and the coverage effective date.

Both the Single Plan option and the Metal Level options use a per member per month model to define the contributions for the employer to pay towards the premium as a percentage of the employees premium rate.

Washington Healthplanfinder Business allows employers to select a contribution percentage towards their employees’ premium contributions and towards dependent premiums as follows:

Employer contribution percentage towards "employee “premiums can be anywhere between 50% and

100%. The same minimum employer contribution percentage of 50% must be applied uniformly to all small employers for contracts sold inside the SHOP and outside in the general market.

Employer contribution percentage towards dependents premiums can be between 0% and 100%.

Any statutorily required participation requirements will apply.

8.1 Employee Roster Factors

Employee and dependent roster factors that affect the small group rating logic consist of the following: Covered employee and dependents dates of birth (used to calculate age) Covered employees and dependents’ tobacco use premium rates for ages 21 and older Group coverage effective date

8.2 Healthplanfinder Business Anonymous Browsing Tool

Healthplanfinder Business provides the user the option to anonymously browse plans offered in healthplanfinder. The user may select any plan that is offered in Healthplanfinder Business, or if a metal level tier is selected, multiple plans. The tool is available in Spanish and English, and is accompanied by a link to a video tutorial on how to use it. https://www.youtube.com/watch?v=XooGdKwmjQA

https://www.youtube.com/watch?v=XooGdKwmjQA


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Anonymous Browsing Tool


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Anonymous Browsing Tool: Show Plans Page

9 Employee Account Creation

9.1 Account Creation

Once an employee has been added to the employer’s roster and emailed the link for coverage, they create an account in the Washington Healthplanfinder system. Employees create their own account and enter household information on the following pages:

Confirm Your Identify Create User Account You and Your Household

9.1.1 Confirm your Identity

Employees start on the Confirm Your Identity page using the employer enrollment-specific link provided to them by their employer, or via an email from Washington Healthplanfinder.


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Employee Confirming Identity

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9.1.2 Create Employee User Account

Upon confirming the employee identity, employees are directed to create a log in and password for their employee account in Washington Healthplanfinder

Employee Creating Log-In Account

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9.1.3 You and Your Household

After successfully creating an account, employees are asked to enter household information that has not already been supplied by their employer. The additional information is required to complete the employee’s (and any dependent’s) enrollment in the plan.

Employees participating in an employer’s Wellness program who use Tobacco should refer to Section 3.3.7.5, Wellness Program for additional account creation instructions.

Employee household considerations: Primary Subscribers are the employees.

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Secondary Subscribers are spouses and/or state-registered domestic partners (if dependent coverage is offered).

Qualifying dependents are allowed to be enrolled in a household (if dependent coverage is offered). o Child dependents ages 0 -20, one rate will be set by carriers for members in this age band.

Please note: The 3+ rule applies to child dependents under 21 years of age. Additional child dependents under age 21 are covered at no additional premium cost to the consumer.

o Qualifying adult dependents (ages 21-25), are rated per member by age and other applicable rating factors.

o Qualifying disabled dependents ages 26+ are rated per member by age and other applicable rating factors. Employees who wish to cover a disabled dependent over age 26 must contact a Washington Health Benefit Exchange Account Worker to enter this individual into Healthplanfinder.

Employees have the option of providing their household income, which would be used to calculate affordability of their employer-sponsored health coverage. If the system determines the plan would not be affordable for the employee based on the income information provided, the employee receives a message indicating this. The employee then has the option of waiving the employer coverage and searching for more affordable coverage in the Washington Healthplanfinder Individual market.


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Employees who indicate they or a dependent are a member of an American Indian/Alaska Native Tribe/Corporation, are required to upload documentation for verification by the Exchange. If an employee is “Verified” as a member of a tribe, and the employer has selected the metal-level option for coverage, then ongoing, they would be allowed to use the change reporting functionality (found through the “Update my plan selection” link on the quick links section) once per month. After use of this link and enrollment in a new QHP, this link would not be shown until the next month.


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Employee You and Your Household

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10 Employee Plan Selection

10.1 Plan Selection

After an employee has entered their household information, they are directed to the Explore Your Options page to view, compare and select a health insurance plan. Employee plan selection consists of the following pages:

Employee Explore Your Options page Compare Plans Employee Final Summary E-sign

10.1.1 Employee Explore Your Options

Qualified Health Plans (QHP’s) are displayed on this page based on the offer chosen by the employer. All the plans shown are certified by the Washington Health Benefit Exchange board.

The employee has the ability to filter and sort the plans using a variety of options in the left hand menu of the Explore Your Options page. From this page, the employee can find out more information about a plan, or they can select a plan and continue the enrollment process.

Plans are displayed for comparison in descending order by premium costs. Premium costs shown are for that employee (and their household if dependents are included).

If the employer selected a single plan option, the employee will only have one plan choice to select. An employee can view more information on a single plan by

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clicking the More Information link to view the added summary of the plan as well as any plan benefit PDF from the carrier.

Employee Plan Selection (One Plan Option)


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Employee Plan Selection (Metal Level)


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10.1.2 Compare Plans

If the employer offered a metal-level option there may be more choices for the employee to select. If the employee wants to compare plans, they can click the Add to Compare button on up to 3 plans and then View the Comparison for a side by side. After comparing the plan benefits on this page, the employee can either go back to explore more options or they can click the Select This Plan button next to their choice and continue the enrollment process.

Employee Plan Comparison


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10.1.3 E-sign

The eSignature page is an electronic signature certifying an employee’s application. After signing and selecting the “Next” button, the employee’s application is submitted.

Employee eSignature Page

10.1.3 Employee Summary & Final Summary

The “Monthly Premium” amount shown in the employee summary is what an employee will pay for coverage under the employer plan. Employees are responsible for paying their employee costs directly to their employer.

For an Employee with a Disabled Adult Dependent (over 26 years old), the adult dependent has to be entered into Washington Healthplanfinder Business as an employee, so they will have a separate “employee” account. The primary subscriber will have to complete the enrollment process for the Adult Dependent “employee” account as well as his own. The Employee will be responsible for the Monthly Premium on the Disabled Adult


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Dependent’s Employee Summary, with adjustments if the employer contribution is different for dependents than it is for employees, as well as the Monthly Premium displayed on his own Employee Summary page.

If the Employee wants to continue with the enrollment, selecting the Complete My Enrollment button will confirm enrollment in the plan. Otherwise, employees may go back to make changes in their plan selection and continue exploring their options.

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Employee Final Confirmation Page

The employee final confirmation page displays a summary of the plan information and final costs (Employee Cost, Employer Cost and the Total Premium).

To again follow the process from end to end, you would need to go back to the Employer section and the Final Plan Confirmation Process.


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11 Employee Account Dashboard

Employees with coverage through Washington Healthplanfinder Business will have access to an employee account dashboard. All adminitration that pertains to an employee account is managed from the account Dashboard.

11.1 Employee Dashboard Tabs

Employees have 3 tabs on the Employee Dashboard:

Account home

Me and My Household

Action Center

11.1.1 Account Home Page

When an employee first logs into their account they see the Account Home page. A Employees can manage their account from this home page.

The employee’s plan information is displayed on the home page. Quick links provide the employee a quick and direct way to access specific actions. The Message Center displays recent correspondence sent regarding the employees account. Any unread messages stand out for the employee by being displayed in bold on the page.

Please note: Employees who have indicated that email is the preferred communication may need to

check their email spam filter to ensure emails from wahealthplanfinder.org are properly received.


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Employee Dashboard – Account Home page

11.1.2 Me and My Household Tab

An employee is able to update General Household information (such as change address, ZIP and/or County), update Personal information (such as add and remove dependents) and View Coverage history (employees and dependents) from this tab.

Account Management


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Me and My Household


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11.1.3 Coverage History

The coverage history link from the employee’s home page directs takes the employee to a page with specific household history indicating the plan, coverage effective date and enrollment status.


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11.1.4 Action Center Tab

This tab is where an employee can upload documentation as well as view the document verification status. Please note: this is not a tab commonly used at this time.

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11.2 C h a n g e Reporting

After the initial plan enrollment, employees can only make changes to their plan selection annually during open enrollment or during a special enrollment period. Depending on other types of changes an employee makes to their household, the system will determine if the change made is a qualifying life event opening a special enrollment period.

The Washington Healthplanfinder will allow special enrollment in an Employer plan based on a change in circumstance outlined below. Removing a dependent or making a change to your employee data could result in a decrease or increase in employee premiums.

If the employee has not made a selection by the end of any special enrollment period, Washington Healthplanfinder will continue the employee’s current plan selection taking into account any applicable changes that triggered the special enrollment.

11.2.1 Qualifying Events

An employee has 60 days to report a qualifying life event (birth/adoption, divorce, marriage, loss of other minimum essential coverage, etc) and may then be determined eligible for a 60 day Special Enrollment period from the date of the qualifying event to select a plan.

Birth, adoption, or placement for adoption are the only mid-month enrollments, with the effective date the date of birth, adoption, or placement for adoption. Loss of other minimum essential coverage will allow enrollment into a QHP 1st of the month following the loss of coverage if reported within 60 days of the life event.

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In the case that an employee elects to change from one QHP to another as a result of a qualifying event, the effective end date of coverage in the current QHP will be the day prior to the qualifying event.

At the end of any special enrollment period, if the employee has not made a selection, the Washington Healthplanfinder continues the employee’s enrollment in the current plan selection, with any applicable changes that triggered special enrollment included in the subsequent enrollment.

Types of changes that affect plan enrollment and potentially affect premiums include:

Adding a dependent to a subscriber’s coverage triggers enrollment. Removing a dependent from a subscriber’s coverage triggers the dependent’s disenrollment. Tribal status.

The coverage effective date for the employees/dependents will follow the rules below, once the employees have made their selection:

o If the employee/dependent is added to the household between the 1st and prior to the 15th of the

month (before invoice for next month's coverage is generated), the coverage period starts on the 1st of the next month.

o Example: July 15th application completion results in August 1st coverage period start date.

o If the employee/dependent is added to the household between the 16th of the month and the end of the month, the coverage period starts on the 1st of the following month.

o Example: July 16th application completion results in September 1st coverage start date. o Example: August 15th application completion results in September 1st coverage start date.


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Change of Circumstance Effective Disenrollment date Effective Enrollment date

Age out (dependent goes from 25 years old to 26 years old)

This is a COBRA qualifying event

11.2.1.1 Note: Qualifying disabled dependents ages 26+ may have continuous coverage. Contact a Washington Health Benefit Exchange Account Worker to enter this individual into Healthplanfinder

Coverage end date is the end of the current month in which the age out occurs.

Note: This event does not trigger a special

enrollment for the employee’s household.

Address Change

Note: This event only triggers a special enrollment for the employee’s household if the employee’s address change results in a

move to a different county.

If an address change reported on 4/16 is a qualifying event, the Special enrollment window is opened until 6/15. Coverage ends in the old plan on 05/31

Coverage is effective in the new plan on 06/01

Divorce

Employee reports a divorce on 04/16 with an event date of 04/02. The employee has a 60 day special enrollment window to select a plan. The employee household is disenrolle ra f t from Plan A on 04/3- and enrolled in Plan b effective 05/01.

The effective enrollment date follows

the 15th of the month cut-off for

employers.

Add a dependent due to birth, adoption, or placement for adoption

Employee reports a birth/adoption or placement of adoption on 04/29 with a date event of 04/16. The employee has a 60 day special enrollment window to select a plan. The employee household is disenrolled from Plan A on the date of the event -1 and enrolled in Plan B on the date of the event.

Note: This event will have a mid-month

enrollments.

Add a dependent due to marriage or loss of other minimum essential coverage.

Employee reports a marriage or loss of minimum essential coverage on 04/29 with an event date of 04/16. The employee has a 60 day special enrollment window to select a plan. The employee household is disenrolled from Plan A on 04/30 and enrolled in Plan B on 05/01


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Change of Circumstance Effective Disenrollment Date Effective Enrollment Date Death of a dependent Employee reports a dependent death on

04/29 with a date of event as 04/01. The employee household has a 60 day special enrollment window. Thdera f t employee household is disenrolled from Plan A on the date of the event and enrolled in Plan B effective the date of the event +1. The date of death is reported to the carriers as the cancellation date. Enrollment is inclusive of the date of death but not beyond that day.

Note: This event is the only mid-month disenrollment.

Tribal member status

Note: Status is verified by account worker,

allows them to change plans on a monthly

basis

Effective coverage end date is the last day of the current month - if the employee change plans.

Effective coverage date in the new plan selected is the 1st of the next month.

Change of Circumstance Effective Disenrollment Date Effective Enrollment Date

Report an employee death

Note: An employer or their designated administrator/broker should contact Healthplanfinder Customer Support Center at 1-855-WAFINDER (1-855-923-4633) to report the death of an employee, and an Account Worker will make the necessary changes in Healthplanfinder.

Account Worker will enter a coverage end date to trigger employee disenrollment. Removal of employee also triggers disenrollment of all household members. . The disenrollment date for the household is the last day of the month of the event date.

Remove an employee

Note: An employer or their designated administrator/broker can remove an employee from the roster

Employer must remove employee from roster to trigger employee disenrollment. Removal of employee also triggers disenrollment of all household members. The disenrollment dates for the household follow the 15th rule.


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Adding an employee

Note: An employer or their designated (administrator/broker/navigator) can add an employee to the roster. (Example: New full time employee is hired)

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Employer adds the employee to the roster on 4/11. The employee has a 60 day enrollment time frame which ends 06/11. The employee coverage effective date is based on the 15th

rule from the date of the plan selection. If the employee selects a plan on 04/15, their coverage is effective 05/01. If the employee selects a plan on 04/16, their coverage is effective 06/01. If the employee selects a plan on 06/10, their coverage is effective on 07/01

11.3 Retroactive Enrollment: Retroactive enrollment functionality allows an account worker the ability to modify an employee’s coverage start

date, end date, or the enrollment status for an entire household back to a desired date.

The change to the employee start date will result in an adjustment on the next invoice that is created for the

employer’s account.

The system will generate an 834 change file and send it to the employer group’s insurance carrier to inform

them of the change in enrollment.

The account Worker will notify the respective field reps and the field reps will reach out to the employer to communicate that change that has been made.

* It is important to note that the employee who’s coverage start date/end date is being changed is in active status,

changing an account that is not in active status may result in a multitude of system errors that will require a data fix.

* if an employee selects a new plan during a special enrollment period, the employee’s coverage start date cannot be

moved back previous to the start date of the new plan.

* The retroactive tool is not available during periods of special enrollment.

* For canceling an account, the account worker must match the employee’s end date with their start date, and then

select “save changes.”

11.4 Retroactive Disenrollment: Retroactive disenrollment functionality allows an account worker the ability to modify an employee’s enrollment

status.

Steps for changing an employee’s enrollment status:

Account Worker logs into an employee’s account via Healthplanfinder

In the “Quick Links” section, the account worker clicks on the link titled “Update Enrollment Dates.”

The current coverage start and end dates for the employee are listed on the dialog box on the “Update Coverage Dates” modal that is generated from clicking the link.


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The account worker can update the Household Enrollment status that is in the “enrollment status”

dropdown.

If the current enrollment status is in “Completed” status, the account worker can change the household

enrollment status to “canceled” and set a date or leave in “completed” and set a date

If the current enrollment status is in “Initiated” status, the account worker can change the household

enrollment status to “canceled” and set a date or leave in “Initiated” and set a date

If the current enrollment status is in “Active” status, the account worker can change the household

enrollment status to “Disenrollment Initiated” and set a date or leave in “Active” and set a date

The account worker will click on the “Save Changes” button on the modal, which will close the modal.

Once the “Save Changes” button has been pressed, the requested changes based on the information

populated in the tool will immediately be reflected in the employee’s dashboard.

The change to the employee start date will result in an adjustment on the next invoice that is created for the employer’s account.

The system will generate an 834 change file and send it to the employer group’s insurance carrier to inform them of the change in enrollment.

The account Worker will notify the respective field reps and the field reps will reach out to the employer to communicate that change that has been made.

11.5 Employee renewals

Employee renewal options will depend on the option selected by the employer. The renewal page appears after the employee has selected the “Complete Renewal Application” quick link on the employee dashboard.

Options include:

o Keeping their current coverage options through their employer o Picking a new plan o Cancelling their current coverage through the employer


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Employee Renewal Page

12 Brokers

Brokers are authorized to help employers on an ongoing basis in Washington Healthplanfinder. They are able to partner with employers once the employer has created their employer account. The broker can then help the employer create and update employee rosters, select plans, pay premiums and assist the employer with any or all employer plan functionality.

An employer can select either a broker or a navigator but not both:

Brokers are licensed in the state of Washington. Brokers assisting employers in Washington Healthplanfinder may work with all insurance providers.

12.1 Broker Account Set-up

Broker accounts are set up by the Washington Health Benefit Exchange Account Worker. Once a broker has been trained and registered to utilize the Washington Healthplanfinder. All Washington Healthplanfinder brokers can help Individuals and/or Employers.

Brokers registered by the Exchange are required to show “all” QHPs not just those they are appointed with, per the ACA per regulations.

12.2 Selecting a Broker

If an employer already has an account set up in Washington Healthplanfinder and want to connect with a broker:


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From Quick links click “Find a Broker” Or from the Company Info tab click “Add a Broker”. By indicating they want to “Add a Broker”, the employer will then select a broker via the “Broker

Search Results” page. Employers can search based on a Broker name, a Broker organization, or by their ZIP code and by language.

When an employer searches for a broker using the search functionality; results are randomized if language and/or Zip code is used . Only those registered brokers will display when an employer searches for a broker.

The search page includes the ability to search by Broker name, Organization name, ZIP code, or by language as indicated in the page print below.

The results returned include all these searchable values. If the employer searches by Broker name and there is more than one Broker with that name, the results will show both brokers. The employer selects the Broker they want to work with.

If no results are returned for the broker search criteria entered, the screen will read “No results found for the search criteria”.

The results shown will include all brokers meeting the search criteria entered who have an account created in Washington Healthplanfinder. Employers will click the “Request Help” button to choose a new broker to partner with. Only one broker can be connected to an employer at a time. Onceselected, employers confirm the selection and the system

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Once a broker is selected, you will be asked to confirm the broker selection to add them as the agent for your account. When you select a broker, they are notified of the request through their Broker dashboard on the Washington Healthplanfinder.

The employer can wait for the broker to contact them or they can reach out to them manually to proceed.

12.3 Employer without an Account

If employer does not have an account set up in Healthplanfinder and they want to connect with a broker: From Washington Healthplanfinder Home page, the employercan click “Customer Support” drop down

and then “Find a Broker” to search for registered Washington Healthplanfinder Brokers. The Employer will need to write down the contact information to connect with the broker external

from Washington Healthplanfinder.


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12.4 Broker Search Results

Only registered Washington Healthplanfinder brokers will appear in broker search results.


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Select a broker

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Once a broker is selected, they are assigned to the employers account. The broker will have to accept the partnership request to assist the employer.

12.5 Broker Dashboard -Account Home Page

When the broker signs into their dashboard the dashboard will display any pending help requests with that individual or employers contact information..

There are 2 tabs available from the Broker Dashboard. The Help Requests section of the page lists employers who have requested help from them.

Account Home My Clients tab

Quick link items located in the right-hand menu assist the broker in managing their clients in Washington Healthplanfinder. The Find a Client link allows the broker to search for and add new clientsto their account.


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Broker Account Home Tab


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12.6 Broker Dashboard- My Clients tab

The My Clients tab lists the client contact information and status of the client’s application in the Exchange.


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12.7 Broker Partnership Confirmation and eSignature

To finalize the client relationship in Washington Healthplanfinder, the broker confirms the relationship and indicates if they want to receive copies of notifications sent to the employer. Once the relationship is confirmed, the broker completes the eSignature making them the broker of record for that employer.

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12.8 Broker Compensation

Broker commission calculations and payments are processed directly to the broker or the agency they work for from the carrier. The broker information collected by the Washington Healthplanfinder will be passed on to the carriers from their client’s enrollment files. The broker information is passed on to the carrier whether or not the broker is appointed with the carrier for the QHP sold since brokers are required to show all plans not just those plans of carriers by whom they are the appointed.

14 C o n s u m e r Help

Throughout the Washington Healthplanfinder employers and employees will find field level help available,

providing additional information for the consumer when they click the “ ” icon located next to a field.

Users are also able to look up and solicit assistance on Healthplanfinder via the following:

Frequently Asked Question link is a link embedded in the header of every page in the site. Upon clicking this link, a “fly-out” pop-up window will be displayed with the following elements.

o Frequently Asked Question search option o Glossary of terms link o Display of the 1-800 call center number

The call center will be able to assist consumers with basic questions and information. For advanced questions or help with transactions, the call center will escalate to an appropriate Health Benefit Exchange Account worker.

15 Correspondence

Below is a list of correspondence that the Exchange will be responsible for sending to employers and employees:

Employer Questionnaire: During Open Enrollment, the Employer receives the Employer Questionnaire

to get the following information from an Employer: TEFRA/MSP information as required by carrier; list of COBRA individuals; data required for employees living outside the employer’s county to facilitate update of employee addresses after system rating correction is implemented.

Confirmation of Coverage Notice to Employees: Employees receive this notice once their employer

completes the application and makes a payment to let them know when their coverage will start.

Age-Out 60-day Disenrollment Notice: Employees are sent the Age-Out 60-day Disenrollment Notice to inform them that their Dependent will be disenrolled due to age-out (turning 26). This is sent approximately 60 days before disenrollment will occur.

Open Enrollment notice (SHOP001): During open enrollment employees will receive an open

enrollment notice, which states the beginning and end date for open enrollment and prompts the employees to select a plan and enroll in the employer sponsored coverage.

Employer Renewal notice (SHOP002): 90 days before the end of the annual coverage period, the

employer receives a Renewal notification. Employers are asked to re-attest to the eligibility criteria and renew their plan option for the following calendar year.

Employer Notification (SHOP004): This is the Email that is sent out for all correspondences, it is the


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delivery system informing employers to check their HPF account and read the accompanying correspondence.

Employee Disenrollment To Employer (SHOP005): This correspondence is sent to the employer to

inform them that the following employees have been disenrolled from their employer-sponsored health coverage.

Update to Employer/Employee Account Information (SHOP006,SHOP007, SHOP010): Notifies employer/employee to account information that has been updated and saved during the day regardless of the end result of the change

Open Enrollment Reminder notice (SHOP008): During open enrollment a reminder is sent 15 days

prior to the end of the open enrollment period if the open enrollment period is active.

Employee Disenrollment to Employee (SHOP009): correspondence to notify employees that one or more people from their household has been disenrrolled in ESI (Employer Sponsored Insurance) coverage.

Enrollment Complete notice (SHOP003, SHOP011, SHOP012): The employer receives this notice

once the small group open enrollment participation has met the employer small group threshold. (Threshold is when employee participation is 100% OR once the Open Enrollment period has ended and there is a minimum participation of 75% for groups of 4 or more or 100% for groups of 3 or fewer.)

Dependent Aging Out of Household (SHOP013): Correspondence sent to employees 2 month prior to

the 1st day of their dependents birthday month.

Employee Health Care Coverage Change to Employee/Employer (SHOP014, SHOP015):

Correspondence sent to employer/employee when account workers change employee(s) or dependent(s)

coverage start or end date.

Health Benefit Termination notice: In a disenrollment scenario, the Exchange will send the employee a Health Benefit Termination notice which states the day that the employee’s coverage will end. Employers also get a notice to let them know of the disenrollment.

Monthly Employer Invoice (FM002): The Exchange will invoice employers in SHOP on the 15th of the

month prior to the month of coverage (electronic correspondence only). The payment is due no later than the last day of the month. Monthly invoice generated for employers will show a breakdown of all charges by employee including Total Premium and Premium for each employee. The breakdown for each employee includes Employer Contribution, Employee Contribution, Employee Contribution to Dependents and Total Amount Due.

Receipt of Payment notice: The Exchange will generate a receipt of payment when Employers make a

premium payment through the Exchange.

Premium Payment Delinquency Notice (FM004): The Exchange will send a delinquency notice to the

employer the day after the payment cut off (the last day of the month in which a payment for that month

was not received) indicating the grace period has started. If payment is not received by 11:59 p.m. on the

10th of the month of coverage, the employers group will be disenrolled from coverage and claims will be

rejected by the insurer. Carriers would receive the termination in the Daily 834 Update file on the 11th of

the month.


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Broker or Navigator Partnership Update (ADM008): Email/mail notice to the client whose ongoing

or pending partnerships were terminated by an HBE account worker. This would enable clients to select

a new broker/navigator

16 Glossary

“Actuarial value” – The percentage paid by a health plan of the total allowed costs of benefits. “Affordable Care Act” – The comprehensive health care reform law enacted in March 2010. The law was enacted in two parts: The Patient Protection and Affordable Care Act was signed into law on March 23, 2010 and was amended by the Health Care and Education Reconciliation Act on March 30, 2010. The name Affordable Care Act (ACA) is used to refer to the final, amended version of the law. “Broker, or Producer”– A broker or producer is an independent agent who represents the buyer, rather than the insurance company, and tries to find the buyer (individual, family or small business) the best policy by comparison shopping. “Carrier or Insurance Carrier” - An insurer, or insurance carrier, is a company selling the insurance; the insured, or policyholder, is the person or entity buying the insurance policy. “Dashboard” – Dashboards are easy to read web pages presenting simple data sets/information to the end user. “Decertify” – A decertified QHP will no longer be offered on Healthplanfinder and the QHP issuer must terminate coverage of the enrollees after providing notice and after special enrollment has been offered to the plan’s enrollees (45 CFR §156.290). “Enroll” – The point at which an individual is covered for benefits under a QHP, without regard to when the individual may have completed or filed any forms that are required to become covered by the health plan. “Enrollee” – Qualified individual or qualified employee enrolled in a QHP. “Expire” – When a QHP issuer does not elect to seek recertification of a QHP offered through Healthplanfinder. This act by the QHP issuer will constitute “non-renewal of recertification” (45 CFR §156.290). “FEIN” – FEIN or Federal Employer Identification Number is also known as Federal Tax Identification Number. This 9 digit code is used by businesses in order to classify and identify them as a tax payer, for banking services and other official and legal purposes. “Health Benefit Exchange Board” – The governing boardraf t d of the health benefit exchange as established in Chapter 43.71 RCW. “Health insurance issuer or issuer” – A disability insurer, health care service contractor, or health maintenance organization as defined in RCW 48.43.005, and a health insurance carrier as defined in the ACA. “Health Plan” – Health plan means any policy, contract, or agreement as defined in RCW 48.43.005 and offered by an issuer and used in accordance with section 1301(b) (1) of the ACA. A health plan is the specific health benefit plan purchased by a subscriber, employer, or employee. Each health plan has a defined set of covered benefits and cost-sharing, and multiple health plans can be associated with a single product. “Healthplanfinder” – The marketplace in Washington State where qualified individuals and small employers can shop for and purchase Qualified Health Plans. “Initial open enrollment period” – The initial open enrollment period offered to applicants from October 1,

2013 through March 31, 2014 to enroll in Individual QHPs through Healthplanfinder for coverage in the 2014 plan year. “Metal Level” – Metal levels refer to the four coverage levels (Bronze, Silver, Gold and Platinum), Health Benefit Exchanges are required to offer to be in compliance with the federal health insurance mandate. Coverage tiers are the differences between these plan levels. In other words, how much a plan will cover before the patient must chip in for co-insurance, deductibles and co-payments. “Navigator” – An organization that has been awarded a grant by the Exchange to carry out activities and meet the standards described in 45 CFR §155.210. Navigator representatives are qualified, trained, and certified to engage in education, outreach and facilitation of selection of a QHP by a consumer for Healthplanfinder. “Plan year” – The consecutive 12-month period during which a health plan provides coverage for health

benefits. For individuals, it is the calendar year, and for SHOP it is the 12-month period beginning with the qualified employer’s effective date of coverage.


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“Producer” – A person licensed by the OIC as an agent or solicitor to sell or service insurance policies.

“Product ” –A suite of Health Plans that share common benefits, formulary, provider network, and additional features. Cost sharing and rates vary at the Plan level. “Qualified Health Plan or QHP” – A health insurance plan that is certified by an Exchange, provides essential health benefits, follows established limits on cost-sharing (like deductibles, copayments, and out-of-pocket maximum amounts), and meets other requirements. A Qualified Health Plan (QHP) will have a certification by each Exchange in which it is sold. “Qualifying Life Event” – A life event that someone experiences such as birth/adoption, death, marriage, loss of minimum essential coverage, divorce, etc. A Qualifying Life Event may enable an individual/family to enroll in a new Qualified Health Plan. “Qualified Health Plan Issuer or QHP Issuer” –A health insurance issuer that provides coverage through a qualified health plan offered through Healthplanfinder. “SHOP” – The Small Business Health Options Program operated by an Exchange through which a qualified employer can provide its employees and their dependents with access to one or more QHPs. “Special enrollment” – A period during which a qualified individual or enrollee who experiences certain qualifying events may enroll in, or change enrollment in, a QHP through the Exchange outside of the initial or annual open enrollment periods. “Washington Health Benefit Exchange” – As part of the national health reform, states are required to have an “exchange” where individuals, families and small businesses are able to buy health insurance in an easily accessible, central marketplace. The Washington Health Benefit Exchange is the name of the organization bringing the Exchange to Washington State. “Washington Healthplanfinder” – Washington Healthplanfinder is the name of the Washington State exchange system where individuals and small employers can shop for health care coverage. “Washington Healthplanfinder Business” – Washington Healthplanfinder Business is the name of the Washington State exchange system for small employers to shop for health care coverage. (Formerly referenced as SHOP).

washington healthplanfinder business manual€¦ · v7 updated to reflect changes for 2015...

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