Washington Health Benefit Exchange Qualified Health Plans

Transcription

1 Washington Health Benefit Exchange Qualified Health Plans SUMMER 2013 NAVIGATOR/IN-PERSON ASSISTER PROGRAM

2 Purpose: Purpose This presentation will provide a high level overview of Qualified Health Plans (QHPs) available through the Washington Healthplanfinder. More in-depth information and procedures will be included in the Healthplanfinder system training module.

3 Course Summary Program rules and guidelines related to Individual Eligibility and Enrollment for Qualified Health Plan (QHP) programs. Application, eligibility results, QHP enrollment and payment for individuals and households applying for coverage. Pediatric dental plans 3

4 Learning Objectives Upon completing this module, you will Understand the different types of health care coverage available through the Healthplanfinder Know program rules and guidelines related to Qualified Health Plans for either an individual or for an entire household Understanding eligibility results Know the steps to facilitate plan selection and enrollment

5 Learning Objectives (Continued) Upon completing this module, you will also understand: The functions performed through the Federal Hub in verifying applicant information Reasons for non-eligibility (incarceration, citizenship, non-wa resident, etc.). 5

6 What is a Qualified Health Plan? A health insurance plan that has been certified by The Office of Insurance Commissioner as meeting all state rules and requirements. Approved by the Washington Health Benefit Exchange as meeting the requirements of a Qualified Health plan to be offered through the Washington Healthplanfinder. A plan that provides comprehensive coverage by meeting the standard of essential health benefits 6

7 Health Insurance Programs and Benefits Competitively Priced Qualified Health Plans (QHP) Individuals or families with income above 400% of the Federal Poverty Level (FPL) can purchase a QHP at the insurance carrier s published premium cost QHPs are offered through commercial carriers such as Blue Cross Blue Shield, Aetna, etc. Consumers choose a plan that best meets their health and financial needs Families with children under 19 must enroll the children in a pediatric dental plan Parents can cover children up to age 26 under a family plan 7

8 Health Insurance Programs and Benefits Free and Low-Cost Opportunities Individuals or households with income below 400 % of the Federal Poverty Level (FPL) are eligible for free or low-cost options. Based on household size and income, applicants can qualify for either: Health Insurance Premium Tax Credit (HIPTC) Washington Apple Health HIPTC-eligible applicants can shop for and enroll in a QHP at reduced premium rates Additional reductions are available to those with the lowest incomes to reduce out of pocket expenses such as deductibles and co-pays 8

9 Eligibility & Enrollment Flow - QHP Account Creation Application Data Collection Eligibility Determination Post Application Shopping QHP Enrollment & Pediatric Dental Enrollment Payment 9

10 Primary Applicant The primary applicant is an individual who creates an account on Washington Healthplanfinder and initiates one of three types of applications types. Individuals: 1. Myself Household: 2. Myself and others 3. Other household members 10

11 Questions 11

12 Lesson 1 Application Type Individual 12

13 Account Creation Account Creation Application Data Collection Eligibility Determination Post Application Shopping QHP Enrollment & Pediatric Dental Enrollment Payment 13

14 Account Creation From the homepage there are two paths to creating an account: Anonymous Browsing Create Account Projected Plan Options Qualified Health Plan (QHP) Free and Low- Cost Health Insurance Qualified Health Plan (QHP) Free and Low- Cost Health Insurance Required to Create and Account Not Required to Create Account Required to Create and Account Not Required to Create Account 14

15 Application Data Collection Once an account is created the first step in applying for coverage is Application Data Collection. The following data pages need to be completed: 1. About You 2. Contact Information 3. Additional Questions 4. Tribal Membership 5. Application Review 6. esignature 15

16 Application Options For Qualified Health Plan (QHP) Programs, the Applicant would select No. For Free and Low Cost Health Insurance programs, the Applicant would select Yes. 16

17 Confidential Information Personal information must be disclosed throughout the application process The primary applicant and all household members who reside in the applicant s household Income information and tax filing status Family composition and relationships, including custody 17

18 Federal Hub Verification The primary applicant s social security number will be verified by the Federal Hub. Application Data Collected: Homeland Security Federal Hub Response: Social Security Number INS IRS Verified Unverified Federal Hub Data Verifications are stored in the Healthplanfinder and are not visible to the consumer. 18

19 Conditional Eligibility If any member of the household is deemed conditionally eligible, additional documentation will be required as shown in these screens. The primary applicant will have 90 days to submit required documentation. 19

20 American Indians/Alaska Natives Special provisions Tribal members can be served by a non-tribal In- Person Assister or a Tribal Assister Training Module for serving AI/AN 20

21 Eligibility & Enrollment Flow (Qualified Health Plan (QHP)) Account Creation Application Data Collection Eligibility Determination Post Application Shopping QHP Enrollment & Pediatric Dental Enrollment Payment 21

22 Eligibility Determination Federal Hub In order for an individual to be eligible for a Qualified Health Plan (QHP) on Washington Healthplanfinder, he or she must be: 1. A U.S. citizen or lawfully present 2. Not incarcerated 3. A resident of the State of Washington INS Homeland Security IRS When the Federal Hub verifies the individual s SSN, it also looks for Citizenship and Incarceration status associated with that SSN. 22

23 Eligibility Results Eligibility determined for each family member Coverage options displayed based on eligibility If eligible for Qualified Health Plan, the consumer will use tools to compare and select a Plan Plan details can be viewed side by side Payment entry finalizes the transaction 23

24 Business Rules Eligibility Determination Business Rule Eligible SSN verified Citizenship or lawful presence verified Resident of Washington Conditionally Eligible SSN not verified or SSN is verified as Match for Death Citizenship or lawful presence not verified Primary applicant has 90 days to provide documentation Denied Incarcerated unless entered the disposition question as yes Not resident of Washington 24

25 Knowledge Check What are the three different application types for eligibility on Washington Healthplanfinder? a. Myself b. Myself and Others Other Members of My Household c. 25

26 Knowledge Check Who creates an account on Washington Healthplanfinder and initiates one of three types of applications types? a. Exchange Administrator (EA) b. Primary Applicant c. Household d. Myself and Others 26

27 Knowledge Check What organization verifies the social security number of the primary applicant? a. Federal Hub b. ehealth c. Eligibility Services d. Washington Healthplanfinder 27

28 Knowledge Check Which of the following it not true about Qualified Health Plan (QHP) programs? a. Households can claim children up to age 26 under the parents' plan. b. Consumer choice offered through plan selection and metal levels. c. Applicants eligible for QHPs only. d. Applicants automatically enrolled in plans. 28

29 Questions 29

30 Lesson 2 Application Type Household (All Eligible Members) 30

31 Application Types The primary applicant is an individual who creates an account on Washington Healthplanfinder and initiates one of three types of applications types. Individuals: 1. Myself Household: 2. Myself and others 3. Other household members 31

32 QHP Eligibility & Enrollment Flow Account Creation Application Data Collection Eligibility Determination Post Application Shopping QHP Enrollment & Pediatric Dental Enrollment Payment 32

33 Application Data Collection When the primary applicant enters data for themselves and their household, the data collected will be the same as for an individual. The sections bolded below will be completed for both the primary applicant and the other household members. 1. About You 2. Contact Information 3. About Your Household* 4. Additional Questions* 5. Tribal Membership* 6. Application Review 7. esignature 33

34 Household Composition Rules To be considered part of the same household, the household member must have one of the following relationships to the primary applicant: 1. Legal Guardian 2. Child (up to age 26) 3. Spouse (including same sex marriage) 4. Spouse (including domestic partners) Other family members living in the same home, such as nieces/nephews, aunts/uncles, cousins, and grandmothers/ grandfathers would not be considered part of the household application for eligibility determination. 34

35 Children Up to Age 26 Children up to age 26 are eligible to be covered under their parent s plans. Common Examples: College Students Young Professionals Children do not need to live in the same household or location as the parents to qualify. For instance, a child away at college would still be covered under his or her parent s plan. 35

36 Eligibility Determination Primary Applicant Completes About You SSN Verification Primary Applicant Enters Contact Information HS Primary Applicant Completes About Your Household IRS SSN Verification INS IRS Primary Applicant Completes Additional Questions HS Primary Applicant Completes Application Review INS IRS Primary Applicant Completes esignature Eligibility Results Displayed 36

37 Eligibility & Enrollment Flow (Qualified Health Plan) Account Creation Application Data Collection Eligibility Determination Post Application Shopping QHP Enrollment & Pediatric Dental Enrollment Payment 37

38 QHP & Pediatric Dental Plan Enrollment For household members over the age of 19: The primary applicant will enroll each eligible household member in a QHP. For household members under the age of 19: The primary applicant will enroll each child in a QHP and is required to also enroll each child in a pediatric dental plan. 38

39 Knowledge Check In order for an individual to be eligible for a Qualified Health Plan (QHP) on Washington Healthplanfinder, he or she must: A. Live with the individual. B. Not live with the individual. C. Not be incarcerated. D. Be employed. 39

40 Knowledge Check To be considered part of the same household, the household member must have one of the following relationships to the primary applicant: A. Niece B. Aunt C. Grandparent D. Legal Guardian 40

41 Knowledge Check The primary applicant will be required to select and enroll their qualifying children (up to age 19) in A. A health insurance policy of their own. B. A pediatric dental plan C. Pediatric health care coverage D. Summer school 41

42 Knowledge Check In a Qualified Health Plan (QHP) scenario, which of the following family members qualify as members of the primary applicant s household? a. Spouse (including same-sex marriage) b. Grandfather c. Child (up to age 26) d. Answers a and c 42

43 Knowledge Check The primary applicant is required to enroll any children under 19 in a pediatric dental plan. a. True b. False 43

44 Knowledge Check To be eligible for insurance coverage through Washington Healthplanfinder, you must be: a. U.S. Citizen or Lawfully Present b. Not Incarcerated c. Washington Resident d. All of the Above 44

45 Questions 45

46 Congratulations! You have completed the QHP Rules and Guidelines course! Thank you!

47 47

48 Appendix 48