o Enrollment requirements for IDPH programs o Contact Information to find a local enrollment specialist

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1 This packet contains IMPORTANT information about The Affordable Care Act and how it will coordinate with the Illinois Department of Public Health s Ryan White Programs This packet contains: Informational letter from IDPH o Types of coverage o IDPH plan requirements o Enrollment requirements for IDPH programs o Contact Information to find a local enrollment specialist Form to take with you (with required documentation) to your enrollment appointment Definition sheet to better understand Affordable Care Act (ACA) wording Take the following action steps immediately: 1. Read all information to gain a better understanding ACA, Ryan White Programs, and you. 2. Contact the for enrollment appointment. 3. Take the completed ACA Passport Form and required documentation with you to your enrollment appointment. Frequently Asked Questions: If I am not a U.S. Citizen, do I qualify for coverage? Yes. If you are a permanent resident (documented) within the United States, and are within the 5 year waiting period you may enroll in Get Covered Illinois. If you are not documented within the United States you may enroll in plans that are offered outside of the Marketplace (without subsidy), and we will assist with those premiums up to $750 per month, if you meet the eligibility requirements and qualify for our program If I have Medicare A&B only, am I required to enroll in Get Covered Illinois? Yes, but not here If you have Medicare A&B you automatically qualify for Part D, and must enroll with a Medicare prescription plan prior to the close of Open Enrollment period for Medicare on December 7, Please contact Medicare for enrollment instructions, you DO NOT enroll for Medicare through the Affordable Care Act (Get Covered Illinois). The official Medicare website is If I receive Social Security Disability Income (SSDI), but have not reached my 24 months to qualify for Medicare, am I required to enroll in Get Covered Illinois? Yes Persons receiving SSDI, but have not met their 24 month eligibility requirement to enroll in Medicare, are required to enroll in health coverage offered through Get Covered Illinois. Page 1 of 8

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3 IMPORTANT INFORMATION Regarding GET COVERED ILLINOIS and the Affordable Care Act Date: October 25, 2013 TO: Clients currently enrolled or interested in enrollment in ADAP or CHIC FROM: Dr. Jeffrey P. Maras - Administrator RE: Follow Up Get Covered Illinois enrollment through the Affordable Care Act Get Covered Illinois is now accepting enrollment that will allow you to obtain Insurance coverage to begin January 1, If you are currently uninsured, you will be required to enroll in Get Covered Illinois by March 31, 2014 If you would like your coverage to begin by January 1, 2014 you will need to enroll by December 15, 2013 Get Covered Illinois Information Medicaid Expansion Coverage that will include any person, regardless of age, gender, family size, or pre existing condition; whose total household income is at or below 138% of the Federal Poverty Level and are a legal resident. Beginning November 28, 2013 we will begin paying for copays associated with Medicaid covered medications contained on our formulary. You must be a current ADAP client and medications must be ordered from our contract mail order pharmacy. Insurance Marketplace Coverage that will include any person, years of age, gender, family size, or pre existing condition; whose total household income is above 138% of the Federal Poverty Level, are a legal resident, and do not have a current insurance plan that would disqualify them from the marketplace. 138% for a household size of 1 = $1,321 per month, or $15,856 yearly (Your enrollment specialist can help you determine income requirements for household sizes larger than 1) Page 3 of 8

4 To ensure client satisfaction, we recommend you enroll in your plan with either an In Person Counselor (IPC) or Certified Application Counselor (CAC). **Note you should never have to pay for ACA enrollment assistance as it is FREE! We recommend you see your Case Manager first to discuss Ryan White requirements and information regarding the IPC or CAC closest to you. Below is the contact information for the Lead Agency that serves your county. The Lead Agent organization that serves your county will be able to connect with your assigned case manager or to answer questions regarding the closest IPC or CAC in your area. (Referenced below by County) SIU School of Medicine - Springfield, IL or Toll Free Adams, Brown, Cass, Christian, DeWitt, Greene, Logan, Macon, Menard, Montgomery, Morgan, Moultrie, Piatt, Pike, Sangamon, Schuyler, Scott, and Shelby Champaign-Urbana Public Health District - Champaign, IL or Toll Free Champaign, Clark, Clay, Coles, Crawford, Cumberland, Douglas, Edgar, Effingham, Ford, Iroquois, Jasper, Kankakee, Lawrence, Livingston, Richland, and Vermilion UIC College of Medicine - Peoria, IL or Toll Free Fulton, Hancock, Henderson, Knox, LaSalle, Marshall, Mason, McDonough, McLean, Peoria, Putnam, Stark, Tazewell, Warren, and Woodford AFC - Chicago, IL or Cook, Dupage, Grundy, Kane, Kendall, Lake, McHenry, and Will Winnebago County Health Department - Rockford, IL Boone, Bureau, Carroll, DeKalb, Henry, JoDaviess, Lee, Mercer, Ogle, Rock Island, Stephenson, Whiteside, and Winnebago Jackson County Health Department - Murphysboro, IL or Toll Free Alexander, Edwards, Franklin, Gallatin, Hamilton, Hardin, Jackson, Jefferson, Johnson, Massac, Perry, Pope, Pulaski, Saline, Union, Wabash, Wayne, White, and Williamson St. Clair County Health Department - Belleville, IL Bond, Calhoun, Clinton, Fayette, Jersey, Macoupin, Madison, Marion, Monroe, Randolph, St. Clair, Washington Please feel free to give us a call if you have any questions. Contact us at if you have questions or concerns about this process. The Department wide TTY number is (for hearing impaired only). Page 4 of 8

5 Prescription Assistance for Copayments and Deductibles (ADAP) For an insurance plan to be eligible for use with our Prescription Assistance Program, it must meet the following guidelines: Have Prescription Coverage. Allow CVS Mail Order Specialty Pharmacy in Monroeville, PA to fill prescriptions. Include Specialty Medication groups similar to ADAP s formulary. The following are the ONLY Insurance Marketplace plans are eligible for use with The IDPH Prescription Assistance Program (ADAP and CHIC): Aetna - Blue Cross Blue Shield Health Alliance - Humana Silver, Gold, and Platinum Plans Only (NOT BRONZE OR CATASTROPHIC PLANS) Insurance Premium Payment Assistance (CHIC) Please note that our Insurance Premium program can help you pay up to $750 per month towards your monthly premium (after any federal stipend). To qualify for our Premium Assistance Program (CHIC) You must: Select Advance Premium Tax Credit when enrolling in the Get Covered Illinois. Not have Insurance Premiums auto deducted from payroll and paychecks, Social Security, Credit Card, or Bank Account, or any similar account. Meet Ryan White Part B eligibility requirements. The insurance plan: o Must have Prescription Coverage. All plans on Get Covered Illinois include prescription coverage. o Can include Dental and/or Vision for premium assistance. o CHIC cannot pay premiums for Life Insurance or Flexible Spending Accounts. Clients may elect these coverage choices, but will be required to pay that portion of the premium on their own. Recommendation: If your income is between 139%-250% of the Federal Poverty Level, a Silver Plan with the Cost Share Reduction could be the most beneficial plan. Cost Share Reductions allow for a lower deductible and Maximum Out-of-Pocket. 139% - 250% for a household size of 1 = $1,321-$2,394 per month, or $15,856-$28,725 yearly (Your enrollment specialist can help you determine income requirements for household sizes larger than 1) Page 5 of 8

6 Affordable Care Act (ACA) Definitions Definitions: Premium What a person must pay in order to enroll in health coverage. Premiums are usually paid monthly by the person who is insured. Federal Subsidy The portion of your monthly premium that the Federal Government will pay for you. This amount is based on income and is taken in the form of a Tax Credit. It will be REQUIRED to be taken in the form of Advanced Premium Tax Credit if you would like IDPH to provide additional assistance with premium payments. Deductible Yearly amount required to be paid before Insurance plan will begin covering their portion. Member is responsible for 100% of all services until Deductible is met. Copayment The set amount paid for services after the Deductible has been met. Maximum out of pocket expense The total amount of deductible and copayments that will be paid before Insurance begins covering 100%. Member will not be responsible for any copayment or deductible during this timeframe, unless the Maximum Dollar Limit is met. Federal Tax Credits New federal tax credit that will help subsidize the cost of purchasing a health plan through Get Covered Illinois ( % FPL). In Advance: Families can receive the tax credit on an advance basis when they buy their plans. Known as an ADVANCE PREMIUM TAX CREDIT. URGENT Required for those seeking Premium Assistance through Ryan White CHIC No Exceptions! At Tax Filing Time: Families can also pay the money up front for their premiums, and receive the credit when they file their tax returns. When taken at tax filing, it is known as a premium tax credit. This will disqualify your plan for premium assistance with our CHIC program. If you would prefer to find your own enrollment specialist, you can go visit the following website: Enter your zip code for a list of locations in your area Page 6 of 8

7 What to do Next Checklist 8 Simple Steps 1. Schedule an appointment with your Ryan White Case Manager to discuss preparation steps for preparing for your meeting with your Get Covered Illinois enrollment session. a. Case Mangers will assist with referrals to the appropriate In Person Counselor or Certified Application Counselor. 2. Fill out the ACA Passport form on the next page. 3. Gather all documents listed on ACA passport. 4. Schedule an appointment with an In Person Counselor or Certified Application Counselor. 5. Take ACA Passport form and documents with you to your appointment for Get Covered Illinois Enrollment. 6. Write what plan you were enrolled in through Get Covered Illinois on the line below (For future reference) 7. As soon as you receive your Insurance cards - Send copies of all cards (both front and back) to ADAP/CHIC 8. As soon as you receive your first Premium Invoice, Bill, Coupon Book, or Benefit Statement Send a copy to ADAP/CHIC. a. Note ADAP/CHIC requires a copy of all OFFICAL documentations received from the insurance plan(s) you enrolled within that outlines the premium amount, frequency of premium payment, and the address that premium payments are to be mailed of the plans you selected. You can , fax, or postal mail all documents to: DPH.ADAPFAX@Illinois.gov Fax: (Toll Free) or Mail: 525 West Jefferson, 1 st Floor Springfield, IL Page 7 of 8

8 ACA Passport for enrollment assistance coordination with IDPH (Bring completed form and all documentation listed below to your appointment with you IPC or CAC) Your Name: DOB My Non ADAP medications are: I currently get my Non ADAP medications from If I became really sick, I would like to go to My primary care provider is: o I see him/her at clinic/hospital. My specialist physician is: o I see him/her at clinic/hospital. Other specialists I see: o I see him/her at clinic/hospital. pharmacy or clinic. clinic/hospital I get my mental health care at o My psychiatrist is hospital or clinic. o My therapist is Documents I need to bring with this form to prepare for my appointment for A.C.A. enrollment State ID or other form of identification with my picture 2012 Tax forms Federal 1040 (If you filed a Tax return) Pay stubs or checks from my job dated within the last 90 days (If you are currently working) Social security card or Number Piece of mail such as government mail, phone or utility bill, rent or lease receipt with my current address URGENT REQUIREMENTS: Please check mark one or more of the IDPH programs you plan to use. Prescription Assistance (ADAP) REQUIRED to pick one of the following plans to comply with the requirements of the prescription assistance program, you are also responsible to verify that your ADAP medications are covered under the plan you choose. Aetna Blue Cross Blue Shield Health Alliance Humana Silver, Gold, & Platinum Plans ONLY (not Bronze or catastrophic plans) Premium Payment Assistance (CHIC) REQUIRED to select the Advanced Premium Tax Credit (Does not apply to Medicaid) Option when enrolling into my Insurance Plan to comply with the program requirements. Any amount above $750 per month is the client s responsibility to pay (See CHIC section on page 3 for specific plan requirements) Any questions about IDPH requirements for ACA Enrollment, please do not hesitate to call us Toll Free at , or (217) for out of state phone numbers Page 8 of 8