During this section we will discuss: Washington Healthplanfinder Homepage Individual and Family Application Flow Household

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4 During this section we will discuss: Washington Healthplanfinder Homepage Individual and Family Application Flow Household Composition and Tax Filing Status Premium Payments and Grace Periods Reporting Changes Changes during Open Enrollment Special Enrollment Period Qualifying Events Aging into Medicare Enrollment Cut Off Dates COBRA 4

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9 *This screen highlights ALL sections required to enroll and apply for Free and Low Cost Health Insurance* Please keep in mind that you can apply for a full premium plan (QHP) by answering No to the question Do you want to apply for Health Insurance Premium Tax Credit, Cost-Sharing Reductions or Washington Apple Health? on the About You screen. This will take you through an abbreviated application and enrollment process. 9

10 For Free and Low-Cost Health Insurance programs: Eligibility Services is called to determine eligibility and the Oracle Policy Automation (OPA) Rules Engine is called to determine eligibility. Let s talk more about what the OPA Rules Engine means. When individuals apply for Free and Low-Cost Health Insurance programs, their Federal Hub and residency data is sent to the State s Eligibility Services (ES) systems and based on a predefined rule set, ES will send a response back to Washington Healthplanfinder with the eligibility results. The Oracle Policy Automation (OPA) Rules Engine is essentially the ES for Qualified Health Plan (QHP) programs. It is a rule set that is already built into Washington Healthplanfinder. When the applicant completes their application review, the OPA Rules Engine will run in the background and will take the Federal Hub and residency data stored to determine eligibility based on a pre-determined rule set. The eligibility results will then be displayed to the applicant after the applicant esigns and submits the application. 10

11 If an individual has already created an account they can click Sign In New customers click Shop for a Health Plan start the process Brokers/Navigators can click Start a New Application for new customers via their Washington Healthplanfinder dashboard The first step in assisting an individual is creating an account. If an individual is applying for HIPTC or QHP they must create an account. You do not have to create an account if the individual is only applying and qualifying for Washington Apply Health Apple Health. 11

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13 On this screen you will assist (or pre-instruct) your HIPTC/QHP Eligible client to Create My Account They will need to have an address to create their Washington Healthplanfinder account You will need to assist (or pre-instruct) customers to create a username and password, answer security questions, and accept the user agreement (The primary applicant will read and accept the User Acceptance Agreement before clicking Create Account. ). Once you have completed the requested information on this screen you can click the Create Account button on the bottom of the page to continue. Customers should only Skip Account Creation if they are only eligible for Washington Apple Health (Medicaid) 13

14 Once a customers account is created they will be taken to the About You page. This page will be the accounts Primary Applicant this should be the primary tax filer. On the About You page the primary application will provide information only about themselves, such as name, date of birth, and social security number. Customers will identify who the individual is applying for: Myself Myself and Others or Other Household Members This will be where the customer indicates if they are applying for Free and Low-Cost Health Insurance programs. For Qualified Health Plan (QHP) Programs, the Applicant would select No. For Free and Low Cost Health Insurance programs, the Applicant would select Yes. In addition to indicating which programs the primary applicant is applying for, this screen also allows the customer to complete race and ethnicity items as well as read and attest to the Washington Healthplanfinder Privacy Policy. Once all information is completed on the About You page click the Next button at the bottom of the screen to continue through the application process. Additional Talking Points: After the primary applicant completes the About You screen, the social security number provided will 14

15 be sent to the Federal Hub for verification. The Federal Hub will then send a response back to Washington Healthplanfinder as either SSN Verified or SSN Not Verified." This information is stored in the Washington Healthplanfinder system and is not visible to consumers. The information will be later used when determining eligibility for coverage. The customer is also assigned a person ID in the Washington Healthplanfinder system once this page is complete 14

16 On this page the customer will complete their home and mailing address (if separate), as well as their phone number, language preference, and correspondence preference. **If the individual wants to receive notices via US Mail- They MUST not select I would prefer to receive written communication by on this page On this page the customer can also add an Authorized Representative. An Authorized representative will be someone the customer gives permission to call the Washington Healthplanfinder or Health Care Authority to make decisions and discuss the account on their behalf. Adding a broker/navigator as the authorized representative does not mean the same as partnering with a customer this is done from the customers dashboard by clicking Add a Broker or from the broker adding a client from the broker dashboard *Note at any time during the Individual application process if you run into a screen where you need more information you can click the Save and Exit button at the bottom of the screen to save what you have done this far and back out of the individuals account. If you click the Back button it will take you to the previous page but will not save any information entered on this screen. If you need to go back click Next or Save and Exit. *By Clicking Save and Exit you will be signed out of the Washington Healthplanfinder and that customers application. 15

17 Once a customer inputs their about you and address they will have to confirm their identity. Have the customer answer the questions correctly as done when setting up the account. Some examples of the questions asked are: -Please select the number of bedrooms in your home or -Please select your astrological sign This is an added measure of security and identity proofing for the primary applicant 16

18 Once the customer confirms identity they will be taken to the additional household members screen where they will then click Add Individual button to add any other members of their household Once they click Add Individual a modal will pop open to allow them to enter that household members name, SSN, DOB, gender, tribal status (if applicable), the relationship between the primary applicant and if they are living in the household. Click the Save button when you have added the additional member or Save & Add Another if you need to add more than one members 17

19 When an individual answers Yes to "Are you an American Indian or Alaskan Native?," provides his/her Tribal name, and is deemed eligible for Washington Apple Health (Medicaid), he/she will not be required to submit verification documentation. American Indian/Alaska native individuals are required to submit verification documentation if he/she is eligible for Qualified Health Plans and wishes to obtain Tribal Benefits specific to QHPs individuals can work directly with Tribal Navigators who are able to manually verify tribal status without pending for documentation 18

20 When a AI/AN customer reaches the Documentation Required screen, they will be directed to upload Tribal documentation. The Primary Applicant will be required to submit Tribal documentation for every individual who has been noted as AI/AN on the QHP application. Acceptable documentation to verify Tribal status is documentation that demonstrates the individual is a member of a Tribe Tribal Membership or Enrollment Card Official letter (that specifies membership or enrollment) Certificate of Indian Blood (that specifies membership or enrollment) that includes Enrollment Number Tribal membership is verified and approved by a Washington Healthplanfinder worker individuals can work directly with tribal assisters who can manually verify tribal identity. 19

21 Next, customers will answer a series of additional questions to indicate: Citizenship Status Incarceration Status Tobacco Use Washington Residency Information provided here will be validated against the SSN provided earlier. Based on the responses captured here and the SSN validation, eligibility results can be determined. *Citizenship, incarceration, and residency responses are used to determine eligibility. *Tobacco use is not used to determine eligibility to participate on Washington Healthplanfinder. However, this information is used to determine what specific plans the individual will qualify for. *For example if you click on a question that may disqualify someone from coverage or need to indicate a specific household member you will see additional boxes to check. In the example we have selected Yes that someone is incarcerated. This will open up any adult household members that this question may apply to and you will need to check the box for each household member it applies to. Click the Next button to continue the application process. 20

22 Household Income Page Summary The Household Income screen asks a series of questions about household income and deductions. Each main question on this page is presented in a Yes/No answer format. Depending on how the customer answers the questions, additional follow up questions may appear. When answered yes the customer will need to indicate who that income and/or deductions apply to **Full detailed Operations Manual for how to fill out this screen is available on the Support Network page for brokers/navigators 21

23 Once a customer has completed the Additional Questions and Income pages they will have the opportunity to review your application information entered. If there is any discrepancy in information entered you will see it highlighted in red. Information highlighted in red may also indicate that the customer will get conditional eligibility results and be required to upload additional documentation for review. If customers need to change anything you can click the Edit button under the section that needs correcting. Washington Healthplanfinder also does an automatic data check on the following screens for any discrepancy *before* the customer esigns their application: Reported income, Date of entry (into the US), Lawful presence, One person must be seeking coverage, Reported relationships, and Tax filing status The purpose of this data check is to comb the application for any possible discrepancies and gives the customer the opportunity to correct before submitting their application for Eligibility 22

24 Once the customer has reviewed this page they will scroll to the bottom and click Next 22

25 The customer will be required to electronically sign their application to submit for an eligibility determination, brokers/navigators can esign on behalf of the customer. Once signed according to how they have listed themselves on the application the customer will click Next to display eligibility results. 23

26 Once a customer esigns their application they will be given their applications Eligibility results. Eligibility results are listed by applicant (see left of the screen) by clicking on another member of the household you will see that members application eligibility results. Most of the information on this screen is clickable for more information. Once reviewed a customer can click Next and the bottom of the page to move forward to plan selection 24

27 In this example our customers family is a mixed household eligible for WAH and Qualified Health Plan with tax credits. Customers with family members eligible for WAH and eligible to select their Medicaid Plan will be routed to the Select Washington Apple Health Plan prior to being able to select their Qualified Health Plan. This screen will allow a customer to search for a Medicaid plan by: health care provider or clinic/hospital Customers can click More Information on this plan to view more information As a whole all Medicaid plans cover the same services the difference in Medicaid plans will be which doctors/clinics/hospitals you are able to see. If a customer does not want to select a Medicaid plan they can click Skip Plan Selection at the bottom of this screen to move forward to Qualified Health Plan shopping. 25

28 From the Select a Qualified Health Plan Page the customer can shop for available QHP s. A customer (if eligible) is able to see the applicable tax credit amount for each plan under the Premium section. A customer can search by: health care provider, premium cost, deductible, out of pocket maximum, etc. A customer can also add up to three qualified health plans to comparison for a side by side full review of the plan. Once a customer has decided on a plan they will click the green Select button for that plan. 26

29 Once a customer adds up to 3 plans for comparison on the Select Qualified Health Plan Page they can click View Comparison to be taken to this page. If you scroll down you can see all comparison information. You can also click on See More Details to display more plan information and links to plan brochures. If the customer wants one of these plans they can click the green Buy button or click the green Back to Plan Results button 27

30 Once a customer chooses their plan (if eligible) they will be taken to the Heath Insurance Tax Credit Options Page where they will use the slider to indicate how much of their tax credit will be applied to their plan. 28

31 Once tax credit amount is indicated the customer will view the Review All Selections screen This screen displays all eligibility results and plan selections along with monthly cost if applicable. Customers will click the green Next button to continue with their enrollment 29

32 Before the customer is committed to their plan they will see the Confirm Insurance Company Selection(s) screen. From this screen they will see the coverage start and end date, premium cost with tax credit amount being applied If a customer has a mixed household they will see the Where's My Washington Apple Health question By clicking the blue Confirm and Send this customer has committed to this plan enrollment if a customer does not click the blue Confirm and Send they have not completed their QHP enrollment. 30

33 After the customer has clicked confirm and send, they will reach the Successful Confirmation Modal. It tells the customer that plan selection is confirmed and on its way! On this modal you will see: A Confirmation Number an ID number as an important identifier for carrier and HPF reference If you click on the question mark at the top right corner of the number, a rectangular bubble opens up to tell customers to use it when contacting the carrier. The Next Steps sections: WAIT: Customers must wait for carrier to contact them via or mail before they can make a payment. The green box indicates that the customer is in the WAIT step. NOTE: In this phase, the carrier may request additional information and/or documentation of the customer during a Special Enrollment Period. PAY COMPANY: Once carrier contacts the customer with instructions on payment, then the customer will pay the carrier directly via the carrier s system. HAVE INSURANCE: Once the payment has been processed, the customer has insurance! Note: The carrier will communicate to HPF that the customer has paid, and HPF will update the customer s enrollment status appropriately. Printing is highly encouraged for customers to keep another copy of their plan confirmation. The PRINT button is at the very top of the page. If the customer does not print, a correspondence will be sent to the customer s message center. Upon clicking Next, the customer will be navigated to their Account Dashboard, on the Payments tab. 31

34 When a customer logs in, they will see their dashboard. The Message Center will be where they will receive correspondence regarding their plan confirmation. There will be red messaging to the customer until they pay their insurance company and the carrier passes the enrollment active file to Washington Healthplanfinder When you hover your mouse over Enrolled it says initiated. This text will also update to active once the insurance company has passed an active file to Washington Healthplanfinder 32

35 Under the customers payments tab they will see: Information for how to make payments directly to the insurance company. If the customer clicks on the FAQ link, they will be navigated to a WAHBExchange.org page about how to pay each different carrier. If the customer clicks on the insurance company logo they will be navigated to the insurance companies website NOTE: If customer tries to call the carrier right after they complete their selection on HPF, the carrier won t have the information on the customer yet. HPF and the carrier systems interface overnight. Please allow up to several business days for the carrier to process. On the right hand side of the Payments tab, we see the confirmation number again with instructions to use the confirmation number when communicating with carriers. Under the confirmation number, there is a notice with messaging to remind customers that all premiums are paid directly to the insurance company. Archived Payment History: In the above example the individual is a new customer to Washington Healthplanfinder, so she does not have any payment history. However, if she did have previous payments made to Washington Healthplanfinder they would be listed here. This section does not list any payments made to the carrier from September 24, 2015 onward. NOTE the archived history will display for customers with a Washington Healthplanfinder payment history up or prior to 9/23/

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37 All voluntary termination/disenrollment and expirations are reported through Washington Healthplanfinder. Termination due to non-payment only occurs when the carrier passes a non-payment termination file to Washington Healthplanfinder. Once a customer has selected and confirmed a plan, Washington Healthplanfinder will direct them to pay the carrier The customer may choose not to pay the carrier. If the carrier does not receive the binding payment, the carrier will send a message to Washington Healthplanfinder to cancel the plan. NOTE: The coverage will terminate due to non payment ONLY when carrier communicates to Washington Healthplanfinder. Washington Healthplanfinder will never terminate a plan due to non-payment. 34

38 QDP enrollment is a required selection for all children under 19 QDP is still tied to the QHP selected, and children must enroll with a QHP and QDP together. However, QDP can be cancelled if no payment is received by carrier, which may result in some children showing up in Washington Healthplanfinder as only having QHP. This is not a system error. NOTE: Children who do not have a paid QDP can still have an active QHP; non-payment of the QDP does NOT affect their enrollment in a QHP. In this sense, the QHP and QDP plans are independent/separated in Washington Healthplanfinder. This also means that an individual may result in only having QDP without QHP (due to non-payment of QHP). 35

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43 In order for an individual to be considered part of the same household they must have one of the following relationships to the applicant: Legal Guardian Child (up to age 26) Spouse (including same-sex marriage) Spouse (including domestic partners) Any other family members living in the same home who do not meet these requirements will not qualify as the same household as the primary applicant. If the primary applicant is applying for Free and Low-Cost Health Insurance programs, the household composition is based on individuals filed on the same tax form either as a spouse or tax dependents. So if grandpa is a tax dependent, he would count as part of the household in a Free and Low-Cost Health Insurance scenario. 40

44 Washington Healthplanfinder allows children up to age 26 to be covered under their parents plans. For instance students away at college or young professionals who are still trying to get started as adults and may not have health insurance on their own. The child does not have to be living in the same home to qualify. They can be living on their own at school or as a young adult. 41

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52 When households want to change plans after coverage has started, these are important things to remember. Providers not covered through a household s insurance plan is not a qualifying special enrollment event and Insureds will need to wait until the annual open enrollment ( through ) to change plans. 49

53 A period of time outside of the open enrollment period when customers may be eligible to enroll in new health insurance or change their current plan due to a qualifying life event 50

54 From the start of a new account OR the customer checking Report a Change in Income/Household from Account Home the customer will see this page and then click See if You Qualify 51

55 For new WAH/QHP customers outside of OE (or customers experiencing an SEP during OE for current year), they will see this version of the Special Enrollment Questionnaire (SEQ) page - read through and select appropriate answer for customer. If Yes is selected for certain questions, additional information fields may appear asking for Date of Event or Date of Court Order Some questions (i.e. Domestic Violence) will not need additional information aside from selfattestation. Selecting answers: A customer can select multiple events at one time on this questionnaire; from there, Washington Healthplanfinder will determine the best possible coverage start date according to the Hierarchy discussed on slide #5 A customer can also select nothing at all (questions are not marked as required). They can click Next to navigate forward or Cancel to go back to the dashboard customers who cancel out will still have 30 days to answer that questionnaire if needed 52

56 For currently enrolled QHP/WAH customers (during or outside of OE), there are additional questions (read through select questions) Based on changes reported in the earlier form, as detected by the Washington Healthplanfinder system, some questions may come with prepopulated answers If Yes is selected for certain questions, additional information fields will appear asking for Date of Event or Date of Court Order However, some questions (i.e. Domestic Violence) will not need additional information aside from self-attestation. Selecting answers: A customer can select multiple events at one time on this questionnaire; from there, Washington Healthplanfinder will determine the best possible coverage start date according to the Hierarchy discussed on slide #5 A customer can also select nothing at all (questions are not marked as required). They can click Next to navigate forward or Cancel to go back to the dashboard already enrolled customers who cancel out may see a Complete My Application link on their account home for not completing the reported change 53

57 When submitting the SEQ, there are potential modals that may pop up when the customer clicks Next The Provide Date of Event(s) modal will pop up if the customer does not provide a Date of Event as required for some qualifying events. Some SEQs may come prepopulated with previously provided information for certain questions and require a Date of Event 54

58 After submitting the SEQ, the approval or denial messaging screen will display and vary based on the time they are attempting to report the change The customer would click Next and be directed to select a plan (if approved SEP) or to the individual dashboard (if denied SEP) 55

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61 Customers are not eligible for a retroactive enrollment when The customer did not enroll according to the 23 rd enrollment/disenrollment cut off date The customer made an update to their application that resulted in change, but not in line with the 23 rd enrollment/disenrollment cut off date The applicant did not experience any Washington Healthplanfinder system error Brokers/navigators/Exchange call center workers should instruct customers that they are not eligible for retroactive enrollment in the above noted instances Brokers/navigators/Exchange call center workers should assist and confirm notifications were sent to customer by looking on their dashboard Eligibility Decisions Document Requests Upcoming Enrollment Deadline 58

62 Customers may be eligible for a retroactive enrollment if Customer experienced a system issue that is documented in Washington Healthplanfinder, by calls to the customer support center, ticket system, etc. Customer experiences a qualifying life event that offers 1 st of the month following the date it is reported but the system didn t recognize the coverage effective date Retroactive enrollment approvals are determined by Exchange account workers 59

63 Customers may be eligible for a retroactive disenrollment when Their enrollment was missed by a system batch job to dis-enroll for Non-Payment Customer experiences a gain of Minimum Essential Coverage (MEC) (see next slide) Aging into Medicare customers may request a retroactive dis-enrollment anytime during the month for which the customer is eligible for Medicare Error of the Exchange Must be documented in Washington Healthplanfinder, call center records, ticket system, etc. Retroactive enrollment decisions are determined by an Exchange account worker Dual enrolled via Washington Healthplanfinder: Result of a customer having multiple applications, resulting in overlapping coverage or multiple enrollments on the same application. 60

64 Reinstatement requests will come direct to the Exchange from the carrier in most scenarios Carriers are managing payments, invoices and grace periods Customers may request retroactive enrollment if: Customer calls and requests due to a documented system issue Customer accidentally dis-enrolled and contacted customer support immediately to reinstate coverage to ensure no gap in coverage Immediately should be no more than 1-3 business days following the accidental disenrollment Customer enrolled in a QHP, reports pregnancy and is put into WAH Pregnancy Coverage Customer can request to have their QHP reinstated and remains eligible for tax credits (special rule) 61

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66 Washington Healthplanfinder has two distinct marketplaces *CLICK* Washington Healthplanfinder for Individuals and Families AND Washington Healthplanfinder Business. We are here to discuss Washington Healthplanfinder Business. *CLICK* 63

67 Washington Healthplanfinder Business offers a way to find health insurance for your employees. Washington Healthplanfinder Business is a customer-friendly, online marketplace where small businesses (2-100 employees for 2016) can find, compare and enroll in the plan that best meets their needs and their budget. Washington Healthplanfinder Business provides: Apples-to-apples comparisons of Qualified Health Plans (QHP) Offer Employee only coverage Access to Small Business Premium Tax credit Expert customer support by phone or through a Washington Healthplanfinder registered insurance broker 64

68 Small businesses eligible for the small business tax credit must enroll their employer group through Washington Healthplanfinder Business to receive the tax credit. The tax credit is not a tax credit they get instantly as individuals through the individual marketplace. Please consult your Tax Professional to work through the calculations for your specific business type and employee count. 65

69 Employers Can Create WAHPF Accounts: Read Slide the employer attests to the three criteria no documentation is required An Employer is required to create an account to enroll in Washington Healthplanfinder Business An account allows the Employer to log into Washington Healthplanfinder and fully administer their account we will demonstrate the functionality in an employer account more later An Employer can easily find and select a broker to partner with Employer can browse through a list of registered brokers via Healthplanfinder 66

70 Create a Employer Account on Washington Healthplanfinder Partner with a Washington Healthplanfinder Registered broker Input employee roster Elect to offer Employee only coverage or Employee and dependent coverage ALL ELIGIBLE employees must be input on the roster Offer employees One Plan or Metal Level Employee Choice Option Shop for plan and elect desired contribution amounts Employers must contribute at least 50% toward employee premiums and if dependent coverage is offered they can contribute 0-100% of dependents premiums 67

71 Offer employees coverage via Washington Healthplanfinder web link Once offered employees must follow the ed link to create their Employee accounts and enroll in the offered coverage Ongoing account administration Employers have an account and dashboard for ongoing administration of their account Employers can designate one of their employees to be a Designated Employer Administrator for access to the Employer account Update payment preferences Employer payments must be made electronically via the Healthplanfinder Employer pays 100% of monthly premium Employers can pay by debit, credit, or electronic check Employers can enroll in auto-pay 68

72 Create Washington Healthplanfinder account via web link sent from the employer If an employee currently has an individual account on HPF, they should keep their employee account separate when given option Compare plans (if offered metal tier) Add dependents (if allowed by employer) Employers may offer coverage to dependents, but not contribute any percentage to their premium View employee final summary E-sign Ongoing Washington Healthplanfinder account administration 69

73 Employers are responsible to pay the entire premium on group plans. Any portion that the employee is responsible for will be collected through payroll deductions from the employer external of HPF 69

74 Before we talk about the Healthplanfinder we will review the Small Business Quoting Tool available to all registered Healthplanfinder brokers. 70

75 Washington Healthplanfinder brokers have access to a Small Business quoting tool external from the Washington Healthplanfinder Brokers have access to the Small Business Quoting tool directly from their Quick Links in their Washington Healthplanfinder Broker Account Brokers must click Register if they have not already registered to create a quote tool account Brokers have access to a training video and instructions for this tool from the Producer Training Materials and Resource Page Small businesses also have access to this quoting tool from the Employer Landing page off of Washington Healthplanfinder Brokers/Employers with quoting tool technical errors can producer@wahbexchange.org 71

76 From the Washington Healthplanfinder broker account brokers can *CLICK* Browse and Quote Group Plans from their Quick Links to access the External Group Quoting Tool. 72

77 The login to the quoting tool would look like this if you have not already created a quoting tool account then you would need to click Register to register and create an account to quote small business plans available on the WA Healthplanfinder. Once registered to use the quoting tool you will have a dashboard that you can input and create employer accounts with any employees/dependents and Run Quotes from plans available on the WA Healthplanfinder. Please note that this will not replace the need for an employer to create a WA Healthplanfinder account 73

78 Employers/Brokers/Navigators the world will have access to the Employer Landing page From this landing page they can click Apply for Coverage to start their small group enrollment or Browse Plans By clicking Browse Plans employers will be routed to a website External to Washington Healthplanfinder where they can input their Small Group information and receive plan quotes and information 74

79 Upon clicking Browse Plans from the new landing page, Washington Healthplanfinder Business employers will be directed to an external website through a modal. 75

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