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This week newsletter includes updates and tips to help assisters facilitate enrollment, including immigration and identity proofing information, and includes detailed information on the plan compare and selection process.
Due to the holidays, there will be no call this Friday, December 27th. We will resume our regular weekly call in the New Year starting on Friday, January 3rd. We want to take a moment to say thank you for the enormous efforts you are making to assist consumers and hope that you enjoy the holidays and get to spend time with family and friends.
Last week, CMS finalized the Application for Exemption from the Shared Responsibility Payment based upon a variety of circumstances, including hardship. The exemptions applications can be found on Marketplace.cms.gov, on the Get Official Resources page, in the Publications & Articles section.
CMS also clarified that a consumer whose health plan has been cancelled and cannot afford a Marketplace plan to replace it may apply for a hardship exemption. The hardship exemption will allow the consumer to buy a catastrophic plan. We remind assisters to make sure these folks check Marketplace coverage prior to submitting an exemption application. Information on this particular hardship exemption, a toll-free number (1-866-837-0677) to call for assistance in understanding the options, the application for a hardship exemption, and a list of catastrophic plans available, by geographic area, may be found on Healthcare.gov under the topic “What if my individual health insurance plan is changing or being cancelled?” and “Cancelled plan? You’ve got coverage options.” More information can also be found in a bulletin published last week, “Options Available for Consumers with Cancelled Policies.”
In addition to hardship, there are exemption applications for
Again, the applications for exemptions may be found on Marketplace.cms.gov (click here).
The deadline to sign up for coverage to start January 1st was December 23rd. Experiencing high demand and the fact that consumers may be enrolling from multiple time zones, we have taken steps to make sure that those who tried to enroll yesterday but had delays due to high traffic have a fail-safe. We have programmed our systems to support January 1 coverage for those who attempt to complete their enrollment through the end of the day today (December 24, 2013). This is similar in concept to Election Day; if you are in line when the polls close, you still get to vote.
We want to remind assisters that consumers need to pay their premium directly to the insurance company in order to have coverage by January 1, 2014. Consumers can pay when invoiced by the plan, call the issuer to make payment, or pay online if the plan accepts online payment. All consumers have until at least December 31 to pay for coverage effective January 1, although some insurance companies have extended this deadline. Consumers should check with their insurance company to find out when their first premium is due in order for coverage to be effective January 1. Consumers should also confirm with the issuer that their first month’s premium has been received and that enrollment is complete.
Please note that once a consumer selects a plan through the Marketplace, it may take the health plan 48-72 hours to receive and process the enrollment, so please encourage consumers to continue to periodically check back with their selected health plan. The insurance company will also send plan information and an insurance card to consumers who have completed enrollment including payment of the premium.
We’ve updated a consumer blog to reflect the latest information:
Tips to help you enroll in Marketplace coverage: Completing your enrollment
Tips to help you enroll in Marketplace coverage: After you’re enrolled
While yesterday was a significant date for Americans looking to secure coverage beginning January 1st, it is important to remember that we are about halfway through the full six month open enrollment period. We will continue to work to ensure that HealthCare.gov and our other enrollment channels continue to improve and are available for consumers looking to sign up for affordable coverage by the end of March and will continue to keep you updated with the latest information.
Our recommended troubleshooting option for the majority of consumers who are experiencing technical difficulties with their online application remains the same as last week. We recommend they try starting the process again by removing and restarting an application. This way, consumers can start with a fresh slate and take full advantage of the recent fixes we’ve made to the system.
If a consumer’s effort to remove and start over with a new application still leads to the same issue, or a consumer has run into other issues, at this point we recommend that the consumer call the Call Center (1-800-318-2596) for assistance. The Call Center will work to assist consumers to successfully move them through the enrollment process.
We wanted to highlight items to remember when assisting a consumer with regards to immigration status and documentation. Consumers filling out the application will need to attest to either being a U.S. Citizen, a naturalized or derived citizen, or in an eligible immigration status in order to be determined eligible to enroll in qualified health plans, to receive Advanced Payments of Premium Tax Credits or Cost-Sharing Reductions, or to be determined eligible for other Insurance Affordability Programs such as Medicaid or CHIP.
If a consumer attests to having an eligible immigration status on the application, they will be asked to provide information about their most current immigration document that supports their status. On the application, there is a drop down field where they can select their document.
After a document is selected, a number of fields will appear requesting certain document numbers that can be found on the immigration document. Depending on the document selected, the document numbers requested of applicants might change. There is a helpful guide on healthcare.gov that outlines which document numbers will be requested of each document type.
The Marketplace uses the document type and associated document numbers to verify an individual’s status with the Department of Homeland Security (DHS). Each of the document numbers shown on the screen are needed in order to successfully run a verification of the information through DHS. We encourage assisters to support applicants in trying to locate and input all of their document numbers, if possible, so that we can verify the individual’s status in real-time.
However, these fields are optional on the application since many consumers may encounter difficulty in locating their document numbers, may be confused, or may have difficulty entering the document numbers into the application. If that is the case, consumers are able to continue through the application without inputting all of the immigration status information, and will then be asked to provide a copy of their documentation to the Marketplace once they have completed the application. The Marketplace will then manually verify the immigration documentation.
The following links on HealthCare.gov should be helpful if there are questions about documentation:
- Information on Eligible Immigration Status Types
- More Information on Eligible Immigration Status Types
- Information for Naturalized or Derived Citizens
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Information on Immigration Documentation and how to correctly put it into the application
Q: How can I help consumers who have problems in the ID proofing process?
A: All applicants must verify their identity in order to be able to fill out the application, compare plans, and enroll in a plan. If the consumer does not pass initial identity proofing online, the screen will show a unique Reference ID Number and the Experian help desk telephone number (1-866-578-5409) for the consumer to call to resolve the issue. The consumer must have their unique Reference ID Number to enable Experian to assist the consumer. The consumer can log back into their Healthcare.gov account and pull up their Reference ID Number if they do not remember it.
The consumer should write down and keep the Reference ID Number the system provided and call the Experian Help Desk at 1-866-578-5409.
If ID proofing was successful with the Experian Help Desk, consumers must log out of their Healthcare.gov account, wait 24-48 hours, and then log back in to see their ID proofing results reflected on their application. When consumers log back in, they can proceed with the ID proofing process again and then complete their application. Consumers should use the same answers they used before to successfully pass the ID proofing process.
If ID proofing through the Experian Help Desk telephone process is not successful, or the consumer cannot locate or the system did not generate a Reference ID Number, the consumer should follow the manual ID proofing process. Consumers who do not have a credit history will have to follow the manual ID proofing process. The fastest way to do this is to upload documents to their HealthCare.gov account. At this point, we recommend that consumers upload documents, rather than mailing them, to ensure faster processing.
Consumers can upload a copy of any one of these documents:
- Driver’s License
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School ID Card
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Voter Registration Card
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U.S. Military Card
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U.S. Military Draft Record
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ID card issued by the federal, state or local government
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Military Dependent ID Card
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Tribal Card
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Authentic Document from a Tribe
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U.S. Coast Guard Merchant Mariner Card
Or, the consumer can upload any two (2) of these documents:
- U.S. Public Birth Record
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Social Security Card
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Marriage Certificate
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Divorce Decree
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Employer Identification Card
- High School or College Diploma
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Property Deed or Title
Consumers also have to option to mail documents to:
Health Insurance Marketplace
Department of Health and Human Services
465 Industrial Blvd.
London, KY 40750-0001
For documents that are uploaded to HealthCare.gov, the ID proofing team reviews the documents and makes a determination quickly, but at this time consumers may not receive notice that the ID proofing process is complete. Thus, consumers should check their HealthCare.gov accounts about 24-48 hours after uploading their ID proofing documents to HealthCare.gov and proceed with their application.
Please note that ID proofing cannot be done for individuals under the age of 18. An adult in the household over 18 should create the account and act as the application filer. It doesn’t matter whether the application filer needs coverage or not. The application filer signs the application and receives all communication from the Marketplace (unless the consumer has appointed an authorized representative). The Marketplace only requests ID proofing for the application filer.
Consumers that receive a message to return to the ID proofing process in 24 hours may have received a server error message and are encouraged to continue to attempt the ID proofing process. Technicians continue to work to improve functionality and we will continue to provide you updates on ID proofing in the future.
More information is available in the Experian FAQs on the CMS Marketplace Assister page (click here).
This week we also posted new FAQs on the Marketplace Assister page, found here. Please make sure you review these FAQs and continue to check this page as we will continue to post additional FAQs in the future.
The online application begins with account creation (including identity proofing) and ends with the consumer seeing their eligibility results. The consumer will then move on to compare plans and select a Qualified Health Plan (QHP) if he or she is eligible. The following includes an in-depth look into the plan comparison and selection process.
Plans displayed are based on information submitted on the eligibility application, including:
- Rating area (zip code & County)
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Number of family members seeking coverage
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Family members’ ages and tobacco status
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Applicant’s preferences
Only eligible plans are displayed. As you are aware, consumers can browse plans before applying at https://www.healthcare.gov/find-premium-estimates/.
After receiving eligibility results, the consumer will be shown their “Enroll to-do list” to help navigate the consumer through the plan comparison process. They will be asked plan compare questions including how much APTC they want to apply to reduce their premiums, their tobacco status, and enrollment grouping. Enrollment group refers to who will be on a plan together. Plans have different rules about who is an eligible dependent, such as spouses and children. Plan Compare will provide valid default enrollment groups that enable a consumer to see plans, but the consumer can also form a different enrollment group. If a consumer forms an enrollment group that isn’t supported by any plans, the consumer will be prompted to regroup until valid groups are formed. In general, putting a family in one plan or several plans doesn’t affect the total premium, though consumers with more than three children under 21 may benefit from one enrollment group, since additional children on the same plan aren’t rated.
Consumers who are eligible for APTC have the option to decide how much of their premium tax credit to use on a monthly basis. This choice is then reflected in the plans they will see and compare. The system will prompt the consumer to select how much APTC amount they want to use for their premium discount each month. There is a slider tool to help the consumer select the amount for premium discount.
Plan Compare Questions
Next the consumer will be asked additional questions on household and tobacco usage prior to seeing plan results. The question about tobacco use is very specific. The question asked on the application is this: Within the past 6 months, have you used tobacco regularly? Regular tobacco use is defined next to the question as “using tobacco 4 or more times per week on average, excluding religious or ceremonial uses.” This question will be asked for each member of the household who is over the age of 18 and seeking health coverage.
When you are assisting consumers, you should tell them to answer this question truthfully. So, if during the past 6 months, they have used tobacco 4 or more times per week, on average, they should answer yes to the question on whether they use tobacco regularly. The only exception to this is if they are using tobacco for religious or ceremonial purposes. Religious or ceremonial use of tobacco does not count as “tobacco use” when determining whether an individual uses tobacco regularly. If a person answers “yes” to the question about regular tobacco use, they will also be asked on the application to provide the date when they last used tobacco regularly. This question should be answered truthfully for each household member who answered yes to the question about regular tobacco use. A tobacco user can’t change their tobacco status until the next enrollment period.
Plan Comparison
Before seeing plan results, the consumer is shown information on plans. Next, the consumer will be able to compare health plans using the “Metal Table” which summarizes plans by metal level, displaying premium ranges and cost sharing, such as deductibles, for all the plans that are available to that family. Once the consumer is on the plan results page, summary information about plans is presented, including the cost of premiums. The more prominent premium shows the monthly price net of APTC, but the consumer can also see the pre-APTC premium. The consumer can filter by premium, deductible, maximum out of pocket, whether adult/child dental is included, plan type including national network, HSA eligibility, and Medical Management Program. If the consumer is a family with an out of state family member, they may want to give consideration to a plan with a national network. The consumer can also compare plans in detail or using a side-by-side view.
Plan Selection
Next, the consumer can select health plans for everyone seeking coverage on the application by clicking “enroll” from the results, side-by-side, or details views. Different warnings may display that indicate a consumer may have missed the opportunity to participate in a plan with cost savings reduction or that they selected a plan covering a child that does not provide child dental coverage.
Dental Plan Selection
Next, the consumer has the option to select a separate dental plan if they choose one (if no separate dental plan is desired, the consumer can skip directly to the “Review and Confirm” task). A Marketplace health plan is required, while dental plan selection is optional. The consumer will be asked if they are interested in separate dental coverage and the process will proceed similar to the medical plan compare and selection process. If someone wants to apply for dental coverage only (e.g. their employer doesn’t offer it), they cannot apply for dental only through the Marketplace at this time as dental plans are not sold through the Marketplace without a Marketplace health plan. The consumer would have to purchase medical coverage and then they will get the option of purchasing the dental plan in addition. Some medical plans do include child or even adult dental. A dental plan must be purchased before coverage starts for the health plan.
Review & Confirm Coverage and Payment
Next, the consumer will attest to their APTC and confirm their plan selection. We want to remind assisters that consumers need to pay their premium directly to the insurance company in order to have coverage by January 1, 2014. Consumers can pay when invoiced by the plan, call the issuer to make payment, or pay online if the plan accepts online payment. The green “Pay for Plan” button means online payment is available. All consumers have until at least December 31 to pay for coverage effective January 1, although some insurance companies have extended this deadline. Consumers should check with their insurance company to find out when their first premium is due in order for coverage to be effective January 1.
Changing Plans
Consumers who want to cancel or change plans can log in to MyAccount and change to a different plan under My Plans and Programs. The consumer will click End or Terminate All Coverage. A consumer should use cancel when no Marketplace coverage is sought or “change plans” to switch plans.
They will go through the process again. It’s important to remind consumers that if they want to remove an application that has a plan associated with it, they must cancel that plan.
If you are a Navigator grantee and have specific questions or issues you’d like to see us highlight in our weekly webinar/conference call, or here in this newsletter, please get in touch with your Navigator project officer. If you are a CAC designated organization, please send an email to CACQuestions@cms.hhs.gov.
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