PATHWAYS TO HEALTH COVERAGE

Transcription

1 The following graphic is a visual representation of the process individuals and families go when learning about, applying for, enrolling in, renewing, and retaining s health insurance affordability programs. AWARENESS OF THE PROGRAMS APPLICATION ELIGIBILITY DETERMINATION Connect learns about health programs Certifi ed Broker Electronic Account created Existing account used verifi ed Denied for fi nancial may appeal shops without fi nancial Is it a special? must wait until next open or special to enroll in a makes selection decides to apply CAC Designated Organization applies as guest with s in-person help? Assistance verifi ed and s How does the client use tax credit? tax credit at the end of year partial APTC presses shop button to transfer info. to Is it open? views and shops for? client select a silver?, client receive, client client select a by the 15th of the and pay 1st s premium by the 25th of that? Where does the client go to get help? County Dept. of Human/ Social Services MA CAAS PE HCPF CMAP SPA Where is the sent? PE into worksheet PE completed Portal faxed to or Connect dropped off at mailed to or Connect or SPA mailed, dropped off, or faxed to County PE is Full Conditionally approved for reasonable opportunity verifi cation s sent full APTC the Fee for payment fee 30 days? 30 days Is a fee due? approved client provide verfi cation in s? is denial reapplies appeals s status MMIS hours ENROLLMENT enrolled the fi rst of the welcome after packet from the following insurance carrier receiving APTCs? premium each? a grace a 30 day grace premiums before grace ends? s ends until next open or special RENEWAL reports change and client need is to report a change? info. shops for a new auto renewable? CHANGES Mail Key enrolled the fi rst of the following action? is in the same verifi cation client provide verifi cation? What group is the client? enrolled until s next before the 21st of the enrolled? until Child Pregnant SMCN with woman is MCO action to change MCO? takes no action to calls to s MCO and Delta Dental send welcome card 7-10 days children s dental benefi ts begin on the fi rst of the after the pre-hmo Prior to renewal, checks for three s and uses to prepopulate re- Re- sent to client 60 days before recertifi cation client have changes to report? need to return the is renewal form RRR client provide changes prior to the RRR date provided on the notice? experiences a change How is it? In-person at an site Online in /SES Can the system verify? goes Do changes need to be change screens RMC? reports client have changes an existing using Report My Changes account? feature sent to SES is must create account and link case client pack and ID card client s dental benefi ts begin immediately is ACC client pick a calls Plan? s to pick a and PCMP DentaQuest welcome dental card up to 7 days after

2 The following graphic is a visual representation of the process individuals and families go when learning about, applying for, enrolling in, renewing, and retaining s health insurance affordability programs. awareness of the programs Connect learns about health programs Certified Broker Electronic Account created Existing account used verified decides to apply CAC Designated Organization applies as guest in-person help? Assistance verified Where does the client go to get help? County Dept. of Human/ Social Services HCPF MA CMAP faxed to or Connect CAAS SPA Where is the sent? dropped off at mailed to or Connect PE PE worksheet completed into PE Portal or SPA mailed, dropped off, or faxed to County

3 Key Denied for financial may appeal shops without financial Is it a special? must wait until next open or special to enroll in a with s and s tax credit at the end of year presses shop button to transfer info. to Is it open? views and shops for? How does the client use tax credit? partial APTC is full APTC Is a fee due? sent Fee for payment 30 days the fee 30 days? denial Conditionally approved for reasonable opportunity verification s client provide verfication in s? approved is PE Full

4 enrolled the first of the after the following welcome packet from insurance carrier premium each? receiving APTCs? a grace a 30 day grace premiums before grace ends? makes selection client select a silver? reapplies appeals, client receive, client client select a by the 15th of the and pay 1st s premium by the 25th of that? enrolled the first of the following What group is the client? s before the 21st of the? Child Pregnant woman enrolled until next enrolled until SMCN with is MCO action to change MCO? takes no action to calls to s s status MMIS hours client pack and ID card client s dental benefits begin immediately client pick a Plan? DentaQuest welcome dental card up to 7 days after is ACC calls s to pick a and PCMP

5 Renewal Key s ends until next open or special client need to report a change? reports change and is info. auto renewable? shops for a new action? is in the same MCO and Delta Dental send welcome card 7-10 days children s dental benefits begin on the first of the after the pre-hmo Prior to renewal, checks for three s and uses to prepopulate re- Re- sent to client 60 days before recertification client have changes to report? need to return the renewal form client provide changes prior to the RRR date provided on the notice? is RRR

6 Changes Key Mail verification client provide verification? experiences a change How is it? in /SES Can the system verify? In-person at an site is goes change screens Do changes need to be RMC? Online client have an existing account? reports changes using Report My Changes feature sent to SES must create account and link case 600 Grant Street, Suite 800 Denver, CO (303)