Re: Special Enrollment outside Qualified Health Plan Open Enrollment Frequently Asked Questions (FAQs) Week of March 24, 2014

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1 Re: Special Enrollment outside Qualified Health Plan Open Enrollment Frequently Asked Questions (FAQs) Week of March 24, 2014 Background: The following FAQs provide additional information for customers regarding criteria and conditions of Special Enrollment after Open Enrollment has closed. This information provides background about who qualifies for Special Enrollment, what documentation is needed, the timeline related to reporting changes for an eligibility and enrollment determination as well as the deadline to submit supporting documentation. Washington Healthplanfinder s Qualified Health Plan Open Enrollment period closes on March 31, 2014 at 11:59 p.m. The next Qualified Health Plan Open Enrollment is November 15, 2014 to February 15, Other related frequently asked questions including information about the Washington Healthplanfinder case-by-case review for retroactive coverage are available at: How can I enroll in a Qualified Health Plan outside of Open Enrollment? Any customers who are still waiting for their application to be finalized may qualify for a special enrollment outside of the March 31 deadline on a case-by-case basis. Applications and any requests for retroactive coverage will be reviewed by staff and steps will be taken to resolve the technical issues associated with these applications. We apologize for the inconvenience these customers have experienced and want to thank them for their patience as these errors are resolved. Outside of Open Enrollment, you can enroll in a Qualified Health Plan through Washington Healthplanfinder only if you have certain life events that qualify you for a Special Enrollment period. Some of these life events include getting married, having or adopting a baby, moving to a new address, or losing other health care coverage. The following Washington Healthplanfinder customers may enroll in coverage year-round: Those who qualify for or are renewing Washington Apple Health (Medicaid) coverage American Indians/Alaska Natives who are enrolled members of a Federally-recognized Tribe or an Alaska Native Corporation Those enrolling in the Small Business Health Options Program offered in Clark and Cowlitz counties What types of life events should I submit to Washington Healthplanfinder to qualify for insurance coverage outside of the standard Open Enrollment period? In order to buy a Qualified Health Plan outside the Open Enrollment period, you must have a qualifying life event. Qualifying life events that create a Special Enrollment period include: Getting married Giving birth, adopting, or placement of a child Permanently moving to a new area that offers different health plan options pg. 1

2 Losing other health coverage (for example due to a job loss, divorce, loss of eligibility for Medicaid or CHIP, expiration of COBRA coverage, or a health plan being decertified). Note: Voluntarily quitting other health coverage or being terminated for not paying your premiums are not considered loss of coverage. Losing coverage that is not minimum essential coverage is also not considered loss of coverage.) For people already enrolled in Washington Healthplanfinder coverage, having a change in income or household status that affects eligibility for health insurance premium tax credits or cost-sharing reductions For additional special enrollment event list, see below for What documentation do I need to submit in order to verify my eligibility for a Special Enrollment? If you have a qualifying life event which is verified either electronically or through documentation, you will qualify for a Special Enrollment period. This means you can enroll in or change your health insurance plan outside the Open Enrollment period. How long is a Special Enrollment period? If you qualify, your Special Enrollment period lasts 60 days from the date of the qualifying life event. Please account for the time that it might take you to report the qualifying event to Washington Healthplanfinder. As an existing customer, how do I apply for a Special Enrollment? You can report a change through your Washington Healthplanfinder account. After you complete the Special Conditions questionnaire through Healthplanfinder and are determined preliminarily eligible for a Special Enrollment period, you will select and pay for a Qualified Health Plan (and dental plan if you have eligible children in your household). If Washington Healthplanfinder is not able to electronically verify your qualifying event, you will receive a letter via or mail directing you to submit documentation. Final determination and confirmation of Special Enrollment will be provided after you submit As a new customer, how do I apply for a Special Enrollment? Click the Apply for Coverage button from the Washington Healthplanfinder homepage to fill out the application for free or low-cost coverage to see if you qualify for Washington Apple Health (Medicaid) or a Qualified Health Plan. Only if you are eligible for coverage through a Qualified Health Plan will you need to provide information about any special conditions that could qualify you for a Special Enrollment period. After you complete the Special Conditions questionnaire through Healthplanfinder and are determined preliminarily eligible for a Special Enrollment period, you will select and pay for a Qualified Health Plan (and dental plan if you have eligible children in your household). If Washington Healthplanfinder is not able to electronically verify your qualifying event, you will receive a letter via or mail directing you to submit documentation. pg. 2

3 Final determination and confirmation of Special Enrollment will be provided after you submit How much time do I have to submit my documentation for Special Enrollment? How do I submit the appropriate documents? You have 60 days to submit documentation to Washington Healthplanfinder from the date that you reported a change to Healthplanfinder or submitted an application and became newly eligible for a Qualified Health Plan through a Special Enrollment period. Please note that this timeline is different from the length of your Special Enrollment period which lasts 60 days from the date of the qualifying life event. There are several ways you can submit documentation to support your qualifying event for a Special Enrollment period: Online: Scan your documents so that they are electronically available to you on your computer Sign in to your Washington Healthplanfinder account at Click the Action tab from your dashboard Click Upload Document Choose Category Life Event, that best relates to special enrollment circumstance Choose Type of Document that reflects the change reported Select Regarding Household Member and choose the individual this document reflects Provide additional information about the document if necessary Upload the scanned document by clicking Browse and choosing the file Click Submit Fax: 1-(360) Documents@wahbexchange.org Mail: Washington Healthplanfinder PO Box 946 Olympia, WA What happens if I don t submit documentation in time? You have 60 days to submit documentation to Washington Healthplanfinder from the date that you reported a change to Healthplanfinder or submitted an application and became newly eligible for a Qualified Health Plan through a Special Enrolment period. If Washington Healthplanfinder does not receive the documentation in time, the new or updated Qualified Health Plan enrollment will not be effectuated. The status will be reverted to the condition prior to change report (i.e. if you submit a change in income and do not provide payroll documents, Healthplanfinder will revert the income you provided in your earlier application and any associated enrollment). Any premium differences will be reconciled on your next invoice. pg. 3

4 What documentation do I need to submit in order to verify my eligibility for a Special Enrollment? Special Enrollment Event Add dependent(s) including: Birth, adoption, placement for adoption, or placement in foster care Type of Documents* Birth certificate, adoption documentation, foster care papers, medical support order, court order appointing a guardian, termination notice (for dependent added due to loss of ESI), other Add dependent(s) including: Marriage or loss of Minimum Essential Coverage Marriage Certificate, Certificate of Loss of Health Coverage, letter from Medicaid or other program indicating loss of coverage, copy of divorce decree or annulment papers, affidavit for dissolution, COBRA letter Address changed (Permanent move) Mail from government to new address, mail from utility to new address, other Citizenship status changed U.S. Passport, Enhanced Driver s license or State ID, Certificate of naturalization, Certificate of Citizenship, Official state/county U.S. Birth Certificate, Other Certification of Birth Issued by Department of State, Department of Health (DOH) printout for Washington State Birth, U.S. Citizen ID Card, Final adoption decree in the U.S., Evidence of civil service employment by the U.S. government before July 1976, Official military record of service that shows a U.S. place of Birth, and Other Incarceration status changed Released Paper from Government Authority, Notarized document declaring nonincarceration status, and Other Income changed Company Payroll Documents (three most current documents), Employer Statement, Income Tax Forms, Award Letter, Bank Statements Showing Direct Deposit, Self- Employment Agreements/Contracts, and Other Individual has tribal nation status National or lawful presence changed Removed dependent Tribe Membership Statement, Documentation from relevant governmental agency, and Other Entry VISA Number, I-551 Alien Number, I-94 Card Number, INS Notice Receipt Number, Passport Number, Permanent Resident Card with Photograph (form I-151), U.S. Military Card or Draft Record Death certificate, Divorce Decree or Annulment papers, Affidavit for Dissolution, COBRA letter *Documentation list subject to change pg. 4

5 What is the process for Washington Healthplanfinder to verify my Special Enrollment eligibility? Washington Healthplanfinder will verify qualifying events using electronic verification whenever possible to verify the most recent information in an application. If electronic verification is not possible, Washington Healthplanfinder requires submission of documents that support the qualifying event within 60 days from the date that the change is reported or new application is submitted to Washington Healthplanfinder. Please note that the review of documentation may take up to two to three weeks, but should not cause the deadline to be missed. If you have questions about your status, please contact the Customer Support Center at If I am an American Indian/Alaska Native (AI/AN) and can enroll throughout the year, why do I receive a message that Open Enrollment is Closed while I m trying to enroll after March 31? Members of federally-recognized tribes are provided an opportunity to select and pay for a Qualified Health Plan once a month. As an American Indian/Alaska Native, make sure you select that you are AI/AN on the Special Conditions page on Washington Healthplanfinder in order to select and pay for your coverage through a Qualified Health Plan. After you complete the Special Conditions questionnaire through Healthplanfinder and are determined preliminarily eligible for a Special Enrollment period, you will select and pay for a Qualified Health Plan (and dental plan if you have eligible children in your household). If Washington Healthplanfinder is not able to electronically verify your qualifying event, you will receive a letter via or mail directing you to submit documentation. Final determination and confirmation of Special Enrollment will be provided after you submit pg. 5