Special Enrollment Period and Pre-enrollment Verification Guide for Assisters 2019

Transcription

1 Special Enrllment Perid and Pre-enrllment Verificatin Guide fr Assisters 2019

2 Cntents Special Enrllment Perids (SEP): The Basics... 3 Ntices fr Pre-enrllment Verificatin Prcess Supprting Dcumentatin Uplad Tl SEP Pre-Enrllment Verificatin Guide January 16, 2019 Page 2 f 54

3 Special Enrllment Perids Special Enrllment Perids (SEP): The Basics Overview... 4 SEP Eligible Qualifying Life Events (QLE)... 4 Length f SEP... 5 Early access t an SEP... 5 Effective Dates... 5 Special effective dates... 6 American Indian/Alaska Native (AI/AN)... 6 COBRA... 6 Steps fr an SEP... 7 Pre-enrllment Verificatin... 7 Gd faith extensin... 9 Effective dates ptins based n pre-enrllment verificatin prcess... 9 January 16, 2019 Page 3 f 54

4 Special Enrllment Perids Overview A Special Enrllment Perid (SEP) is a time utside f pen enrllment when an individual r family can enrll in a qualified health (and dental) plan r change their existing qualified health (and dental) plan due t a qualifying life event, such as a change in family size, change in eligibility fr cverage thrugh MNsure r lss f ther cverage. A cnsumer must be apprved fr an SEP in rder t enrll r change a qualified health plan (QHP) utside f the annual pen enrllment perid. An individual r family must experience a qualifying life event in rder t be eligible fr an SEP. A member f a federally recgnized tribe qualifies fr a mnthly SEP. SEP Eligible Qualifying Life Events (QLE) Qualifying life events that make a cnsumer eligible fr an SEP include: Change in husehld size: Due t birth, adptin, placement fr adptin r fster care, child supprt rder Due t divrce, legal separatin, death Due t marriage Lss f qualifying health cverage Lss f minimum essential cverage (MEC) including lss f emplyerspnsred Insurance (ESI) r lss f public prgram cverage. Change in primary place f residence Access t new qualified health plans as a result f a permanent mve Change in eligibility fr cverage thrugh MNsure Newly eligible fr QHP due t gain f citizenship, US natinal, lawfully present status r change in incarceratin status Enrllee r enrllee s dependent is newly eligible r ineligible fr advanced premium tax credits (APTC) r change in cst sharing reductin (CSR) eligibility Newly Eligible fr advanced premium tax credits (APTC) r cst sharing reductin (CSR) eligibility due t a change in an Emplyer-Spnsred Plan Members f a federally recgnized tribe, American Indian r Alaska Native, and dependents wh enrll with a qualifying tribal member Enrllment errr Due t agency errr, misrepresentatin, miscnduct r inactin Vilatin f qualified health plan cntract by carrier Other qualifying events including: January 16, 2019 Page 4 f 54

5 Exceptinal circumstance Special Enrllment Perids Small emplyer newly ffers a health reimbursement arrangement (HRA) 30- day SEP Fr mre infrmatin g t Special Enrllment Perid n MNsure.rg. Length f SEP If a cnsumer experiences a qualifying life event (QLE), as a general rule they have 60 calendar days fllwing the event, t enrll. After that time perid the individual cannt enrll r change plans until the next pen enrllment, r they experience anther QLE. Early access t an SEP Fr certain qualifying events, an individual r family may access their special enrllment perid up t 60 calendar days prir t the triggering date in rder t select and enrll in a QHP. The individual r family must call MNsure in rder t have their SEP eligibility cnfirmed. Cverage cannt begin prir t the triggering event. The length f the SEP includes the 60 days prir t the triggering date and the regular 60 calendar days fllwing the triggering date. Fr example, if a cnsumer will be lsing their existing cverage n 3/31, they culd select their plan and request an SEP up t 60 days prir t 3/31. If the SEP is apprved, cverage culd nt start until after the lss f cverage. If they d nt chse t enrll prir t 3/31, they will still have 60 days after that date, t enrll. Early access t an SEP is available fr the fllwing qualifying events: Lss f minimum essential cverage Newly eligible fr advanced premium tax credit (APTC) r cst-sharing reductins (CSR) due t a change in emplyer-spnsred insurance (ESI) Fr all ther SEPs, the cnsumer has t experience the event befre being eligible t enrll. Cverage Effective Dates Mst cverage effective dates are based n the date the cnsumer selects a plan. In rder t determine if the cnsumer qualifies fr an SEP, the cnsumer must call MNsure. If the cnsumer selects a plan prir t the SEP trigger event, cverage cannt begin prir t the date the qualifying life event ccurred. In general, cverage starts accrding t the regular effective date rule, als called the 15/16 rule. This means: Fr a plan selected n the first thrugh the 15th f the mnth, cverage is effective the first f the fllwing mnth. Fr a plan selected n the 16th thrugh the last day f the mnth, cverage is effective the first day f the secnd fllwing mnth. January 16, 2019 Page 5 f 54

6 Special Enrllment Perids Fr example, if a plan is selected n August 12, the cverage is effective September 1. If a plan is selected n August 30, the cverage is effective Octber 1. Cnsumers will be required t pay their initial premium fr cverage t start, based n the invice sent by the carriers. Special effective dates Sme qualifying life events have special effective dates available. Fr the lss f minimum essential cverage, including MA r MinnestaCare cverage, the cverage effective date is the first day f the mnth fllwing the date f plan selectin. But nt befre the lss f ther cverage. Fr example, if an individual will lse MA cverage August 31 and selects a QHP n August 18, cverage wuld be effective September 1. Sme qualifying life events prvide ptins fr the effective dates, such as: Gain f dependent due t birth, adptin, fster care r child supprt rder Lss f dependent due t death r divrce Enrllment due t MNsure errr Fr example, a family that wants t add a newbrn t their cverage may chse an effective date retractive t the newbrn s date f birth, r the first day f the mnth fllwing the birth, r accrding t regular effective date rules. American Indian/Alaska Native (AI/AN) A member f a federally recgnized tribe can enrll in r change a QHP nce a mnth. In additin, members f the husehld wh are nt tribal members but are n the same applicatin as a qualifying tribal member can enrll with the tribal member. COBRA A cnsumer wh lses their emplyer-spnsred insurance (ESI) may qualify fr a special enrllment perid (SEP) even if they are ffered COBRA cverage (r cntinuatin cverage required under state law). If a cnsumer accepts COBRA cverage, they can enrll n MNsure: During the 60-day SEP fr lss f emplyer-spnsred insurance During MNsure s annual pen enrllment At any time if they are eligible fr MA r MinnestaCare Once the COBRA benefit has been exhausted Accepting COBRA des nt cancel the 60-day SEP due t lss f emplyer-spnsred insurance, but the cnsumer cannt drp COBRA and enrll in a QHP after the 60-day lss f cverage SEP is ver, unless it is during the annual pen enrllment. January 16, 2019 Page 6 f 54

7 Special Enrllment Perids Steps fr an SEP 1. The cnsumer experiences a qualifying life event (QLE). 2. The cnsumer ges t MNsure.rg t apply/enrll. 3. The cnsumer needs t call the Cntact Center t cnfirm their eligibility fr an SEP. 4. In general the Cntact Center will: Cnfirm that the cnsumer selected a plan. Verify the cnsumer s identity, read the Tennessen Warning, and verify attestatin f the qualifying life event. Gather infrmatin frm the cnsumer and determine if the cnsumer is eligible fr an SEP. If the cnsumer is nt eligible the Cntact Center will ntify the cnsumer. If the cnsumer is eligible, the Cntact Center will infrm the cnsumer f the apprpriate infrmatin regarding effective dates and whether verificatin dcumentatin is needed. Create a request fr verificatin ntice, if apprpriate. If n pre-enrllment verificatin is needed, the Cntact Center will verify that an enrllment recrd is created, r if needed, will create a manual enrllment. If pre-enrllment verificatin is needed the cnsumer will have 30 days frm the date f the ntice t prvide the verificatin dcumentatin. Verificatin must be prvided r the enrllment/enrllment changes will nt take place. Instructins regarding hw t prvide the verificatin will be n the request ntice. Special nte fr assisters: Brkers can call the Brker Line t cnfirm the cnsumer s eligibility fr an SEP. Navigatrs and CACs can call the Assister Resurce Center (ARC) t cnfirm the cnsumer s eligibility fr an SEP. The cnsumer must be physically present, r n the call at the time the call is initiated. ARC staff must speak with the cnsumer t verify three PIIs and give data privacy and security attestatin warnings. The cnsumer may then authrize the navigatr/cac t cmplete the SEP with the ARC. Pre-enrllment Verificatin MNsure will ntify the enrllee by mail if mre infrmatin is needed t verify the qualifying life event. MNsure must receive the infrmatin within 30 days f the date n the request ntice r the enrllment will expire and will nt be frwarded t the insurance cmpany. When verificatin is received within the 30 days, MNsure staff will: Verify that the dcumentatin is acceptable. January 16, 2019 Page 7 f 54

8 Send the enrllment/enrllment changes t the insurance cmpany. Special Enrllment Perids Send ntice t the cnsumer that the enrllment has been sent. The ntice will infrm the cnsumer f the cverage start date. Pre-enrllment verificatin is required fr these SEPs: Change in Husehld Size (Birth, Adptin, Placement fr Adptin r Fster Care, Child Supprt Order) Fr birth, when electrnic evidence des nt verify, dcumentatin is required t prve the date f birth. Fr adptin, placement r curt rder, dcumentatin is required t prve date f adptin, placement r curt rder. Change in Husehld Size (Divrce, Legal Separatin, Death) Dcumentatin is required t prve date f death, divrce r legal separatin. Change in Husehld Size (Marriage) Dcumentatin is required t prve date f marriage and t prve health care prir t the marriage, unless they are a MNsure enrllee r living utside the U.S. Lss f qualifying health cverage Lss f minimum essential cverage (MEC) Dcumentatin is required t prve date f the lss f MEC. When cnsumer attests t lss f a public prgram (Medical Assistance r MinnestaCare), MNsure verifies the lss f cverage with recrds available in Minnesta s Eligibility Technlgy System (METS). If METS des nt cnfirm the lss, the cnsumer will asked fr dcumentatin. Change in primary place f residence Address change resulting in access t new qualified health plans When METS has a recrd f the previus address, dcumentatin is required t prve the date f the mve. When METS des nt have a recrd f the previus address (i.e. the cnsumer is a new applicant in METS), dcumentatin is required t prve previus address and date f mve. Dcumentatin is required t prve health care cverage prir t the mve, unless they are a MNsure enrllee r mving frm utside the U.S. Newly eligible fr QHP due t gained citizenship, US Natinal, r lawfully present status When electrnic evidence des nt verify, dcumentatin is required t prve status. Newly eligible fr advanced premium tax credits (APTC) r cst sharing reductin (CSR) due t a change in emplyer-spnsred insurance (ESI) Dcumentatin is required t prve change in emplyer cverage. Fr mre infrmatin n the pre-enrllment verificatin prcess see the SEP Pre-Enrllment Verificatin Guide. January 16, 2019 Page 8 f 54

9 Special Enrllment Perids Gd faith extensin The cnsumer may receive a gd faith extensin if: They call the Cntact Center within 30 days f receiving the request fr verificatin dcumentatin and prvide an adequate reasn t require mre time. They send dcumentatin within 30 days f receiving the request fr verificatin but dcumentatin is marginally insufficient t verify their qualifying life event. If the cnsumer is determined t have made a gd faith attempt, they will be sent a ntice that extends their verificatin perid t 30 days after their riginal deadline. If n verificatin dcumentatin is sent, r the dcumentatin is nt determined t be a gd faith attempt, the cnsumer will be infrmed that their SEP was denied. Effective date ptins based n pre-enrllment verificatin prcess When an enrllee is required t pay tw r mre mnths f retractive premiums in rder t effectuate cverage, the enrllee must be given the ptin t start cverage based n the riginal effective date r mve the start ahead n mre than ne mnth. Example: Determined eligible fr an SEP n March 30 with cverage set t begin April 1. If SEP verificatin is prcessed May 2, then the enrllee can elect t keep the April 1 start date r mve the start date frm April 1 t May 1. January 16, 2019 Page 9 f 54

10 Ntices fr Pre-enrllment Verificatin Prcess Request fr Infrmatin and Special Enrllment Eligibility...11 Qualifying Life Event Nt Cnfirmed-Special Enrllment Perid Denied...17 Qualifying Life Event and Special Enrllment Perid Cnfirmed...22 Special Enrllment Perid Verificatin Extensin...27

11 Pre-enrllment Verificatin Ntices Request fr Infrmatin and Special Enrllment Eligibility Wh gets this ntice? Cnsumers wh have reprted a qualifying life event (QLE) that requires pre-enrllment verificatin. They have cntacted the Cntact Center and have been determined t meet the requirements fr a special enrllment perid (SEP). The enrllment r enrllment changes will nt be sent t the insurance cmpany, unless verificatin dcumentatin is received within 30 days. The life events that require pre-enrllment verificatin are: Change in Husehld Size Birth Adptin, Placement fr Adptin r Fster Care, Child Supprt Order) Divrce, Legal Separatin Death Marriage Lss f qualifying health cverage Lss f minimum essential cverage Permanent mve resulting in access t new qualified health plans (QHPs) Gained citizenship, US Natinal, r lawfully present status Newly eligible fr advanced premium tax credits (APTC) r cst sharing reductin (CSR) due t a change in emplyer-spnsred insurance (ESI) What shuld they d? The cnsumer must submit a cpy f at least ne f the dcuments listed n the ntice. The first and last name and case number shuld be n all dcuments submitted. They can submit the dcuments t MNsure in the fllwing ways: Uplad dcumentatin at Fax dcumentatin alng with the first page f the ntice t Mail dcumentatin alng with the first page f the ntice using the enclsed return envelpe What will happen next? MNsure will review any dcumentatin sent. If the dcumentatin is sufficient and verifies the qualifying life event, MNsure will frward the enrllment t the insurance cmpany, and send a ntice t the cnsumer, with the effective date f cverage. January 16, 2019 Page 11 f 54

12 Pre-enrllment Verificatin Ntices If the dcumentatin is nt sufficient, but it is determined t be a gd faith effrt, MNsure will send a new ntice extending the time perid fr the cnsumer t prvide sufficient dcumentatin. If n dcumentatin is sent within 30 days, r the dcumentatin sent des nt verify the qualifying life event, the enrllment r enrllment changes will nt be sent t the insurance cmpany, the cnsumer will be receive a written ntice f the SEP denial. January 16, 2019 Page 12 f 54

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17 Pre-enrllment Verificatin Ntices Qualifying Life Event Nt Cnfirmed-Special Enrllment Perid Denied Wh gets this ntice? Cnsumers wh have selected a plan and reprted a qualifying life event that requires preenrllment verificatin. They had been sent the Request fr Infrmatin and Special Enrllment Eligibility but they did nt send verificatin dcumentatin, r the dcumentatin they sent did nt verify their eligibility. What shuld they d? The cnsumer can enrll during the next Open Enrllment, r can request a special enrllment perid, if a new qualifying life event takes place. What will happen next? The enrllment r enrllment changes will expire and MNsure will nt frward any enrllment t the insurance cmpany. January 16, 2019 Page 17 f 54

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22 Qualifying Life Event and Special Enrllment Perid Cnfirmed Wh gets this ntice? Pre-enrllment Verificatin Ntices Cnsumers wh have selected a plan and reprted a qualifying life event that requires preenrllment verificatin. They had been sent the Request fr Infrmatin and Special Enrllment Eligibility and MNsure verified the infrmatin and cnfirmed the eligibility. The ntice tells the cnsumer the cverage effective date. In sme cases, if the cverage effective date is tw r mre mnths retractive, the cnsumer will be given a chice t call the Cntact Center, within 14 days, t change the effective date by ne mnth. Cnsumers that meet this criteria will have specific language in their ntice. Only cnsumers with the specific language in the ntice are able t make this chice. Example: Determined eligible fr SEP n March 30 with cverage set t begin April 1. If an SEP verificatin is prcessed May 2 then the enrllee can elect t keep the April 1 start date r mve the start date frm April 1 t May 1. What shuld they d? After they receive an invice frm the insurance cmpany, they must pay their premium fr cverage t start. If they have language in the ntice that allws fr a change in effective date, they can call the Cntact Center within 14 days, t make the change if they chse. What will happen next? They will receive an invice and infrmatin abut their cverage frm the insurance cmpany. January 16, 2019 Page 22 f 54

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27 Special Enrllment Perid Verificatin Extensin Wh gets this ntice? Pre-enrllment Verificatin Ntices Cnsumers wh have been sent the Request fr Infrmatin and Special Enrllment Eligibility ntice, and given 30 days t prvide verificatin dcumentatin but have dne ne f the fllwing, will be allwed extended time t prvide dcumentatin: Cntacted the MNsure Cntact Center and asked fr additinal time t get acceptable dcumentatin. OR Sent in acceptable dcumentatin that was nt sufficient, but was determined t demnstrate a gd faith effrt t cmply with the riginal request fr infrmatin. What shuld they d? The cnsumer must submit a cpy f at least ne f the dcuments listed n the ntice. The first and last name and case number shuld be n all dcuments submitted. They can submit the dcuments t MNsure in the fllwing ways: Uplad dcumentatin at Fax dcumentatin alng with the first page f the ntice t Mail dcumentatin alng with the first page f the ntice using the enclsed return envelpe What will happen next? MNsure will review any dcumentatin sent. If the dcumentatin is sufficient and verifies the qualifying life event, MNsure will frward the enrllment t the insurance cmpany, and send a ntice t the cnsumer, with the effective date f cverage. If n dcumentatin is sent in 30 days, r the dcumentatin sent des nt verify the qualifying life event, the enrllment r enrllment changes will nt be sent t the insurance cmpany, the cnsumer will be ntified f the SEP denial. January 16, 2019 Page 27 f 54

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32 Supprting Dcumentatin Uplad Tl Overview...33 Dcument Requirements...33 Verificatin Dcumentatin Request Ntices...33 Special Enrllment Perids (SEP)...33 Eligibility...34 Using the Verificatin Uplad Tl...34 Cnsumer has a Dcumentatin Request Ntice...34 Cnsumer des nt have a Dcumentatin Request Ntice...34 Supprting Dcumentatin Uplad Tl...35 Authenticatin Page...36 Supprting Dcumentatin Uplad Page...37 Transitin Page...41 Thank Yu Page...42 Example Imprtant Tips fr Assisters...44

33 Supprting Dcumentatin Uplad Tl Overview This Supprting Dcumentatin Uplad tl allws cnsumers t uplad verificatin dcumentatin requested by MNsure. The link fr the tl is fund n the verificatin dcumentatin request ntices manually sent by MNsure. Cnsumers can access the tl with the link frm their ntice, r they can search n MNsure.rg using the keywrd verify r uplad. They shuld select the search result titled Uplad Supprting Dcuments. Dcument Requirements A cnsumer can take a picture f the dcuments, r scan their dcuments t a PDF, in rder t be able t uplad them. Dcuments can be submitted using a cmputer r mbile device. Dcuments can be a JPEG, GIF, PNG r PDF file type. Cnsumers can include up t three separate files fr each supprting dcument submitted. PDF files can cntain multiple pages. JPEG, PNG r GIF file types cntain ne page. Files cannt exceed 25MB in size. All dcuments must be labeled with the first name, last name and reference number f the individual that the supprting dcumentatin is fr. Verificatin Dcumentatin Request Ntices Requests t Verify Special Enrllment Perids (SEP) A cnsumer may be required t send dcumentatin t verify eligibility fr a special enrllment perid (SEP). In many cases the verificatin dcumentatin is required befre the cnsumer s enrllment infrmatin is sent t the insurance cmpany. The cnsumer may receive ne r bth f the fllwing ntices in an SEP scenari: Actin Required: Request fr Infrmatin and Special Enrllment Perid Eligibility This ntice is sent when a cnsumer cntacts the Cntact Center and requests a special enrllment perid (SEP) based n a qualifying life event that requires verificatin dcumentatin. They have 30 days frm the date f the ntice t send the dcumentatin. Actin Required: Special Enrllment Perid Verificatin Extensin January 16, 2019 Page 33 f 54

34 Supprting Dcumentatin Uplad Tl This ntice is sent when a cnsumer qualifies fr an extensin t the 30 day requirement fr dcumentatin fr a SEP. Requests t Verify Eligibility When submitting an applicatin, a cnsumer may be required t verify infrmatin n their applicatin that cannt be verified thrugh electrnic resurces. The cnsumer has 90 days t send the dcumentatin. In mst cases, they are already enrlled; if the dcumentatin is nt received they may lse their cverage. The cnsumer will receive a ntice with the heading Actin Required: Dcumentatin Needed. Using the Verificatin Uplad Tl Cnsumer has a Dcumentatin Request Ntice If the cnsumer has received a verificatin dcumentatin request ntice. They will need the fllwing infrmatin frm the ntice: Reference/case number printed under the date f the ntice letter. Heading n the ntice they received, fund n the first page beginning with Actin Required. It will be ne f the three ntices listed in the previus sectin. They will als need: First and last name f the primary applicant (persn the ntice was addressed t). Date f birth f the primary applicant. First and last name f any individuals that the supprting dcuments are fr. Date f birth f any individuals that the supprting dcuments are fr. address if they wish t receive an cnfirmatin (ptinal). The cnsumer shuld submit the first page f their ntice when prmpted n the tl. Cnsumer des nt have a Dcumentatin Request Ntice If a cnsumer requests t uplad their dcumentatin prir t receiving the ntice, after verifying the cnsumer s identity, the Cntact Center r an assister can: Prvide the cnsumer s case number (Integrated Case number) Based n the cnsumer s scenari, direct the cnsumer which buttn t chse under Actin Required January 16, 2019 Page 34 f 54

35 Supprting Dcumentatin Uplad Tl Request fr Infrmatin and SEP Eligibility The cnsumer has cntacted the Cntact Center regarding eligibility fr an SEP, and the cnsumer must verify infrmatin regarding their qualifying life event, and SEP eligibility within 30 days. Special Enrllment Perid Verificatin Extensin The cnsumer has cntacted the Cntact Center regarding eligibility fr an SEP, and the cnsumer must verify infrmatin regarding their qualifying life event, and SEP eligibility. They have been given an extensin frm the riginal 30 days. Dcumentatin Needed The cnsumer must verify infrmatin n their applicatin, which the system is unable t verify electrnically. Instructins t get t the uplad tl: The cnsumer can g t MNsure.rg and search fr the keywrd verify r uplad. When the search results are listed, they shuld select Uplad Supprting Dcuments. The cnsumer will als need: First and last name f the primary applicant (persn the ntice was addressed t). Date f birth f the primary applicant. First and last name f any individuals that the supprting dcuments are fr. Date f birth f any individuals that the supprting dcuments are fr. address, if they wish t receive an cnfirmatin (ptinal). If a husehld requests t submit their dcumentatin prir t receiving a ntice requesting infrmatin, the assister can prepare a Verificatin Dcumentatin Cver Letter fr the husehld t submit with their dcumentatin. This will help t ensure that the infrmatin is filed crrectly. If the husehld has already received a ntice requesting infrmatin, they shuld submit the first page f the ntice with the dcumentatin, and this cver letter is nt needed. Fill ut Supprting Dcumentatin Uplad Tl Cnsumers wh find the tl using a keywrd search will be taken t a MNsure page. The tl can be launched frm that page. Cnsumers, wh use the URL in the ntices, will be taken directly t the Authenticatin Page. January 16, 2019 Page 35 f 54

36 Supprting Dcumentatin Uplad Tl Authenticatin Page The cnsumer must have the Reference/case number, and the primary applicant s first and last name t use the tl. All fields are required. It is imprtant the cnsumer fill ut the fields exactly as the instructins specify. If the infrmatin is nt authenticated r is entered incrrectly, the cnsumer will get an errr message and a chance t reenter the infrmatin. Errr Message The infrmatin that yu entered des nt match ur recrds. Try entering yur infrmatin again as it appears n the ntice yu received frm us. If yu are unable t submit yur dcuments using this website, fllw the directins n yur ntice t send yur dcuments by mail r fax r call r If the cnsumer lgs in crrectly they will see the page that they will use t uplad the first dcument. January 16, 2019 Page 36 f 54

37 Supprting Dcumentatin Uplad Tl Supprting Dcumentatin Uplad Page January 16, 2019 Page 37 f 54

38 Supprting Dcumentatin Uplad Tl Primary Applicant Infrmatin 1. The cnsumer must enter the date f birth f the primary applicant. Actin Required 2. Based n their ntice, r infrmatin frm the Cntact Center r an assister, the cnsumer shuld select the scenari that describes their dcumentatin. This selectin is required. 3. The cnsumer can submit the first page f the ntice they received requesting dcumentatin. When they select Brwse they will be taken t their web brwser. They can select the file that cntains the first page f their verificatin letter. This is nt required, but is encuraged if the cnsumer has the ntice. A cnsumer wrking with an assister can prepare a Verificatin Dcumentatin Cver Letter fr the husehld t submit instead f the ntice. This will help t ensure the infrmatin is filed crrectly. If the husehld has received the ntice, the first page f the ntice shuld be submitted and the cver letter is nt needed. Supprting Dcumentatin Infrmatin 4. The cnsumer shuld type in the first name, last name and date f birth f the persn the supprting dcumentatin is fr. This may r may nt be the primary applicant. 5. The cnsumer will select the type f verificatin dcumentatin that is being submitted. This infrmatin will be n the verificatin letter. The selectins fr Type f Verificatin Needed are different fr SEP and Eligibility scenaris. Fr SEP scenaris: Lss f minimum essential cverage Gain f dependent(s) thrugh marriage Gain f dependent(s) thrugh birth Gain f dependent(s) thrugh adptin, fster care r thrugh curt rder Lss f dependent(s) due t divrce r legal separatin Lss f dependent(s) due t death January 16, 2019 Page 38 f 54

39 Supprting Dcumentatin Uplad Tl Gain f citizenship r lawfully present status Change in emplyer-spnsred insurance (ESI) and newly eligible fr APTC Permanent mve and gained access t new QHP(s) Fr Eligibility scenaris: U.S. citizenship r natinal status Lawful presence in the United States Scial Security Number Incme Deductins (expenses) Prjected annual incme Incarceratin status Membership in a federally recgnized tribe Husehld cmpsitin 6. When the type is selected, a list f pssible dcuments will appear. This is text nly used t assist the cnsumer; the cnsumer des nt need t indicate which f these dcuments they are sending. Belw is the example fr Gain f Dependent(s) birth: 7. After the cnsumer selects the verificatin type, they select the number f files they will be sending fr this specific dcumentatin type and participant. They can select a maximum f 3. If they have mre, they will have an ptin t submit mre dcuments, after submitting these. 8. The Brwse buttn will appear. The number f buttns that appear will crrespnd t the number f files the cnsumer selected in step 7. These are required fields. If the wrng number is selected, the cnsumer must g back and select the crrect number. 9. The cnsumer will select Brwse, and will g t their brwser and select the JPEG, GIF, PNG r PDF file they want t uplad. Each file can be up t 25MB in size. January 16, 2019 Page 39 f 54

40 Supprting Dcumentatin Uplad Tl Cnfirmatin Optin Submit 10. T receive an t cnfirm the submissin, the cnsumer will need t enter an address, and re-enter it fr accuracy. 11. The cnsumer will select submit t uplad the dcument(s). After they select submit, they will receive an errr if all fields are nt filled ut. The errr will indicate which fields are nt cmplete. NOTE: All selected files will be cleared, and the cnsumer will need t select all files (including the cver letter) again. 12. The cnsumer will receive an errr if they are attempting t uplad a file that is nt accepted. Errr Message One r mre dcuments did nt uplad prperly. Make sure yur dcuments are in JPG, JPEG, PNG, GIF r PDF frmat and d nt exceed 25MB. If yu are unable t submit yur dcuments using this website, fllw the directins n yur ntice t send yur dcuments by mail r fax r call r If there is n errr, the cnsumer will be taken t a Transitin Page (screensht belw), and an will be sent t the indicated address. The will be frm DNtReply@MNsure.rg, and will include the verificatin type and the name f the individual the supprting dcuments were fr (example belw). If a cnsumer gets t this page and des nt want t submit a dcument, they select Cancel submitting any dcuments and lg ut nw befre selecting Submit. January 16, 2019 Page 40 f 54

41 Supprting Dcumentatin Uplad Tl Transitin Page Submitting Mre Dcuments If the cnsumer selects Yes and selects Submit Mre Dcuments, they will be taken t anther uplad page. They will nt have t submit the cver letter again and will nt have the ptins under Actin Required. The cnsumer must enter the name f the individual the dcumentatin is fr and the date f birth f the individual. It may r may nt be the same as previus uplads. The cnsumer will select the type f verificatin. It may r may nt be the same as previus uplads. The cnsumer can fllw the instructins t uplad up t three files. If they chse t add an they will receive an fr this uplad. After they select Submit, if there are n errrs, they will be taken back t a transitin page. An will be sent t the indicated address. When they are dne submitting dcuments they will select N n the transitin page. January 16, 2019 Page 41 f 54

42 Supprting Dcumentatin Uplad Tl Lg Me Out They can select Lg Me Out. When they lg ut they will be taken t the Thank yu page. Thank Yu Page Frm the Thank Yu Page if the cnsumer selects lg in, they will be taken back t the first page f the tl, and can enter new infrmatin. Fr security purpses they will need t lg in again. T ensure their security a cnsumer shuld always clear their brwser histry when leaving the site. January 16, 2019 Page 42 f 54

43 Supprting Dcumentatin Uplad Tl Example Frm Dear (Name f primary applicant), We received yur verificatin submissin fr (Name f persn dcumentatin was fr) Yu sent us prf f: Gain f dependent(s) thrugh birth (Verificatin type selected) Thank yu. MNsure Cntact Center r January 16, 2019 Page 43 f 54

44 Supprting Dcumentatin Uplad Tl Imprtant Tips fr Assisters The tls cannt be used fr verificatins fr cases that are public prgram nly. The tl is used nly fr qualified health plan and mixed husehld cases. The verificatin uplad tl cannt be utilized the same day an SEP is requested. Cnsumers shuld be able t uplad cnsumer verificatin dcuments the day after requesting an SEP frm MNsure. The preferred way t use the verificatin tl is t wait fr the cnsumer t receive their SEP ntice frm MNsure and use the infrmatin n that ntice t fill ut the infrmatin required t use the verificatin tl. The uplad tl can be used withut the SEP ntice, but yu will need the fllwing infrmatin, which yu will can get when yu call the ARC/Brker Line/Cntact Center t reprt the SEP. Case number n the applicatin. This number is als knwn as the Integrated Case (IC) number. Name and Date f birth f the primary applicant n the applicatin. Nte: this may be different than the primary applicant n the enrllment. If yu are using the verificatin tl withut a ntice, skip the sectin asking t uplad the first page f the verificatin ntice. In rder t crrectly file the dcumentatin, the cnsumer s name, date f birth, and case number shuld be n each page f the verificatin that is upladed. Brker Line/ARC teams are unable t prvide infrmatin n whether a verificatin has been received in real time. Please wait a few days and using the Case Status Request frm fr this infrmatin. If a navigatrs r CACs calls the ARC t cnfirm the cnsumer s eligibility fr an SEP, the cnsumer must be physically present, r n the call at the time the call is initiated. ARC staff must speak with the cnsumer t verify three PIIs and give data privacy and security attestatin warnings. The cnsumer may then authrize the navigatr/cac t cmplete the SEP with the ARC. January 16, 2019 Page 44 f 54

45 SEP Pre-enrllment Verificatin Guide Cnsumer Prcess:...46 MNsure Prcess:...46 Acceptable Dcument List...48 Change in Husehld Size-Birth, Adptin, Placement fr Adptin r Fster Care, Child Supprt Order...49 Gain f dependent(s) thrugh birth...49 Gain f dependent(s) thrugh adptin, fster care r thrugh curt rder...49 Change in Husehld Size-Divrce, Legal Separatin, Death...49 Lss f dependent(s) due t divrce r legal separatin:...49 Lss f dependent(s) due t death:...49 Change in Husehld Size-Marriage...49 Gain f dependent(s) thrugh marriage...49 Lss f qualifying health cverage Lss f Minimum Essential Cverage (MEC)...50 Change in primary place f residence Address Change Resulting in Access t New Qualified Health Plans...50 Change in eligibility fr cverage thrugh MNsure-Newly Eligible fr Advanced Premium Tax Credits (APTC) r Cst-Sharing Reductin (CSR) fr Dependent Enrlled in Emplyer- Spnsred Plan...52 Change in eligibility fr cverage thrugh MNsure-Newly eligible fr QHP due t Gain f Citizenship, US Natinal, r Lawfully Present Status...52

46 SEP Pre-enrllment Verificatin Guide Cnsumer Prcess: The cnsumer: Receives a Request fr Infrmatin and Special Enrllment Perid Eligibility ntice The ntice will include: The due date (30 days frm the date f the ntice) The qualifying life event that the verificatin is fr Instructins fr submitting the dcumentatin The name and MNsure ID number f the individual A list f acceptable dcumentatin Submits cpies f the required dcuments. The cnsumer can submit dcuments by: Online at Or by ging t MNsure.rg and searching fr the keywrd verify r uplad. Fax ( ) Mail (Use return envelpe enclsed with the ntice) Includes the first page f the request fr verificatin ntice. Includes their name and case number n each dcument submitted. MNsure Prcess: MNsure peratins will be ntified and review verificatins as they are received. If the verificatin was received befre the 30 day due date, peratins staff will: Check if verificatin is sufficient and cnfirm SEP eligibility Check if the SEP enrllment is apprved based n the verificatin and cnfirm the effective date Verify enrllment Release enrllment t g t insurance cmpany Ntify the cnsumer f the apprval using the Qualifying Life Event and Special Enrllment Perid Cnfirmed ntice. January 16, 2019 Page 46 f 54

47 SEP Pre-enrllment Verificatin Guide If the dcumentatin is nt sufficient, but it is cnsidered a gd faith effrt, the cnsumer will be sent the Special Enrllment Perid Verificatin Extensin ntice, and be allwed anther 30 days t send sufficient dcumentatin. The cnsumer will be given instructins t submit dcumentatin using the same prcess as the riginal verificatin request letter. If the verificatin is sufficient, but des nt supprt the SEP eligibility, the cnsumer will be sent a Qualifying Life Event Nt Cnfirmed-Special Enrllment Perid Denied ntice. If the verificatin was received after the 30 day due date MNsure peratins staff will check t see if a gd faith extensin was given. If n extensin was given, they will deny the SEP and send a Qualifying Life Event Nt Cnfirmed-Special Enrllment Perid Denied ntice. If a gd faith extensin was given, and the verificatin is received within the extensin perid, they will fllw the same apprval steps listed abve and ntify the cnsumer f the SEP apprval using the Qualifying Life Event and Special Enrllment Perid Cnfirmed ntice. If the verificatin is nt sufficient, they will nt give anther extensin, and send a Qualifying Life Event Nt Cnfirmed- Special Enrllment Perid Denied ntice. If a gd faith extensin was given and the verificatin is received after the extensin perid, they will deny the SEP and send a Qualifying Life Event Nt Cnfirmed-Special Enrllment Perid Denied ntice. If n verificatin was received, after the 30 days, the cnsumer will be sent a Qualifying Life Event Nt Cnfirmed-Special Enrllment Perid Denied ntice. January 16, 2019 Page 47 f 54

48 SEP Pre-enrllment Verificatin Guide Acceptable Dcument List Select the links belw t g t the page listing the acceptable dcuments based n the reprted qualifying life event. Change in Husehld Size (Birth, Adptin, Placement fr Adptin r Fster Care, Child Supprt Order) Change in Husehld Size (Divrce, Legal Separatin, Death) Change in Husehld Size (Marriage) Lss f qualifying health cverage Lss f MEC Change in primary place f residence Address Change Resulting in Access t New Qualified Health Plans Change in eligibility fr cverage thrugh MNsure-Newly Eligible fr Advanced Premium Tax Credits (APTC) r Cst-Sharing Reductin (CSR) fr Dependent Enrlled in Emplyer- Spnsred Plan Change in eligibility fr cverage thrugh MNsure (Newly eligible fr QHP due t Gain Citizenship, US Natinal, r Lawfully Present Status r Change in Incarceratin Status) January 16, 2019 Page 48 f 54

49 SEP Pre-enrllment Verificatin Guide Change in Husehld Size-Birth, Adptin, Placement fr Adptin r Fster Care, Child Supprt Order Gain f dependent(s) thrugh birth Dcument t prve the date f birth: Birth certificate Gain f dependent(s) thrugh adptin, fster care r thrugh curt rder Dcument(s) t prve the date f adptin, fster care placement r curt rder. Accepted prfs: Curt rder defining the adptin, fster care r placement fr adptin r fster care Curt rder defining child supprt Other curt rder Change in Husehld Size-Divrce, Legal Separatin, Death Lss f dependent(s) due t divrce r legal separatin: Dcument t prve date f divrce r legal separatin. Accepted prfs: Curt rder Lss f dependent(s) due t death: Dcument(s) t prve date f death. Accepted prfs: Death certificate Public ntice f death (i.e. published bituary) Change in Husehld Size-Marriage Gain f dependent(s) thrugh marriage Dcument t prve the date f marriage. Accepted prfs: Marriage certificate Dcument(s) t prve the relatinship f child(ren) t the spuse, if adding child(ren) due t marriage. Accepted prfs: January 16, 2019 Page 49 f 54

50 SEP Pre-enrllment Verificatin Guide Birth certificate Curt rder defining the adptin, fster care placement r child supprt Other curt rder Dcuments t shw health care cverage prir t the marriage: HIPAA Certificatin shwing cverage within 60 days f the marriage Pay stub dcumenting emplyer/insurance deductin within 60 days f the marriage Dcumentatin f premiums paid r invice within 60 days f the marriage Cverage clsure r terminatin letter shwing the last date f cverage within 60 days f the marriage Other dcumentatin shwing that the last date f cverage was within 60 days f the marriage Lss f qualifying health cverage Lss f Minimum Essential Cverage (MEC) Dcument t prve the date that minimum essential cverage ended. Accepted prfs: Letter frm the health plan cmpany that indicates lss f cverage Letter frm emplyer Emplyer plan ntice that indicates a lss f cverage Ntice f lss f benefits frm a federal gvernment prgram (i.e. Medicare, TRICARE) Change in primary place f residence Address Change Resulting in Access t New Qualified Health Plans A cnsumer must submit ne f the listed prfs frm each f Grup A and Grup B (prvided belw), t prve the date f mve: If MNsure already has a recrd f the previus address (i.e. the cnsumer previusly applied fr cverage thrugh MNsure and recently reprted a permanent mve address change) AND The cnsumer had ther health care cverage fr ne r mre days during the 60 days befre the mve. January 16, 2019 Page 50 f 54

51 SEP Pre-enrllment Verificatin Guide A cnsumer must submit ne f the listed prfs frm each f Grup A, Grup B, and Grup C (prvided belw), t prve the date f mve: if they are a new applicant t MNsure AND either: Had ther health care cverage fr ne r mre days during the 60 days befre the mve OR Mved t Minnesta frm utside the U.S r frm a U.S. territry. Grup A list f accepted prfs (t shw date f the mve): Cpy f current lease Cpy f current mrtgage r real estate transitin Recently issued Minnesta driver s license r state ID Recent utility bill r billing statement frm the new address Recently issued vter registratin card Regarding a schl-aged child, schl recrds shwing recent enrllment in schl with new address Grup B list f accepted prfs (t shw health care cverage prir t the mve): HIPAA Certificatin shwing cverage within 60 days f the mve Pay stub dcumenting emplyer/insurance deductin within 60 days f the mve Dcumentatin f premiums paid r invice within 60 days f the mve Cverage clsure r terminatin letter shwing the last date f cverage within 60 days f the mve Other dcumentatin shwing that the last date f cverage was within 60 days f the mve Grup C list f accepted prfs (t shw address prir t the mve): Cpy f previus lease Cpy f previus mrtgage r real estate transitin Previus state driver s license r state ID Utility bill r billing statement frm the previus address January 16, 2019 Page 51 f 54

52 SEP Pre-enrllment Verificatin Guide Vter registratin card frm previus address Regarding a schl-aged child, schl recrds shwing enrllment in schl with previus address Change in eligibility fr cverage thrugh MNsure-Newly Eligible fr Advanced Premium Tax Credits (APTC) r Cst- Sharing Reductin (CSR) fr Dependent Enrlled in Emplyer-Spnsred Plan Dcument that prves the change in emplyer-spnsred insurance: Appendix A Change in eligibility fr cverage thrugh MNsure-Newly eligible fr QHP due t Gain f Citizenship, US Natinal, r Lawfully Present Status Dcument(s) t prve citizenship r immigratin status. Accepted prfs: U.S. Passprt Certificatin f citizenship r naturalizatin Tribal Affiliatin card r dcument Reprt f birth abrad f a U.S. citizen Birth certificate Certificatin f reprt f birth U.S. Citizen ID card Nrthern Marianas ID card Final Adptin decree Evidence f U.S. Civil Services emplyment befre June 1,1976 Military recrd shwing U.S. place f birth Sectin 1-1 f the Child Citizenship Act f 2000 dcumentatin Medical recrds January 16, 2019 Page 52 f 54

53 SEP Pre-enrllment Verificatin Guide Schl recrds Official religius recrds Federal r State census recrd DS2019 (Certificatin f Eligibility fr exchange visitr status. I-20 (Certificatin f Eligibility fr nn-immigrant student status) I-94 (Arrival/Departure Recrd) I-327 (Reentry Permit) I-551 (Permanent Resident Card) I-571 (Refugee Travel Dcument) I-766 (Emplyment Authrizatin Card) Machine-readable Immigrant Visa n unexpired freign passprt Temprary I-551 Stamp Unexpired Freign Passprt Other dcuments generally accepted as legal prf f citizenship r immigratin status January 16, 2019 Page 53 f 54

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