Online Application Feature Release and Other Updates

Transcription

1 Online Application Feature Release and Other Updates The Outreach and Sales Distribution Services Team May 19, 2016

2 1. Updates to the Online Application 2. Special Enrollment Quick Tips 3. Conditional Eligibility 4. Vision Coverage 5. Agent Extranet 6. Questions AGENDA May 19,

3 Visit In the footer, click Enrollment Partners Click Partner Tool Kit PARTNER TOOLKIT 2 2

4 UPDATES TO THE ONLINE APPLICATION 3

5 Full Scope Medi-Cal Access for Children Without Eligible Immigration Status (SB-75) New California law Implemented May 1, 2016 Children eligible up to 19 years old in households up to 266% Federal Poverty Level (FPL) UPDATES TO THE ONLINE APLICATION Aims to provide full-scope Medi-Cal benefit access to eligible children regardless of immigration and lawfully present status Applicants are not required to indicate Eligible Immigration Status in the online application Receive full-scope MAGI Medi-Cal eligibility 4 4

6 Full Scope Medi-Cal Access for Children Without Eligible Immigration Status (SB-75) Eligible children will no longer be asked to provide Proof of Citizenship, Lawful Presence or Proof of Immigration Status when applying for Covered California Children under 19 with an existing restricted-scope Medi-Cal eligibility determination will be reviewed and re-determined by a County Eligibility Worker. UPDATES TO THE ONLINE APLICATION 5 5

7 One Time Passcode for CalHEERS Account Access Release 16.4 allows consumers and certified enrollers to receive an or text message for a One Time Passcode Reset password Access username Must register for the One-Time Passcode verification method in CalHEERS to access these options UPDATES TO THE ONLINE APLICATION 6 May choose to register address Phone number Or both The One Time Passcode Registration Page will be displayed to Consumers and Certified Enrollers upon first time logging in after Release 16.4 For more information on helping consumers with the one time passcode, view One Time Passcode Job Aid 6

8 Non Tax Filer Status Consumers will receive an ineligible status if they did not file taxes for a previous coverage year Renewing consumers seeking premium assistance Existing Advanced Premium Tax Credit (APTC) eligible consumers using the Report a Change function Existing APTC eligible consumers that did not file taxes for a previous coverage year Received a notice reminding them they must file taxes to continue eligibility for APTC Eligibility will be re-determined by CalHEERS Redetermination may result in the discontinuance of APTC eligibility in the current year if taxes are not filed for a previous coverage year UPDATES TO THE ONLINE APLICATION 7 7

9 Non Tax Filer Status Consumers may self-attest to having filed taxes in the online application Renewing and currently enrolled consumers may access the Update Consent for Verification and Tax Filing Attestation page in the online application UPDATES TO THE ONLINE APLICATION Consumers may attest under penalty of perjury File federal taxes for the year in which they received premium assistance Update their APTC eligibility For more information on helping consumers self attest, view Tax Attestation Job Aid 8 8

10 CalHEERS Will Screen All New Applicants for Current Medi-Cal Enrollment New Applicants and members added during Report a change Current message for Medi-Cal enrollment will continue We checked our files, and you already have health coverage. If you think this is incorrect, please contact your County Social Services office for help UPDATES TO THE ONLINE APLICATION Consumers will receive a pending Medi-Cal eligibility if all other MAGI Medi-Cal requirements are met CalHEERS is not able to communicate with Medi-Cal enrollment system Your application is pending. This is because we were unable to check if you already receive Medi-Cal coverage 9 9

11 Access to Withdraw the Consumer Application has Been Restricted The Withdraw Application link will now be disabled on the Individual homepage after an eligibility determination is run in CalHEERS In Progress applications will continue to have the Withdraw Application option available UPDATES TO THE ONLINE APLICATION This functionality is intended prevent applications from being withdrawn after eligibility determinations have been sent to Medi-Cal Duplicate applications in the Medi-Cal system have led to enrollment and eligibility issues 10 10

12 SPECIAL ENROLLMENT QUICK TIPS 11

13 Qualifying Life Event Had a baby or adopted a child Lost or will soon lose my health insurance Got married or entered into domestic partnership Effective Date Day of birth/adoption 1 st of following month SPECIAL ENROLLMENT QUICK TIPS Released from jail or prison Permanently moved to/within California Gained citizenship/lawful presence Federally Recognized American Indian or Alaska Native Returned from active duty military service If a plan is selected by the 15 th, coverage starts on the 1 st of the following month. If a plan is selected after the 15 th, coverage starts on the 1 st of the second following month. Consumers do not need to be previously or currently enrolled in a Covered California plan to qualify

14 Medi-Cal Enrollment Special Enrollment does not apply to Medi-Cal applicants Apply for coverage anytime during the year Does not need a Qualifying Life Event to gain coverage SPECIAL ENROLLMENT QUICK TIPS Select None of The Above (continue to review my application for Medi-Cal) American Indian/Alaska Native (AI/AN) Enrollment Special Enrollment does not apply to AI/AN applicants Apply for coverage anytime during the year Does not need a Qualifying Life Event to gain coverage Select Federally Recognized American Indian/Alaska Native 13 13

15 Reporting a Prospective Loss of Minimum Essential Coverage (MEC) Currently enrolled consumer in MEC coverage and aware of future date their coverage will expire Contract ending Aging out of parents coverage COBRA coverage expiring SPECIAL ENROLLMENT QUICK TIPS Loss of MEC may be reported up to 60 days in advance Complete the application and select Loss of MEC qualifying life event Expected coverage start date will be the following month To help a consumer proactively enroll with Covered California more than one month in advance Covered California Consumer Service Center (800)

16 Reporting a Change in Consumer Income Consumers should report any income increases or decreases during the coverage year Maintaining up to date income reporting will ensure that the consumer is receiving the appropriate amount of APTC SPECIAL ENROLLMENT QUICK TIPS Help consumers avoid the need to reconcile (pay back) tax credits when filing taxes 15 15

17 Reporting a Change in Consumer Income Access the consumer s application to Report A Change Input the consumer s updated income SPECIAL ENROLLMENT QUICK TIPS If there is no qualifying life event for the consumer select None of the Above 16 16

18 Reporting a Change in Consumer Income If the income change reported results in new APTC eligibility, or adjusts the amount of existing APTC, the consumer should move forward with plan selection The new plan will reflect the adjusted amount of APTC available to the consumer SPECIAL ENROLLMENT QUICK TIPS For more details: Job Aid: Income Pages 17 17

19 Income for Self Employed, Contract, and Seasonal Workers Some consumers may be unable to use their current monthly income to accurately determine their annual income Self employed, contract, and seasonal workers may estimate an annual income based on the previous years earning SPECIAL ENROLLMENT QUICK TIPS If consumers do not report changes to monthly income throughout the year, they may be required to reconcile APTC when filing taxes 18 18

20 Income for Self Employed, Contract and Seasonal Workers Edit Total Expected Yearly Household Income The Total Expected Yearly Household Income displayed may not be what the applicant expects to make this year Consumers can manually input their projected annual income to override their reported current monthly income SPECIAL ENROLLMENT QUICK TIPS APTC eligibility will be based off this new amount Adjust APTC received monthly or collect at the end of the year Applicants can choose how much of their premium assistance to apply each month Applicants can choose to receive the premium assistance as a yearly tax credit For more details: Job Aid: Change Premium Assistance Amount 19 19

21 Limitations on Repayment Amount of Excess APTC Limits are based on a consumer s household income and filing status Household Income Percentage of Federal Poverty Line Limitation Amount for Single, Married Filing Separately, and HOH taxpayers Limitation Amount for all other filing statuses SPECIAL ENROLLMENT QUICK TIPS Less than 200% $300 $600 At least 200%, but less than 300% $750 $1,500 At least 300%, but less than 400% $1,250 $2, % or more No limit No limit Source:

22 Conditional Eligibility 21

23 What you need to know Monthly reminder notice Notice in English Spanish Chinese Korean Vietnamese Documents required for one or more: CONDITIONAL ELIGIBILITY No documentation is required if box is not checked for that category 22 22

24 Providing Documentation CoveredCA.com provides a list of acceptable documentation Attestation of Non Incarceration Status Form is now online Distribution schedule for upcoming notices: CONDITIONAL ELIGIBILITY Coverage Start Date Notice Received by Consumer Week of Submit Document Deadline 4/1/16 5/16/16 6/10/16 5/1/16 6/20/16 7/10/16 6/1/16 7/18/16 8/10/16 7/1/16 8/15/16 9/10/16 8/1/16 9/19/16 10/10/16 9/1/16 10/17/16 11/10/16 10/1/16 11/21/16 12/10/16 11/1/16 12/19/16 1/10/

25 Next Steps Upload, fax, or mail documentation More than one document may be required Legible copies only - not originals Cover page included for fax or mail responses Consumers with difficulty in obtaining valid documentation by the Submit Document Deadline date, can call the consumer service center to provide a date when the documentation will be received If documentation has already been provided, no action is needed. Covered California will contact consumers directly if additional information is needed. CONDITIONAL ELIGIBILITY 24 Terminated Consumers Citizenship/lawful presence or incarceration terminations One month from termination date to call consumer service center for reinstatement Request reinstatement of coverage Provide documentation Example: consumer terminated on 4/30/16, must call by 5/31/16

26 VISION COVERAGE 25

27 Pathway to Vision Coverage Covered California partners with VSP & EyeMed Link: VISION COVERAGE Vision enrollment is available year-round - Open Enrollment and Special Enrollment do not apply Adult vision is an ancillary benefit and coverage is handled directly through VSP Vision services for children are included in all health plans purchased through Covered California VSP & EyeMed Agent commission information is found in the Partner Tool 26 26

28 Contact VSP directly for any related questions: VSP Agent Service Center Hours Monday - Friday, 5:00 a.m. to 5:00 p.m. PST (888) or CCAgentEnrollment@vsp.com Appointment status Agent of Record Changes Commission inquiries Consumer enrollment and VSP account issues VISION COVERAGE VSP Consumer Service Center Hours Monday - Friday, 5:00 a.m. to 8:00 p.m. PST Saturday, 7:00 a.m. to 8:00 p.m. PST Sunday, 7:00 a.m. to 7:00 p.m. PST (800) CECs to contact this number Consumer enrollment or VSP account issues 27 27

29 Contact EyeMed directly for any related questions: Agents EyeMed Agent Online Inquiry form: Appointment status Commission inquiries Consumer enrollment and EyeMed account issues Consumers contact (844) for the following: Consumer enrollment EyeMed account issues Provider or plan information Designation of Agent of Record Consumer must first contact billing or claims Request HIPAA form Complete and return HIPAA form VISION COVERAGE 28 Benefits and Provider Questions Monday Saturday, 4:30 a.m. to 8 p.m. PST Sunday, 8:00 a.m. to 5:00 p.m. PST Billing and Policy Change Questions Monday Friday, 5:00 a.m. to 6:00 p.m. PST 28

30 AGENT EXTRANET 29

31 Agent Extranet Found outside of the online application (CalHEERS) Book of Business Conditional Eligibility Extract Return Mail Extract AGENT EXTRANET Access the Agent Extranet Login with user name and password: Password reset link Enter user name If you do not have your user name, please contact the Agent Service Center at Personally Identifiable Information (PII) Job Aid found in Tool Kit 30 30

32 Book of Business Generated from CalHEERS Every Monday COB Reflects consumer data from week prior Excel document Contains Covered California, Mixed Household, and Medi-Cal members AGENT EXTRANET 31 31

33 Conditional Eligibility Report Conditional eligibility consumers Available same week consumers receive notice - monthly Help consumers maintain APTC and/or coverage No file no conditional eligibility consumers AGENT EXTRANET 32 32

34 Return Mail Report Consumers with incorrect addresses Available same day Conditional Eligibility Extract monthly Help consumers receive important notices from Covered California No file Covered California has not found any of your consumers with incorrected addresses AGENT EXTRANET 33 33

35 QUESTIONS? 34

36 THANK YOU! 35