Broker Q&A Tracker. Topic Question Response. Enrollment. Account Login. Enrollment SHOP. Out of State

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1 Broker Q&A Tracker Topic Question Response Yes, we will have a paper application that will be available from our website on November 15th. Will we have paper applications to enroll new members? The financial downloadable PDF/ paper app is available here: Account Login I m registered as an Agent for YHI. I want to shop for insurance for me. Do I create a new login under the register tab to view plans as a person looking to purchase a plan and not as an agent? And the non-financial downloadable PDF/ paper app is available here: You will need to create an Individual account in the YHI system, which will be available on November 15. You will need to use a different address than the one associated with your agent account to set up your individual account. You can create an individual account at From there, you will be able to create your individual account and shop for plans. Here is the URL for setting up an individual consumer account on YHI: As you know, we are now a State Based Marketplace, so many of the options available on the Federal Marketplace last year are modified or adjusted to reflect Idaho s needs. Because of this, we will not be enrolling individuals over the phone. The good news is that agents and brokers will have the option of enrolling those individuals with a paper application, in person in your office, or over the phone. Working with your client, you can create an address for them, apply for financial assistance with DHW, and wait for the determination to show up in their account. As long as you have permission from your client (designation), you can complete the full application on their behalf. The process is fully explained in Module 11 (Creating Consumer Accounts and Consumer Connector Designation) of the LMS agent training system. What if my client doesn t have a computer and/or ? Can we call YHI to enroll in the subsidies, get an immediate award decision in the same call and then enroll my client in a 2015 QHP all in the same call? This was an option for enrolling for 2014 QHPs with the FFM after they worked out the bugs in the system The on-line application process will require you to enter a valid address. If you are setting up the account for your client over the phone or on your computer, you can create an account when you are logged in to your Agent account on YHI. You will first click on the Individuals tab, and select Add New Individual, which will be available to you the agent on November 15. If your client does not have an address you may choose to: 1. Use a paper application 2. Ask your client to create an account (or enter any they want (Gmail, etc.) However, it is imperative that if you process web-applications for a client without , REMEMBER to mark MAIL (not ) as the communication preference. Also, if you do the application in paper form, your client will receive all notifications (eligibility, etc.) via paper mail. Real-time determination of the is not possible for 2015 insurance whether applying online or over the phone. The turn-around time for the is 2-10 days, at which point they can enroll in any QHP on the exchange they choose. The determination of the small business tax credit (SBTC) process occurs outside of the Exchange. Employers must complete IRS Form 8941 to obtain the SBTC. This link will connect you with a very helpful resource to estimate the employer s potential tax credit and eligibility requirements. SHOP I have a company who wants to possibly see if they would qualify for the small employer tax credit. I have been told that our Idaho SHOP will not be up and running but they still could buy a qualified plan and still get the tax credit. I thought that they had to get an Employer Determination Notice for from the government first. Can you please advise me as to how I should proceed. Thanks for the help it is greatly appreciated. Additionally, the Idaho SHOP Marketplace will be up and running. It will not be available online, but will be done through paper forms and agent/broker management (or direct with the carriers); the process is much the same as the standard small group health insurance enrollment process has been in the past. The SHOP enrollment forms will be available when Open starts on November 15 for employer groups who want to participate in SHOP. Employers and/or their agents can work directly with the carriers to enroll in the SHOP Qualified Health Plans. Forms are not necessary for enrollment. Here are some helpful steps for the employer to follow: Employer researches Small Business Tax Credit eligibility and applies. Employer or Agent/Broker will reach-out to carriers requesting Small Group QHP plan details. Employer, with the help of his/her Agent or Broker, will look through plans and pick a plan that works for their business. Once a plan is selected, the Agent/Broker will work with the Carrier to provide premium costs. will occur directly with the Carrier, facilitated by a broker or on their own. After enrollment, employers will pay the first month s premium directly to the insurance company following the carrier's standard process. Where you live can affect the health insurance plan for which you are eligible as well as your eligibility to get help paying for coverage. When you log in to your account and fill out your Marketplace application, you will need to know certain things about reporting where you live. Generally, people must live in a state to be considered residents and get help paying for health coverage there. If someone is living out of the state temporarily, they can still be considered a resident of the state. You ll be asked if everyone on your application lives at the same permanent home address in your state. Out of State When you apply, you ll be asked to enter your permanent home address. Give the permanent home address where everyone on your I have a client who just aged off her father s health insurance. She is a full time application lives. This can t be a P.O. box. We ll use this address to determine if you re a resident of the state where you re seeking health student at BYU. She uses her Idaho address as her permanent address. She does coverage. have Utah income and files a Utah tax return. Is she eligible for health insurance in If a child splits time between 2 parents who don t live together, use the address where the child spends most of his or her nights. Idaho or should she purchase a Utah plan? You ll be asked if your mailing address is the same as your permanent address. Select no if you have a different mailing address. You ll also be asked if you re applying for coverage for yourself. You can select no if you aren t applying for yourself, but you are applying for other people in your household who have the same permanent home address. You can find more information at Healthcare.gov or you can follow this link As a reminder please be sure to check out the Agent and Broker Q&A section in our weekly newsletter.

2 Certification I am a certified agent with the DOI. The agent/broker is licensed with the DOI, but not yet with YHI as he probably won t be enrolling clients. Would I be able to be certified on YHI and use the agent info so the agent/broker gets the credit/commission through the carrier? Does that make sense? I know that when we signed people up on the exchange this past year, we just used our agency (agent s) NPN# so that commissions would be applied to his broker number. If it would be easier for me to call and speak to someone that would be great as well. You will be listed as an agent/broker on the YHI website as soon as it goes live on Nov 15, 2014 (or once the agent is certified by YHI). Your name will be listed with your business name, which will be identifiable in the system. However, at this point, I cannot guarantee that you will be able to search by business name. The agent designated in the YHI system at the time the consumer selects a plan will be the AOR sent to the carrier. Therefore, if an agent is not appointed with the enrolling carrier, then no one will receive a commission. However, if you would like to ensure that the agent (must be appointed with the enrolling carrier) is paid for your enrollments, there are a few extra steps that you will need to complete. 1. All licensed agents will need to become certified on YHI and complete the LMS training and exam. 2. You may work with your clients, have them designate you as their, allowing you to help to set up their accounts on YHI, research plans, confirm eligibility, and decide on a plan. 3. HOWEVER, before SELECTING a plan for enrollment, you will want to have your client de-designate you as the, and designate your agent/broker by whom you are employed (must be appointed with the enrolling carrier to receive a commission). 4. The agent appointed with the enrolling carrier will then complete and confirm the enrollment process with your client, and the final will show their name, which will be recorded in the billing process so that he receives the commission on the sale. Thank you for your inquiry, here is the link: You will be able to complete your training modules here and also complete your final exam. Also, if you haven t already done so be sure you create a Your Health Idaho system account, please follow the instructions below. Step 1: Account Creation The first step is to Signup for an account. Here is the link for this step: In this first step, you will enter your name, address, phone number, security question, and create a password. You may have already completed Step 1. If so, skip Step 1 and move on to Step 2. After you complete Step 1, you will be prompted to log in (page shows up with a little log in screen enter your /password). You HAVE to login to confirm your account set up. Certification I can't figure out the website for the exam or anything else. Can you please send the information to me? Step 2: Agent Information Step 2 takes place after you log in (either through the screen I mentioned above or directly through click the login link in the lower, right-hand corner of the page then click the big orange Log Into your YHI System Account button.) Once logged in, the system recognizes that you are on Step 2 and that you need to complete some additional information. So it asks you to fill out your Agent Information. That information includes name, license number, renewal date, phone numbers, addresses, etc. Step 3: Profile Information Step 3 asks you to fill out your Profile Information. This is information that will be shown to the public and will include things like your public address, your education level, and your About Me (where you should enter your carrier appointments). --- After you have completed all three steps, your status will be set to Pending. We will verify that your license is in good standing with the Dept. of Insurance and will then change your account status to Certified. You will be notified via when your account status has changed. Certification After entering my information and viewing my public profile, I do not see a way to edit it. The top of the page begins, "Review and edit your public profile, which can be seen by YHI users looking for Agents. " but I cannot edit it. I did not enter carrier appointments yet. Some are in process so I will need to add them as I receive them. What about other adult dental/vision e.g. Humana? The agent & broker initial profile is locked until you become certified. You are currently pending certification. We are waiting for Department of Insurance (DOI) to confirm that your license is in good standing. Once we receive this confirmation, we will certify you. When you receive notification from our office that you have been certified, you will have full access to edit your account and profile details. It may take up to 5 working days to approve your certification. We encourage our certified agents and brokers to list all of their appointments (dental as well), regardless of which plans YHI is offering. This is your opportunity to showcase your expertise on your profile, as this is what the public sees. Technical No message is showing for either the link or the "here". We were experiencing some technical difficulties, those have since been resolved. Please click onto the link again. You can also access the link through the secure if you log on to your YHI account. As a certified Consumer Connector, you are not authorized to speak on behalf of Your Health Idaho, but you can educate consumers via social media or other channels to let them know you are available to provide assistance. Logo Advertisement How can I download the YHI logo for advertisement? I already have my account agent/broker account certified. Are there any specific guidelines on how to request it and use it on the website or do I get it through my personal account? You are welcome to share and repost Your Health Idaho content and let others know of your role as a Certified Consumer Connector. Consumer Connectors cannot use our brand, name or logo for anything unless you have express written permission from Your Health Idaho. If you would like to use the logo or host an event in coordination with YHI there is now an Event Participation Agreement located in the Tool kit under the "communities" tab in the LMS training system. Once you have completed the Your Health Idaho Training course, you will be able to use the badge across all material (your website, signature block, social media ) as long as you maintain your YHI certification. This will be available in the Toolkit under the "communities" tab in the LMS training system once you have been certified. They submitted their form It came back putting the husband on Medicaid and not the wife. I called both YHI and DHW and neither one could help me. DHW said that is just how it works. Anyway they are paying the premium for Medicaid for the husband---so now my question is do you automatically cancel him off the BC plan? Or do they just keep on paying both premiums---someone has to know this answer. I'm enquiring for my brother who will be working in Mountain Home Idaho for 2 years. My mother will be coming along on Visa for 2 years as well. I would like to find out if she is eligible to buy healthcare plans in the marketplace? Based on your description and explanation, your clients information and household changes that warrant a qualification for Medicaid will be reported by DHW to YHI in time for open enrollment. When the information transfers from DHW to YHI, only the individuals with will be transferred. In this example, the carrier will only be sent the enrollment information for the wife, so it is not necessary to cancel the husband's enrollment in the Blue Cross plan as he will not be passively re-enrolled given that he is now on Medicaid. However, YHI would encourage your client to log in to her YHI account between Nov. 15th and Dec. 15th to check the information AND the plan renewal information to confirm that this is the case. Additionally, she may want to review her plan options during the open enrollment period for renewals (11/15-12/15), at which point she could choose and enroll in a different plan, if desired. Thank you so much for your inquiry. We appreciate your interest in getting insurance this year! Based on the information that you've shared with us, you will need to call YH-IDAHO to get an eligibility determination. If your family members are eligible to enroll in the exchange, they can apply for insurance coverage beginning November 15th. In my study today it is saying that if they had coverage in 2014 and want to shop for This stipulation applies to consumers with 2014 coverage with an Idaho carrier that was obtained through healthcare.gov. Consumers a possible plan change for 2015 they have to do it between Nov 15th and Dec 15th. I must complete any plan changes by 12/15/2014 as carriers must follow the regulation requiring them to renew a consumer's plan. Any thought open enrollment lasted until Feb 15. If they completed a plan change by 2- coverage purchased through healthcare.gov for plan year 2014 ends on 12/31/2014, regardless of when they enrolled. Therefore, in order wouldn t they have that plan effective ? to have coverage effectuated on 1/1/2015 consumers must make a new plan selection by 12/15/2014 or they will be automatically renewed in their current plan. If an AOR is submitted to us for a YHI client (mid-year, or otherwise), should we just In the Your Health Idaho system, individuals can designate a broker at any time. The broker has the option to accept or decline the ignore it, or should we just direct them to you, and you will make the determination designation. There is no need for the individual to contact Your Health Idaho. as to whether or not they are able to complete an AOR? I have a quick question about my clients who are renewing Dec 1st. Many of them are on non exchange plans and some are looking to get coverage on the exchange because they now may qualify for a subsidy. Do I send them to the healthcare.gov web site or can they enroll at yourhealthidaho.org for coverage starting Dec 1st. For a coverage effective date of 12/1/2014, individuals must apply on healthcare.gov. Please be aware that to ensure a coverage effective date of December 1st, they must have completed the application process by November 15th. They also will need to apply and be approved for a special enrollment period (SEP) as open enrollment on healthcare.gov is now closed. Coverage on ACA health insurance exchanges is based on calendar year, so these individuals should also go to to apply for coverage in plan year 2015 at which time they can update their household information and get a 2015 /CSR determination.

3 I have a question, one of my clients received the letter from YHI, called number, where he was asked the estimated income for Consumers who are currently enrolled in health insurance plans on the FFM will be either contacted by the Department of Health & Welfare to update their tax household information or they may use the form available on He gave all the information over the phone and said that his plan changed $1 in premium for Does it mean he was sign already for a health insurance for the next year? He called me after that because he wasn't sure you guys had my information as his agent of record. The broker is not required to be involved in this process. Renewing consumers are encouraged to provide this information as soon as possible, but should report any household changes at any time to YH-IDAHO. For passive re-enrollments (2014 FFM YHIHIX), the will be maintained in the carriers systems. However, the Agent of Record is not established in the Your Health Idaho system. If a consumer experiences a life event, they will they will then create an account in the Your Health Idaho system and, at that time, will need to designate an in order to associate an agent with their Your Health Idaho account. I have contacted the Exchange twice and received difference responses to my question(s). The last representative suggested I pose my question here. I am inquiring for a client. She is married and currently working part time for her employer. She may have an opportunity to advance to full time status. The employer offers a qualified health plan for all full time employees. They offer 100% contribution for the employee only. The monthly premium for adding a spouse is $600. Her annual income is approximately $28,000 and will increase to approximately $36,400 They are currently both on the exchange and receiving subsidy. Her spouse is currently not employed. Her spouse is Native American. My question is based on the "affordability" of the employer sponsored plan. For eligibility and tax credit determination, the individual should call YH-IDAHO Will she be eligible to remain on the exchange AND still qualify for the subsidy if she moves to full time status? Will her spouse be eligible to remain on the exchange AND still qualify for the subsidy if she moves to full time status? Catastrophic Plans I am looking up some plans and looking at some costs and discovered there aren't any plans under the catastrophic area. I know some companies have some catastrophic plans so they are missing. I verified this with Randy Gardner. I was looking at a 27 year old with 40k income and zip code. Catastrophic plans are not listed on anonymous browsing. They will be available to view when a consumer shops for plans after filling out an application, if they are determined eligible for a catastrophic plan, post 11/15. Some consumers will need to apply for a hardship exemption. Learn more here: I had a client who accidentally left the income amount blank on her and so now they were told they have Medicaid-she needs to fix this. How does she go about this the best way? If your client has an determination for 2015 renewal they should call YH-IDAHO to provide an updated income. If it is in regards to their 2014 plan, they will need to call Healthcare.gov. Qualifying Event/ I am not able to find on the website an answer to the following question. If an A change in income does not necessarily make someone eligible for a Special Period (SEP). If the individual lost coverage due to individual is terminated from employment, but did not have health insurance as part loss of a job then they would qualify for a SEP because they would have lost Minimum Essential Coverage (MEC). However, in the case of his position, can he purchase insurance through the exchange outside of open given, the individual would most likely not qualify for a SEP and would need to wait for open enrollment to enroll in coverage. enrollment? It was my understanding if the individual s income changed, they would be eligible and that prior insurance was not a requirement. SEP is described here in more detail: We have an applicant in this circumstance and he has received varying information. I am checking to find out what our agency needs to do to support renewal migrations for our Idaho customers over to the Your Health Idaho system. A couple of our customers have received notifications from HWS about their standing and we have provided support for them. However I wanted to make sure we are doing what we can need to do to provide the correct support for all our customers. We do have some that do not receive subsidies. We are more than happy to help make sure our customers experience a smooth transition from the FFM to YHI. The information I have about the data collection for FFM customer enrollment migration to YHI system is: Renewal Customers Agents need to collect policy information and income detail for existing customer for submission to State for FFM transfer to IHX pdf form available. Consumers who are currently enrolled in health insurance plans on the FFM will be either contacted by the Department of Health & Welfare to update their tax household information or they may use the form available on The broker is not required to be involved in this process. Renewing consumers are encouraged to provide this information as soon as possible, but should report any household changes at any time to YH-IDAHO. Consumers will have a variety of ways to confirm their information is accurate. Consumers can go online and fill out a form over a secure website at work with their agent or broker, call YH- Idaho or fill out a form mailed to them. In order to ensure accounts are set up and tax credits are calculated before open enrollment starts, consumers need to provide their information by September 1. Special (SEP) What will occur for Special s (SEP) during the 2015 enrollment process? If an existing customer wants to make a change after December 15, can they do so after the renewal deadline? Why is a state based exchange better than the Federally Facilitated Marketplace? If the SEP customer has an existing 2014 enrollment through healthcare.gov, any changes should be reported to and processed by the federal marketplace. Consumers should also report these changes to YHI via the YH-IDAHO phone number, as these changes might impact 2015 eligibility and enrollment. For new clients signing up through SEP in 2014, YHI is working with carriers to ensure that all 2014 enrollments are included in the passive enrollment process. To ensure there is no gap in coverage, customers will need to make a new plan selection before December 15th. If a new plan is not chosen, they will be enrolled in their existing plan. The customer will be permitted to make a change if they qualify for a special enrollment period. Due to the complexity of launching a health insurance exchange, Your Health Idaho is using a phased approach as we develop our technology in order to minimize risk and ensure we are not trying to take on more than we can successfully accomplish in this first year. We will continue to develop new functionality one piece at a time. In this first year, we will not be able to process in real time or have the agents listed in the system as agents of record prior to the customer creating an account and designating an agent. We recognize these items are important and will continue to work towards making them a reality. As is our directive from the Idaho Legislature, we are focused on becoming a fully functional state-based exchange as quickly as possible. As a state exchange, Idaho is in control of critical elements like ensuring Idahoans a low assessment fee, maintaining a prominent role for agents and brokers and regulating the exchange in Idaho. Will IOIx software (ebroker software) have a seamless connection to enroll people in the exchange through YHI? YHI will not support IOIx software (ebroker software) for the 2015 Open period. Direct enrollment functionality is part of deferred functionality that will be reviewed and prioritized for the 2016 open enrollment period. Your Health Idaho is building its own specific technology so that consumers, with the support of agents and brokers, can shop, compare and choose a plan that is best for them. How are agents able to use social media with regards to YHI? As a certified agent or broker you can tell clients of your certification, that you can help them find plans, educate them about the exchange, and use your badge (you will get this after the upcoming YHI certification), but you are not authorized to speak on behalf of the exchange. When will the log-in process begin so that people can activate their accounts? Open enrollment begins on November 15. This will also be the date which the consumer account creation process will begin. Will agents use their State License number instead of their NPN for 2015 enrollment? When Agents and Brokers set up their account on Your Health Idaho, they will be asked to include their State License Number. This is the value that YHI will use going forward.

4 Does the Form that we are using for for renewing clients work for new clients or not? If a consumer chooses to be passively enrolled, will they need to create an account profile with YHI? The Renewal form has been designed specifically for people who enrolled in healthcare.gov. When the YHI training through LMS is available, agents will learn more about the open enrollment process which begins November 15. Consumers do not need to create an account with YHI to be passively enrolled. They and their broker should be aware, however, that if the consumer experiences any life event that creates a special enrollment period, the consumer will then need to create an account on the YHI system. One of the options during account creation is to designate a broker. If no broker is designated at that time, then the life event transaction will be transmitted to the carrier with no designated. 1. Are the people who sign up Sept-Dec. with Healthcare.gov with a tax credit to be notified by Idaho DHW to complete an form for next year? If not, how will they know they need to complete a form? 1. A consumer will need to fill out the form (as long as it s available) to determine for We encourage all users to log in to the Your Health Idaho (YHI) system, create an account, review their and other plan details to ensure it is still the best choice and meets their needs. Consumers can begin the renewal process on November 15, 2014 and it needs to be completed by December 15, 2014 for a January 1, 2015 effective date. 2. I was not able to attend the Friday before last Q & A webinar. Is there a place I can go to hear or see the discussions? 3. If a person received a credit for 2014 and failed to return the form by tomorrow, can they apply during open enrollment as a new enrollee and apply for the credit then? 4. Is there any extension beyond Sept. 30 that the form can still be completed? 2. Meeting information will be available for the Q&A Webinar. This will be on the weekly Newsletter that goes out on Monday Morning. 3. Yes. If the consumer does not provide the documentation requested, they would receive a notice explaining their will end December 31, The consumer can reapply and provide the verification to have their 2015 calculated. Again, we encourage all users to log in to the Your Health Idaho (YHI) system, create an account and review their as well as other plan details to ensure it is still the best choice and meets their needs. Consumers can begin the renewal process on November 15, 2014 and it needs to be completed by December 15, 2014 for a January 1, 2015 effective date. 4. Consumers will be able to fill out the form until the form is no longer available at The form should be available until at least 10/31/2014. Process Our agency had several questions and are hoping you can assist us with those. If you d like, you can reply next to the question. 1. Will there be some type of rater showing quotes? (I used the one with YHI earlier this week and when I went to the marketplace it was a $200 per month difference in the ). 2. During the last open enrollment, YHI provided applications and login forms to assist during the enrollment events. Will there be similar forms available to streamline the process? 3. We want to make sure we are clear on the proposed process for the upcoming open enrollment. We will have an initial consultation where we will fill out some form to send to H & W (and hopefully have ballpark #s from a rater) The insured will receive a letter stating what the for their family will be with a few days Insured will call us to make a second appt During second appt we will be able to plug in the and sign up for insurance right then 4. Where can we obtain the paper forms for Idaho's SHOP program? 5. Will there be spanish language options in Mtn Home when Jody is doing her press tour? 6. Will there be more than one date for the presentation in Mtn Home (right now, there only seems to be one)? 1. There will be an estimator available beginning Wednesday, October 1, to give customers an idea of what they may qualify for. It is an estimator and the actual will not be exact until the customer completes the financial application on the YHI system. will be filed for when customers apply for insurance, completing the financial assistance form, and final calculations will be made based on that application. 2.Similar materials will be available to agents and brokers after they complete their training and certification on the Learning Management System (LMS). The materials will be accessible on the LMS for certified agents and brokers. 3. We want to make sure we are clear on the proposed process for the upcoming open enrollment. i. You and the customer will have an initial consultation during which you can use the estimator available at this will give you a "ballpark #". a. If the customer would like to apply for financial assistance through the insurance affordability programs ( or CSR), the individual will then fill out the application to apply for lower costs (tax credit) b. If the customer does not want to apply for a tax credit, the customer will complete the shopping and enrollment process. ii.if the customer applied for financial assistance, the customer will receive a letter stating what the for their family will be within 2 10 days a. The customer will set up a second appointment to select and finalize plans. This may be done over the phone or even via . b. During this second consultation, the (if eligible) will be available to the customer to apply to the desired insurance plan. This is the point at which the customer can enroll in a plan. 4. The SHOP enrollment forms will be available when Open starts on November 15. Please note: Employers and/or their agents can work directly with the carriers to enroll in the SHOP Qualified Health Plans. Forms are not necessary for enrollment. 5. Translators will be invited and asked to participate in the enrollment events we facilitate this year. 6. At this point, the schedule is not finalized. Income (MAGI) Your recent newsletter with the income limits shows the same amounts exactly as the CMS recent training but your chart talks about gross income whereas As our newsletter states, it is the Modified Adjusted Gross Income (MAGI). CMS is based on MAGI income. So, which is it please? I have several clients that went direct to the carrier at their renewal some of them will qualify for the tax credit. Will they have to re apply at AEP to get this? Or can they send in the form? Anyone receiving in 2014 can send in the renewal form and have a determination made for If they are receiving an in 2014, DHW will automatically calculate their for 2015 using information provided by healthcare.gov. If there are changes to household circumstances, the family should report changes to YHI so the 2015 tax credit is accurate. Sustainability Because Idaho had to transition off of the Federal Marketplace this year, many of the processes are manual and cumbersome. It will be our priority next year, to improve the redetermination process and significantly streamline this for next year. Once a family has been It is understandable that this year s process will be a bit more cumbersome than in determined to be eligible for in Idaho s system, we will renew their benefits annually as long as they have provided DHW with the future. However, part of our business decision going forward will be to try and authorization to validate their information against the IRS annually. If we can verify their current situation through interfaces, the only determine whether a business model can be developed to make individual contact the family will have with us will be a notice to the family explaining what income and tax household information we are using and insurance a profitable industry going forward. Can you please speak to the business asking them to contact us if the information is wrong. We will then automatically set up the following year's. So, for a family that has processes you foresee will be in place into the future. reported changes and we can verify their situation, they will not be required to fill out any forms or need to contact us at all. If we can t verify their situation, they will be asked to provide verification so we can move them through the process. Real-time Determination Do you foresee a one step process for approval and Plan selection starting next year? This year is a unique situation as Idaho is transitioning off the federal marketplace. It is Idaho s priority to streamline the renewal process including both redetermination and plan selection next year. While the ongoing renewal process is still in development for consumers who allow the Department of Health and Welfare to verify their income and their current situation can be confirmed via interfaces, there may be no action at all required by the consumer to maintain enrollment in their existing plan. Note that enrollees will always have the option to change plans during the open enrollment period. I have a customer who is getting a verification of termination of employment. DHW is requesting that they take it to their former employer and have them fill it out. Is this the only way to handle this verification? The termination form is not the only option the family has to verify that their employment situation has changed. A contact to the employer, the termination form, a letter from the employer, or proof of unemployment can also verify the income has ended. If a family is eligible for Medicaid based on lower income OR the verification sources we have show a family is over income for, we must verify income has decreased or ended. Can you provide more detail on how the DHW verification process works? When a family declares their income, we access information through various interfaces including their tax information (if they have given us permission to access it), Idaho Department of Labor for wages and unemployment, Social Security, or the Work Number (Equifax) for wages. If we can verify the family s information from one of those sources, we do not need any additional information. If we cannot verify their information from an automated source, we may contact the family or the income source to verify the situation or request that the family provide documentation. There are two ways to know what a family will potentially be eligible for during the application. There will be a calculator to do an early When signing up new clients during the 2014 Open period, the user estimate of the family s. This calculation has been tested against the rules and will provide very similar results. Also, after the family would get notifications that the children on the application were eligible for has submitted their application, a preliminary eligibility decision will be shared with the applicant showing what they are likely to be eligible Medicaid and the parents were eligible for. Will agents be guided through the for, including Medicaid and. It will not show an calculation amount but it will display a preliminary eligibility decision. Once a process for mixed households for the 2015 Open? determination is made, customers will receive an official notice from DHW on their eligibility and a notice from the Marketplace to go shop for plans. If you are the agent of record, you will also receive the notice from the Marketplace that it is time to shop for a plan.

5 Process I am trying to come up with a letter to send out to my clients. I would like to give them a play by play of what to expect each month. I just wanted to make sure with all the information and confusion that I have it down right. Helping to point out the things they should look for, actions necessary, and just what to expect. Depending on the family s situation and if we can verify it without assistance from the family, they will have one of two paths during the eligibility process. Path 1: If we have what we need to determine the for the family when we process their renewal, they will receive a notice explaining what information we used to calculate their and what their 2015 will be. The family will need to review the tax household information and the income we are using and contact us if it is not correct. If the information is correct, they will not need to contact us and they will be able to shop for a new plan or keep their remaining plan in November. Path 2: If we are not able to verify a family s situation, we will ask the family to provide additional documentation. They will be given 30 days to provide the information and once we receive it, they will receive a notice explaining what information we used to calculate their and what their 2015 will be. The family will need to review the tax household information and the income we are using and contact us if it is not correct. If the information is correct, they will not need to contact us and they will be able to shop for a new plan or keep their remaining plan in November. If the family does not provide the documentation requested, they would receive a notice explaining their will end December 31, The family can reapply and provide the verification at any time to have their 2015 calculated. When we list a client s income to see what their subsidy will be, will it show the various plans available and what the cost will be and also will it show if they get cost Open enrollment begins on November 15, and it will be this date on which the consumer account creation process will begin. sharing and what the plan would look like then? As Subsidy results are not immediately available when we are meeting with a client say on December 15th, how can we select a plan and still meet the deadline for a For those customers that are part of the renewal group and they follow through with all requests about their renewal for 2015, January 1st enrollment? We won t know how much the is going to be to help they will have a letter from us giving them the amount of their 2015 amount. The family should have this letter by the end of October us determine which plan is the most appropriate for the client? We won t have and this information will be available in the Marketplace on November 15th. If they don't follow through with the, they will have to enough info to be able to make an informed decision to assist them with enrollment reapply for an during open enrollment. by the deadline. On the forms that we ve already submitted, the form did not ask who in a household was enrolling; it only asked about household income. As there are individuals living in a household whose income will be counted but who are Medicare eligible either through aging in or disability, how will the DHW know for whom to calculate the? The insurance companies have indicated that we as agents will retain the broker of record for our client if no changes are made and the plan automatically renews. Will YHI/DHW be able to see the broker of record if we call in to assist our client with a question? If not, why not? We use the entire tax household to determine eligibility for the amount. We have interfaces that tell us who is receiving Government sponsored insurance. This interface includes Medicare, so our system will be updated for any individual receiving Medicare and that will be used in the determination of who is actually eligible to receive. For passive enrollment clients, YHI cannot see the agent or broker of record until an account is created and the agent/broker is designated. Please note that clients with agent or brokers who call the call center will be told to reach out to their agents and brokers regarding questions. If a client automatically renews, do they still need to create an account with YHI? Will you be able to see that we are their broker of record? For passive enrollment clients, carriers have agreed to maintain the agent of record on their systems. YHI will not be able to see agent/broker of record unless the client account is created and an agent/broker is delegated. The letter to the client is letting them know about their amount and the next steps to begin shopping for or enrolling in a plan. DHW I can see on the material that you have mailed out to the customer that they will get will automatically send the and CSR levels to the Marketplace on November 15th for all those renewing for The customer will a letter with a case number on the right hand side of the page. This is Step 2 in your receive an invitation from the Marketplace to create an account and shop on November 15th. Once they go in to the Marketplace and program. When will the consumer shop for a new plan? Do they hold that letter create their account, their amount for 2015 will already be available. They can designate a YHI certified agent/broker, shop, compare, until November 15th? What does the letter in Step 3 that gets mailed out to the and choose a new plan for If they do not create an account or designate an agent/broker, they will be enrolled in their 2014 plan for customer look like? I don t see much emphasis placed or actually any mention placed for them to use an agent. Renewals/Applications When and how will new enrollees submit their information to determine their subsidy amount? What is the process for the renewal customers who complete and submit the form and have some changes that they didn t expect. Their subsidy amount will be incorrect. Do we send in another form now or wait? What is the turnaround time for that process? I would like to know the process for clients to submit their additional documents that are needed when they receive their request for verification notice. How will the additional documents that are submitted be linked to the electronic tax credit form they do on line? Any client can apply for Health Coverage Assistance at any time during the year. DHW will process eligibility and if they are eligible for an, they will receive a notice letting them know the maximum amount of the calculation and the next steps in shopping for and enrolling in a QHP. They can then create an account and see if they are eligible to enroll in insurance (either because of open enrollment or an event that qualifies for special enrollment). We will use the information the family provided on the renewal form. We will send a notice to the family showing the information we used and their amount for If the family does not agree with the information used, they will need to contact us and let us know what information needs changed. They can let us know what information they provided to us that was wrong and why. We will verify the change and re-calculate the. If the family calls us to report the discrepancy and we can make the changes and verify during the call, we will reprocess and mail the notice to the family the next day. If we are not able to make the change during the call, the family typically will receive the notice within a week from when the change is verified. The family can the verification to us, mail it to us or fax it to us. We have an electronic record for each family and the renewal form and all verifications are stored within that record. The family cannot attach verification to the form when submitting it electronically. Broker Privacy/Security I have understood that there will be a 2 day verification period to confirm eligibility which means agents will need to schedule 2 appointments with clients. Is this being addressed to minimize this wait time? How do we resolve issues which have arisen as a result of the DHW sending out subsidy terminations through the Idaho exchange when I know these folks indeed qualify? Is there a broker help desk? At this time, we are not able to do a real time determination that provides the calculation. In 2015, we hope to have the ability for a client to apply on line for the and receive a real time eligibility determination that includes the amount. We use the information the family provided on the renewal form. We will send a notice to the family showing the information we used and their amount for If the family does not agree with the information used, they will need to contact us and let us know what information needs changed. They can let us know what information they provided to us that was wrong and why. We will verify the change and re-calculate the. Agents will be able to submit questions via to YHI staff at support@yourhealthidaho.org. The call center is geared toward assisting consumers. In the first conference call, it was mentioned the DHW would be putting out a list of DHW will provide the carriers with the information about each of the clients they submitted to us beginning October 17. Carriers will work clients who had NOT yet submitted their renewal form. Will that list be made out how agents/brokers can receive the information. available to the agents, and if so, when? Is there a way I can look over the privacy and security settings guidelines without The YHI privacy policy may be reviewed and is available to all interested parties at taking the course? It is likely that your client may fall in the gap in coverage since ID is not a Medicaid Expansion state and may not be eligible for any I have a client that has $0 income, but draws money from savings. She is 59 years subsidies. She can still enroll in insurance, but will likely have to pay full price; alternatively, she can apply for a hardship exemption and, if old and cannot qualify for Medicaid in Idaho as far as I know, since she has assets. she qualifies, enroll in a catastrophic plan. She files a tax return every year to get her grocery credit back, but does not pay any taxes due to no income. For those who do not currently have insurance or who have insurance, but outside of the exchange can we direct them to you now to get an determination sooner rather than later? Is it best for them to call? Which number? Can they just the form to you? What ? On October 1st, individuals will be able to use the YHI tax credit estimator to get an estimated determination for To complete the tax credit application and enroll in a health plan, individuals who were not enrolled in healthcare.gov will have to wait until November 15, 2014 for open enrollment. On October 1st, individuals will be able to use the YHI tax credit estimator to get an estimated determination for To complete I have a few clients that were enrolled direct with a carrier. They may now be the tax credit application and enroll in a health plan, individuals will have to wait until November 15, 2014 for open enrollment. eligible for the as their income changed. Can they fill out THE FORM with their If your client is looking for coverage for the remainder of 2014, they may qualify for a Special Period. This will need to be new eligibility? processed through healthcare.gov. Yes, all policies on the exchange will renew Jan 1, this includes determination for 2015 and any SEP (special enrollment period). Will the new determination for in 2015 be applied to a renewal starting Jan 1 on all policies or at the insured's particular renewal date (say April 1?)? If a consumer enrolled March of 2014 through healthcare.gov, their plan will be renewed as of January 1, We encourage all users to log in to the YHI system and create an account and review their and other plan details to ensure it is still the best choice and meets their needs. Consumers can begin the renewal process on November 15, 2014 and it needs to be completed by December 15, 2014 for a January 1, 2015 effective date.