2018 Illinois Insurance Marketplace Open Enrollment FAQ s

Transcription

1 2018 Illinois Insurance Marketplace Open Enrollment FAQ s Open Enrollment 1. When is the Open Enrollment period for Illinois Insurance Marketplace plans? Answer: Open Enrollment for the Illinois Insurance Marketplace starts November 1, 2017 and ends December 15, 2017, which is only 6 weeks to enroll. Payment must be received and applied by the insurance carrier no later than December 15, 2017 to ensure coverage starts January 1, Any payment applied after December 15, 2017 will result in coverage beginning February 1, Are case managers actually enrolling clients, or are we just assisting with navigating to the American Exchange site? Answer: Case managers or benefit coordinators can enroll the client through the American Exchange website. The Center for Medicaid/Medicare Services is allowing a proxy application this year, which allows the client information submitted through the American Exchange website to go directly to the Illinois Insurance Marketplace for processing. This data is not changed or manipulated in any way. Case managers and benefit coordinators can then enter client insurance information into Provide Enterprise via the Health Benefit Update process. 3. What are the hours of operation for American Exchange staff during open enrollment period? Answer: American Exchange is available from 7:00 AM to 7:00 PM CST, Monday Saturday. 4. Can changes be made to enrollment once submitted? Answer: No, once submitted, no changes can be made. Therefore, it is extremely important to have all information and plan selection correct before submitting the enrollment. Individuals have only one chance to select a plan. 5. What client information is required to enroll? Answer: Please refer to GetCoveredIllinois.gov or HealthCare.gov for specifics on the information required. Some of this information includes name, date of birth, social security number, address, and income information. 1

2 6. Does the client have to select the Advance Premium Tax Credit when enrolling? How is enrollment tied to income tax documents? Answer: Yes, you must select the Advance Premium Tax Credit, option so that the tax credit is applied directly to the monthly premium instead of reconciled at the end of the year. The tax credits provided by the Federal government are reconciled when individuals/households complete their tax filings. At this time the federal government determines if the amount of tax credit provided was correct, or if there was too much or too little provided. If the reconciliation finds that too much tax credit was provided, the client is required to pay back this amount to the federal government. If the reconciliation finds that too little tax credit was given, the client is provided with a tax refund. For anyone receiving Premium Assistance, this refund amount must be sent to the Department, as the payer of the insurance premiums. The Department can also assist with any amount required to be paid back to the federal government per program guidelines. If a client does not file tax documents, the advanced premium tax credit will be terminated, and the Department must be notified. 7. Can you please verify that the Department will be accepting screenshots as proof of first premium documentation this year? Answer: Yes, the Department will accept a screenshot of the confirmation message once the insurance enrollment application is submitted. A copy of the that is sent to the client by the Illinois Insurance Marketplace can also be used. 8. Can this proof of enrollment be used in place of the insurance card? Answer: No, the insurance card, once received, is still required. The initial premium documentation screenshot or can only be used temporarily until the insurance card is received by client. 9. If a client does not need to make changes to the insurance plan, does the client need to do anything at this time? Answer: Clients who do not log in and actively choose a plan will automatically be reenrolled in their current plan or a plan with a similar premium on December 15. However, the Department strongly discourages auto re-enrollment, as many of the insurance plans have changed for Clients should actively compare plans to find the best option for their needs. 10. Should the case manager s be used during enrollment? Answer: No, the client s should always be used, as enrollment updates or reminders will be ed to the client. 2

3 11. Will a confirmation or enrollment notification be sent through the mail, as well as ? Answer: No, a confirmation of enrollment will not be mailed to clients. The screenshot once the application is submitted can be printed if client wants documentation. Clients will receive a mailing from the insurance carrier approximately one week after enrolling that gives details of the plan. There is no printable summary document this year. 12. Does the client get a confirmation number after submission through American Exchange? Answer: No, there is no confirmation number issued to the client. A confirmation number will be assigned in the system, but it is not sent to client or case manager. If a confirmation number is needed, the client must contact American Exchange who can provide it. Confirmation is provided when the final congratulatory screen is reached. This year, as eligibility documents are entered, a Marketplace ID will be generated and transmitted to the Illinois Insurance Marketplace. Insurance/Premium Assistance Program 1. What are the 2018 Illinois Insurance Marketplace plans that meet Medication Assistance Program/Premium Assistance Program requirements? Answer: The Department has vetted the 2018 plans and found that Silver-level plans with Blue Cross Blue Shield (BCBS), Health Alliance, Ambetter/Celtic, and Cigna comply with Medication Assistance Program /Premium Assistance Program requirements. Availability of plans is determined by county of residence, and some counties may only have one plan available. When the client s zip code is entered into the American Exchange website, all available plans will be shown. BCBS, Health Alliance, Ambetter/Celtic, and Cigna will work with CVS Caremark Specialty Pharmacy for Medication Assistance Program/Premium Assistance Program clients. Also, BCBS and Health Alliance will allow off exchange enrollment for individuals without a social security number (SSN). 2. Does a client have to choose one of the Silver-level plans with either Blue Cross Blue Shield (BCBS), Health Alliance, Ambetter/Celtic, or Cigna? Answer: No, the client is not required to choose one of the mentioned plans. However, the Department will only provide Premium Assistance for the Silver-level plans through these specified insurers. 3

4 3. Why has the number of insurance carriers decreased this year? Answer: Insurance companies voluntarily elect whether to offer plans through the Illinois Insurance Marketplace every year. This year, Humana and Coventry have decided not to offer plans through the Illinois Insurance Marketplace. Specific questions about insurance companies should be directed to the Illinois Department of Insurance. 4. If clients are receiving Premium Assistance, can they get their medication at any pharmacy? Answer: No, regardless if the plan has other medical, dental, prescription, or vision benefits, the Department can only pay for premiums when formulary medications are filled and dispensed by CVS Caremark Specialty Pharmacy. 5. How much will the Department cover regarding premiums? Answer: The maximum amount of Premium Assistance provided by the Department is $750 per month for any combination of insurance plans. Any amount over $750 per month is the sole responsibility of the client. 6. In the past, some clients have enrolled in Bronze level plans due to increased premiums because of age. Should clients still enroll in Bronze-level plans this year? Answer: In order to receive Premium Assistance, clients must enroll into a Silver- level plan. The Department will not assist with premiums for Bronze- or Gold-level plans. 7. What should a client do if their current medical provider is not a preferred provider for 2018? Answer: Clients whose provider is no longer an in-network preferred provider have 3 options. They can either select a new insurance plan that includes the provider or find a new provider in the plan they want to participate in. Alternatively, they can request their provider submit paperwork to become part of an insurance carrier s network. 8. Some clients are enrolled in Premium Assistance but then utilize Gilead copay cards at Walgreens or another pharmacy for their medications. Is this allowable? Answer: No, in order to receive assistance with premiums, clients must be enrolled in Medication Assistance and must receive their medications through the Department s contracted dispensing pharmacy, currently CVS Caremark Specialty Pharmacy. Failure to comply with this requirement will result in Premium Assistance being terminated. 9. What is the process for enrolling into a standalone dental plan off-exchange? Answer: Individuals should work with their local Medical Benefit Coordinators or contact American Exchange directly to enroll into an off marketplace dental plan. 4

5 10. If a client chooses a plan with copays, is the client responsible for the copays or are they covered? If copays are covered and a client has to make a copay at time of the visit, does the client let the office know that they have RWPB funding and that should suffice for the copay? Answer: Clients can receive assistance with copays and deductibles for HIV-related medical services by enrolling into the local Medical Case Management provider in the region in which the client resides. These out-of-pocket costs are not covered by the Medication Assistance or Premium Assistance Programs. 11. If a client gets terminated from Premium Assistance Program services, will this be permanent or just for that current enrollment year? Answer: Depending on the reason for termination, clients are eligible for Premium Assistance Program as soon as they meet all the eligibility requirements again. Clients may be permanently removed from the Illinois Ryan White Part B Program for various reasons, including, but not limited to, fraudulent reporting of information, threats or acts of violence toward program and/or program provider staff, etc. 12. What plans accommodate a client who does not have a social security number? Answer: Health Alliance and BCBS will allow clients who do not have social security numbers to enroll in off-exchange plans. Enrollment forms are available on the American Exchange website, and American Exchange is able to provide assistance if requested. 13. Will a client be able to enroll in a plan through the Illinois Insurance Marketplace when eligible for Medicaid? Answer: No, Medicaid-eligible clients are not able to enroll. Our understanding is that the Illinois Insurance Marketplace uses the income entered to determine if clients are Medicaid eligible. If a client is determined to be eligible for Medicaid, the Illinois Insurance Marketplace will automatically redirect the client s enrollment to the ABE system (Medicaid) and then block the client from the Illinois Insurance Marketplace. If a mistake is made when entering income or household information, please contact American Exchange, and they will attempt to reset this information. 14. Can a client enroll in a plan through the Illinois Insurance Marketplace if employer-based insurance is available? Answer: No, clients cannot enroll in a plan through the Illinois Insurance Marketplace if an employer-based plan is offered. The only time the Illinois Insurance Marketplace will allow an individual to enroll in a plan is when the employer-offered plan premium is more than 9.5% of the client s household income. In this instance, the individual must 5

6 work with the Illinois Insurance Marketplace and will be required to supply documentation to this effect. 15. What is the procedure when a client can only enroll into their employer-based plan during approved Open Enrollment periods? Answer: The client should contact the Illinois Insurance Marketplace to notify them of this restriction and provide a letter from the employer that indicates the next Open Enrollment period. Upon approval, the Illinois Insurance Marketplace will allow the client to enroll in a plan. When the employer s Open Enrollment period begins, the client must enroll in an employer-based insurance plan and notify the Illinois Insurance Marketplace. 16. What happens if a client refuses to enroll in a Medicare plan when eligible? Answer: If a client is eligible for a Medicare Plan but does not enroll, the client will incur lifetime penalties which can affect benefits or monthly premiums. 17. Where should clients send odd bills or checks they may receive from the insurance company? Answer: Please submit any odd bills or refunds/returned checks, along with client s name and client s , to: Pool Administrators Inc. 628 Hebron Ave. Suite 502 Glastonbury, CT Pharmacy/Medication Assistance Program 1. Can Medication Assistance Program/Premium Assistance Program clients use any CVS pharmacy to fill prescriptions? Answer: No, in order to receive Medication and/or Premium Assistance, clients must receive their medications through the Department s contracted dispensing pharmacy, currently CVS Caremark Specialty Pharmacy. If clients do not utilize CVS Caremark Specialty Pharmacy for their medications, the Department will not assist with any outof- pocket costs related to medications, and Premium Assistance will be terminated. 2. What does the IL Medication Assistance Program formulary include? Answer: The Illinois Medication Assistance Program is currently utilizing an open formulary, with the exception of a few medications. The Program s formulary and prescribing guidelines can be found at the link below. 6

7 3. Previously, individuals on Medicaid who do not use CVS Caremark Specialty Pharmacy were advised by Medicaid "to un-enroll in the Medication Assistance Program" yet the client can still remain in the RWPB program. Is this correct? Answer: The Department highly encourages individuals enrolled in Medicaid to also enroll in Medication Assistance. This allows the Department to act as a safety net in instances where Medicaid may deny coverage for any reason. In order for the Department to act as this safety net, clients must receive their medications through the Department s contracted dispensing pharmacy, currently CVS Caremark Specialty Pharmacy. Any costs arising from medication not received through the Department s contracted dispensing pharmacy will not be covered by the Department. 4. How should a client report a problem that occurs with CVS Caremark Specialty Pharmacy? Answer: Case managers can DPH.ADAPFAX to report problems that clients experience with CVS Caremark Specialty Pharmacy. Please include RW ID and details of the situation, but please do not client names, as regular systems are not secure. 5. If a client has several documented grievances or incidents that occur with CVS Caremark Specialty Pharmacy, will they be allowed to move to a new pharmacy? Answer: No. Clients enrolled in Medication Assistance and/or Premium Assistance must receive their formulary medications through the Department s contracted dispensing pharmacy, currently CVS Caremark Specialty Pharmacy. Any costs arising from medication not received through the Department s contracted dispensing pharmacy will not be covered by the Department. Contact Information: Ryan White Part B Program Illinois Department of Public Health 525 West Jefferson Springfield, IL Hotline: Phone: Fax: (to send enrollment documents) DPH.ADAPFAX@illinois.gov (to send enrollment documents) American Exchange 246 E. 11th Street Suite 202 Chattanooga, TN Illinois Hotline: Fax: llinois Pool Administrators Inc. 628 Hebron Ave. Suite 502 Glastonbury, CT Phone: Fax: