WebEx Training

Wednesday, January 29th 2014

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Agenda

Open Enrollment for Employee Sponsored Insurance

Certification Number for Assisters

Eligibility during Special Enrollment

Income Question for Retroactive Medicaid

Divorced/Widow Workaround

Anonymous Browsing

Worker Portal vs. Consumer Portal

Applying on the Worker Portal

Medicaid Eligibility vs. APTC

Certified Application Counselor’s access to Navigator and In Person Assistor Website

Income Year Display Error

How do assisters enter their certification number after the consumer

application is complete?

• After eligibility is determined, during the enrollment process, the consumer is

asked “Is anyone helping you with this application?” If the consumer chooses

“No” then the application will proceed and there will be no option to input any

assister information. If the consumer chooses “Yes”, the screen gives an option

for the consumer to enter the certification/license number of the assister. (If this

were a broker, he or she would enter the CT license number.)

• Assisters are also being asked to self report any application they helped

complete, or, handed off to another entity. This will be manually tracked through

their NIPA unit.

Scenario

Certification Number for Assisters

Topic

Step 2:“Yes” will allow the assister to enter the assister certification number

Certification Number for Assisters

Step 1: Click Yes for is anyone helping you with application?

Topic

Steps

4

What does eligibility in a special enrollment period mean?

• A special enrollment period is a time outside of the open enrollment period. A

new application or a person seeking to make a coverage or carrier change

outside of the open enrollment period can only make such change when there is

a qualifying life event as defined by Access Health.

• The first year, 2014, is a unique year, where open enrollment has been extended

to 3/31/14. During this period, special enrollment events are still applicable to

determine effective dates however are not needed to change plans or carriers or

add new household members eligible to be on the same plan.

Scenario

Eligibility during Special Enrollment

Topic

The Special Enrollment events are as follows:

The Exchange must allow qualified individuals and enrollees to enroll in or change from one QHP to another as a result of the following triggering events: (60 day eligibility period)1) A qualified individual or dependent loses minimum essential coverage;2) A qualified individual gains a dependent or becomes a dependent through marriage,

birth, adoption or placement for adoption;3) An individual, who was not previously a citizen, national, or lawfully present

individual gains such status;4) A qualified individual's enrollment or non-enrollment in a QHP is unintentional,

inadvertent, or erroneous and is the result of the error, misrepresentation, or inaction of an officer, employee, or agent of the Exchange or HHS, or its instrumentalities as evaluated and determined by the Exchange. In such cases, the Exchange may take such action as may be necessary to correct or eliminate the effects of such error, misrepresentation, or inaction;

Eligibility during Special Enrollment cont’d

Scenario

Scenario

Topic

The Special Enrollment events are as follows:(cont’d) (60 day eligibility period)

5) An enrollee adequately demonstrates to the Exchange that the QHP in which he or she is enrolled substantially violated a material provision of its contract in relation to the enrollee;

6) An individual is determined newly eligible or newly ineligible for advance payments of the premium tax credit or has a change in eligibility for cost-sharing reductions, regardless of whether such individual is already enrolled in a QHP. The Exchange must permit individuals whose existing coverage through an eligible employer-sponsored plan will no longer be affordable or provide minimum value for his or her employer's upcoming plan year to access this special enrollment period prior to the end of his or her coverage through such eligible employer-sponsored plan;

7) A qualified individual or enrollee gains access to new QHPs as a result of a permanent move;

8) An Indian, as defined by section 4 of the Indian Health Care Improvement Act, may enroll in a QHP or change from one QHP to another one time per month; and

9) A qualified individual or enrollee demonstrates to the Exchange, in accordance with guidelines issued by HHS, that the individual meets other exceptional circumstances as the Exchange may provide.

Eligibility during Special Enrollment cont’d

Scenario

Scenario

Topic

All Special Enrollment events follow the 15 day Rule except for the following:

• A household member has been born, adopted, or placed for adoption in the last

60 days: Retroactive to the date of the birth or adoption.

• A household member had a loss of Minimal Essential Coverage in the last 60

days or is going to lose Minimal Essential Coverage in the next 60 days:

Effective date starting the 1st of the month following the date of event.*

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

1st of the month following the date of event.*

Note: Events must be reported within 60 days of the trigger date otherwise these events follow the 15 day rule

Eligibility during Special Enrollment cont’d

Scenario

Scenario

Topic

Birth of a household member and loss of Minimal Essential Coverage

• A consumer reports a loss of Minimal Essential Coverage on 04/30 and

enrolls in a plan the same day. The father also includes his son who was

born on 03/18. When will their new effective coverage begin?

Scenario

Eligibility during Special Enrollment cont’d

Topic

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

Step 2: • Consumer chooses QHP with APTC for one household member

and a QHP for another household member

Eligibility during Special Enrollment cont’dTopic

Steps

10

Step 3: • Consumer receives the following coverage effective dates. Note that the baby’s coverage effective date is retroactive to the date of

the birth. Since the father lost Minimal Essential Coverage on 4/30 his new coverage effective date is 5/1.

Eligibility during Special Enrollment cont’dTopic

Steps

11

When applying for retroactive Medicaid the system asks “Was your income

in the last 3 months equal to this month’s income?.”

• If the consumer selects “no,” the system will ask for more information

regarding the variable income over the last 3 months.

• If the consumer selects “yes,” the system will use the current month’s income

and apply the same amount for the previous 3 months.

Scenario

Income Question for Retroactive Medicaid

Topic

Step 2: If “Yes is selected the system will use the current months income and apply the same amount for the previous 3 months .

Income Question for Retroactive Medicaid cont’d

Step 1: When applying for retroactive Medicaid the system asks “Was your income in each of the last 3 months equal to this month’s income?.”

Topic

Steps

13

In the current divorce/widow workaround, at what point in the process will the

divorced/widowed spouse be removed when the individual is added with an

income of $0?

• The divorced/widowed workaround will not be necessary after the 2/2 release.

We will highlight this change when the 2/2 update is reviewed next week.

• If the workaround is needed prior to the fix, the link below will demonstrate the

steps required.

Scenario

Divorced/Widow Workaround

Topic

Divorced/Widow Workaround

Please help me to understand the purpose of Anonymous Browsing.

• Anonymous Browsing is valuable when a consumer is not sure what plan they

would qualify for or not sure if they might be eligible for any financial assistance

with affording health insurance premiums (APTC). The consumer can receive a

quick determination without completing an entire application.

• It is also a good way to check the plan benefits so that the consumer can start

comparing options or to remind them of the benefits of the plan they have already

chosen.

Scenario

Anonymous Browsing

Topic

What is the difference between the AHCT Worker Portal and the Consumer

Portal?

• The Consumer Portal is the Access Health Website consumers use to determine

eligibility for the applicant and for the consumer to complete an application.

• The Worker Portal is an administrative tool used to override or reset information

entered by individuals while trying to complete an application. Only authorized

users (such as call center representatives) are given access to this system.

Scenario

Worker Portal vs. Consumer Portal

Topic

What happens if the consumer applies via the Worker Portal (e.g. Call Center

or DSS) for Husky D and does not create an account on the Consumer Portal?

• If a consumer applies on the Worker Portal but does not create an account on the Consumer Portal they will receive notices regarding their application in the mail or via email.

• If the consumer wishes to view their enrollment details they can create a User ID and then call the Call Center to link their existing application to their User ID.

Scenario

Applying on the Worker Portal

Topic

A consumer applied on the exchange and the system found that he was eligible for HUSKY. If the consumer does not want to enroll in Medicaid, can the individual be eligible for a tax credit?

• The application will only determine if a consumer is eligible for a tax credit if the individual has failed Medicaid eligibility.

• If the individual is Medicaid eligible and does not want to enroll in Medicaid, then the consumer can purchase an unsubsidized Qualified Health Plan. (The option to select a QHP always is presented on the eligibility screen even if the applicant is eligible for Medicaid.)

Scenario

Medicaid Eligibility vs. APTC

Topic

Can Certified Application Counselor’s (CAC’s) access the Navigator and In

Person Assisters (NIPA) website?

Yes, there is valuable information on the NIPA website that applies to both NIPA’s

and CAC’s. The link to the website is below. There is no ID or Password required.

http://www.ahctcommunity.org/

Scenario

Certified Application Counselor’s access to Navigator and In Person Assistor Website

Topic

In several applications the income confirmation screen has displayed the years 2014 and

2015, when the income entered was for 2013 and 2014.

A field level display issue has been encountered on the Annual Income page:

• This page asked the consumer for their 2013 and 2014 income information.

After the consumer saves the information, the years on the screen changes to

2014 and 2015 income information.

• This is a known issue that is being resolved and does not affect the eligibility

determination. Disregard this labeling change and avoid calling the Call Center.

This fix will occur in the February 2nd Release.

Scenario

Income Year Display Error

Topic

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