Affordable Care Act Toolkit Enrollment and Implementation Information for 2014 Broker Resource Guide Choose coverage that fits. Form No. 3-1020 (06-14)
The Affordable Care Act Nearly all the major provisions of the Affordable Care Act (ACA) took effect in 2014. This guide provides information about new regulations and selling insurance in the ACA environment. We ve included information about broker responsibilities and how the ACA impacts your clients, including new ways they can get a break on insurance costs and a stepby-step guide to navigating enrollment on the Exchange. Requirements to sell health insurance The ACA requires all brokers to create a user ID, take online training and obtain a yearly certification through CMS to sell insurance on the Idaho Health Insurance Exchange. You can access the training at Marketplace. MedicareLearningNetworklms.com/ Default.aspx. Registration takes about fifteen minutes, and all necessary courses and exams appear on the training home page. If you want to continue to sell Blue Cross of Idaho individual products on or off the exchange, it is important you complete the certification process. This is required to sell qualified health plans (QHP) on the Idaho Health Insurance Exchange at YourHealthIdaho.org. Blue Cross of Idaho relies on the Idaho Department of Insurance as the system of record to determine broker certification. Please double check that you completed all the state requirements, and the system lists you as a certified broker. We cannot pay your sales commission for any QHP no matter if you sell on or off the state exchange if you are not a certified broker. To ensure you are certified, please check the Idaho Department of Insurance s Health Insurance Exchange certification list at doi.idaho.gov/insurance/searchhie. aspx. If you are not a certified broker or agent, or your name does not appear as a certified broker on the Idaho Department of Insurance s website, please contact Becky Barton-Wagner at the Idaho Department of Insurance. 2 Affordable Care Act Toolkit from BLUE CROSS OF IDAHO Brokers
Brokers You can reach Becky at 208-334-4279, or by email at Becky.Barton@doi.idaho.gov. Alternatively, if you decided not to become certified, please contact Blue Cross of Idaho at brokerrelations@bcidaho.com. You will receive commissions for existing grandfathered and non-grandfathered individual policies until those individuals purchase a QHP. Your commission for group business is not impacted and does not require certification. CMS also offers webinars that may be useful to you as you complete the registration process. You can access the webinars and other information at cms.gov/cciio/programs-andinitiatives/health-insurancemarketplaces/a-b-resources.html Blue Cross of Idaho offers short training sessions to help you learn more about its products and services, the ACA and its impact on individual and group lines of business. You can access that training here: https:// bluecrossofidaho.pinpointglobal.com/ Apps/Medicare/default.aspx You can submit your certification of completion of the Pinpoint training by e-mailing it to us at brokerrelations@ bcidaho.com or by mailing a copy to: Broker Relations, Blue Cross of Idaho, PO Box 7408, Boise, ID 83709 Impacts on your clients Penalties for not having insurance The ACA requires individuals must have health insurance or pay a penalty. In 2014 the penalty is $95 for adults and $47.50 for children, with a maximum of $285 per family or 1 percent of the family income, whichever is greater. In 2015 the penalty increases to $325 for adults and $162.50 for children, with a maximum of $975 or 2 percent of family income. In 2016 the penalty increases to $695 for adults and $347.50 for children, with a maximum of $2,085 or 2.5 percent of family income. How has coverage changed? All plans sold with effective dates on or after January 1, 2014, must cover essential health benefits in the following categories. Ambulatory patient services Emergency services Hospitalization Maternity and newborn care Mental health and substance abuse disorder services, including behavioral health treatment Prescription drugs Rehabilitative and habilitative services and devices Choose coverage that fits bcidaho.com 3
Laboratory services Preventive and wellness services and chronic disease management Pediatric services, including oral and vision care Here s a snapshot of some of the other changes: Clients can t be denied coverage because of a pre-existing health condition. Insurance companies can t drop coverage if members get sick. After your premium payments, the most in a year members will pay for covered healthcare services from in-network providers is $6,350 for individuals and $12,500 for families. Parents can keep their kids on their plans until they re 26 years old. Covered preventive care, such as annual doctor visits or regular screenings, is now covered with no outof-pocket costs. federal law requires dependents under age 19 to have dental insurance with their medical insurance. Blue Cross of Idaho offers dental products that provide the coverage clients need and meet all ACA requirements. All Blue Cross of Idaho plans provide coverage for immunizations. Options for your clients Your clients have three ways to obtain health insurance. Through their employer, group or union. Keep in mind: If you want to sell Blue Cross of Idaho products on or off the exchange, you must complete a certification on CMS. To ensure you re certified, please review the Idaho Department of Insurance s Health Insurance Exchange certification list at doi.idaho.gov/insurance/searchhie. aspx. Grandfathered health plans If your client bought a plan before March 23, 2010, the plan may be grandfathered under the ACA. If a client has a grandfathered plan, he/she can keep their current Blue Cross of Idaho coverage, avoiding some of the requirements of the ACA. Grandfathered plans are not completely exempt from the ACA regulations, however, and are required to incorporate some of the new rules and regulations. Blue Cross of Idaho implemented some additional ACA changes to grandfathered plans to be consistent in the coverage we provide our members. The changes we make will not affect any member s grandfathered status. If a client has a grandfathered plan, he/she may purchase a new health insurance plan during their normal renewal period, during the upcoming open enrollment period from November 15, 2014 until February 15, 2015 and in the case of a qualifying event. (See page 5 for a partial list of qualifying events.) Purchase an individual plan directly from Blue Cross of Idaho. Purchase a plan on yourhealthidaho.org. 4 Affordable Care Act Toolkit from BLUE CROSS OF IDAHO Brokers
Brokers Non-grandfathered plans Non-grandfathered plans (also called grandmothered plans) were scheduled to end in 2014. However, the federal government and Idaho Department of Insurance decided to allow members to keep these plans through 2016 renewal. Non-grandfathered members can choose new QHPs during their normal renewal period, during the upcoming open enrollment period from November 15, 2014 to February 15, 2015 and in the case of a qualifying event. Open enrollment If applicants are new to the individual market or if they want to shop for a new plan, they can buy a QHP directly from Blue Cross of Idaho or through the new Idaho Health Insurance Exchange at yourhealthidaho.org during open enrollment from November 15, 2014 through February 15, 2015. Special enrollment and qualifying events While open enrollment period won t begin until November 15, certain life events allow people to enter a special enrollment period (SEP). We have listed below some of the more common events that will trigger an SEP, allowing your clients to change or purchase a qualified health plan. We have additional information about the special enrollment period on the broker portal. Go to bcidaho.com/brokers and select Beyond the Basics of Exemptions and Special Enrollment Periods. Please note: The information provided is a general overview of the rules and regulations of the ACA. It may not address every specific situation you face with a client, and is not intended to be legal advice. Qualifying events that may allow members to change coverage outside of the open enrollment period: Individual or family policy renewal Marriage Birth or adoption of a child Loss of minimum essential coverage Covered dependent who turns 26 is allowed to enroll in a QHP Change in work hours causes loss of eligibility for employer coverage Loss of employer-provided coverage due to termination or closing of business New citizenship Change in or loss of subsidy eligibility A CCO member moves outside of CCO area Member receives hardship exemption and desires a catastrophic plan Renewal period Grandfathered and non-grandfathered clients have 60 days prior and 60 days after their renewal date to choose a new QHP. Clients can purchase a plan on or off the exchange. Report life changes on the exchange If your client purchased a plan on the exchange, then he/she needs to report any life change on their account. This includes any qualifying event or even a new email address or phone number. 1. Your client signs into their account to report a life change. Select the link on the left that reads Report a Life Change. 2. The next screen asks what change your client wants to report. Select the most appropriate bubble. 3. The exchange asks your client a series of questions. Your client s answers are tabulated by the exchange, and the exchange determines their eligiblity for a special enrollment. 4. Your client is given an enrollment To Do list. 5. Next, your client chooses the level of monthly assisistance he/she wishes to use, and then selects a plan. 6. The exchange notifies Blue Cross of Idaho of the new plan. CMS provided a guide on reportable changes. Go to bcidaho.com/brokers. Under Special Enrollment, Peroid select the document titled Overview of the New Change in Circumstances Functionality. Choose coverage that fits bcidaho.com 5
Loss of minimum essential coverage Nearly any loss of minimum essential coverage (MEC) results in a SEP for your client. The loss of coverage must be completely involuntary and not due to inability or failure to pay premiums. Here are three examples of common life events that trigger an SEP. Marriage Both spouses and any dependents get an SEP. Both spouses can enroll in a new or different QHP. One spouse can add the other to their existing plan as a dependent. They must choose a plan within 60 days of the event. Their effective date is the first day of the month following selection of a plan. Example: Buddy and Peggy Sue get married on April 6. Their SEP ends on June 5. They have the option of enrolling in a new QHP, changing their QHP, or if Peggy Sue already has a plan she likes, she can add Buddy as a dependent. If they decide to buy a new plan on April 15, their effective date is May 1. However, if they decided to buy a plan on June 1, their effective date is July 1. Birth/adoption/Placement of a foster child The parent and the child have an SEP. The new mom can add her child to her QHP or enroll in a new QHP. Other dependents receive an SEP, regardless of their current enrollment. They must choose a plan within 60 days of the event. The effective date is the date of birth, adoption or placement of foster child. Example: Morticia has a baby boy on June 6. She has a QHP, but now wants to make some changes to her plan. Ultimately, she purchases a new plan on July 4 for her new baby Pugsley and her husband Gomez. Their effective date is June 6. If you helped your client purchase a policy on the exchange, be sure he/she completed an Agent of Record form. This ensures you get paid for your sale. Find a Agent of Record form at bcidaho.com/brokers. 6 Affordable Care Act Toolkit from BLUE CROSS OF IDAHO Brokers
BRokERS Permanent move to an area served BY the idaho exchange An individual or family permanently moves into the area and now has access to new QHPs. They must choose a plan within 60 days of the event. All family members are eligible to enroll in coverage or change to a different QHP. If a plan is purchased between the 1st and 15th of the month, then the effective date is the 1st of the following month. If a plan is selected between the 16th and end of the month, the effective date is the first day of the second following month. Example: Ward, June and Wally move from Pocatello to Coeur d Alene on July 2. They look into a new health insurance plan and purchase on July 17. Their effective date is September 1. Get a break on costs monthly Premium tax credit This tax credit helps reduce or eliminate the cost of your client s monthly premium. Your client s household income must be between 100 and 400 percent of the federal poverty level, they must not have access to affordable insurance that also meets minimum value through an employer and must purchase a plan on the state exchange to qualify for assistance. cost sharing reduction This is additional financial assistance that helps your client pay for out-ofpocket expenses (deductible, coinsurance, copayments). Your client s household income must be between 100 and 250 percent of the federal poverty level, they must not have access to affordable insurance that also meets minimum value through an employer and must purchase a plan on the state exchange to qualify for assistance. Individual and family plans from Blue Cross of Idaho Blue Cross of Idaho offers a number of health insurance plans with a variety of coverage options and price points to ensure your clients get the coverage they need at a price they can afford. Whether they buy directly from Blue Cross of Idaho or through the Idaho Health Insurance Exchange at yourhealthidaho.org, you can find affordable coverage for your clients and their families through Blue Cross of Idaho. You can view our plans and order sales literature through the broker portal of our website at bcidaho.com/brokers. the federal PovertY level (2013) family size and federal Poverty level cost sharing reduction 250% of fpl if you make less than this, you may qualify for help paying expenses such as deductible and coinsurance payments Need the federal poverty level for a 2015 policy? Go to http://aspe.hhs.gov/ poverty/14poverty.cfm for the 2014 federal poverty limit income guidelines. monthly Premium tax credit 400% of fpl if you make less than this, you may qualify for help paying your monthly premiums 1 $11,490 $28,725 $45,960 2 $15,510 $38,775 $62,040 3 $19,530 $48,825 $78,120 4 $23,550 $58,875 $94,200 5 $27,570 $68,925 $110,280 6 $31,590 $78,975 $126,360 7 $35,610 $89,025 $142,440 8 $39,630 $99,075 $158,520 * for families with more than 8 people, add $4,020 for each additional person. CHooSE CovERAGE THAT fits bcidaho.com 7
What will applicants and brokers need when applying for coverage through Your Health Idaho? Registration The applicant needs to provide basic information to create an exchange account. This is similar to creating an account for an online store. They need to have an email address. The applicant can sign up for a free email account at Gmail.com, Yahoo.com, or Outlook.com. The exchange asks a number of security questions to ensure and validate the applicant s identity. These security questions are used in case the applicant forgets his or her username or password. Questions range from the applicant s favorite pet, childhood friend, or favorite radio station. A link is sent to the applicant s email address within a few minutes of registering. The applicant must click that link or copy and paste the link into their browser. This finalizes the applicant s account. 8 Affordable Care Act Toolkit from BLUE CROSS OF IDAHO Brokers
Brokers Enrollment The enrollment process is very similar to requesting an online credit report. Applicants will get questions about their previous addresses, cities they ve lived in, or businesses they ve been associated with. Going through this process ensures their identity. The application process begins. It s vital the applicant has the full names, dates of birth, Social Security Numbers, and all income information for their family members and those in the household applying for insurance. Insurance agents can select the Agent or Broker bubble, and then enter their identification number. Choose coverage that fits bcidaho.com 9
Applicants need to provide all people who will be covered by their new health insurance. This is a critical slide for applicants, as they can determine if they are eligible to receive assistance with their monthly premium The exchange is the only way they can receive financial assistance with their premium. You can help your clients estimate their monthly premium subsidy using our calculator on GetCoveredIdaho.com. Next, the exchange needs to know the full names and dates of birth for everyone in the family and household, even if they aren t enrolling through the state exchange. Relationships to the primary application will be asked (i.e. Husband/Wife, Son/ Daughter, etc.). 10 Affordable Care Act Toolkit from BLUE CROSS OF IDAHO Brokers
Brokers The Family & Household section asks more detailed information about each person included on the applicant s federal income tax return and all family members and dependents who live with the applicant, even if they are not applying for health coverage. This section asks for Social Security Numbers, citizenship, if they filed a tax return, how it was filed (separate or jointly), relationship to the primary applicant, and race/ethnicity of each person applying for health insurance. The Income section states that clients may need pay stubs, W-2 forms, and tax returns. It s important that applicants have this information when applying for coverage. It will speed the application process. Applicants will also need to provide annual income information for each dependent. If a dependent has an income, please ensure his/her information is available during the application process. The Additional Information section asks the applicant if he or she or any spouse/dependent has other health insurance like Medicare, TRICARE, or through an employer. Choose coverage that fits bcidaho.com 11
The applicant must agree or disagree with a statement that they did not provide false information. The applicant electronically signs the application and then select Submit Application. Choosing a Plan The applicant now sets their premium tax credit usage. Select Set. These are informational slides explaining the monthly premium credit, how an applicant can use the credit, and for exactly how much the applicant is eligible. 12 Affordable Care Act Toolkit from BLUE CROSS OF IDAHO Brokers
Brokers The applicant has the option to use any premium tax credit they qualify for. Select Yes to use it or No to not use it. If Yes, the applicant can change tax credit amount they wish to use each month using a slide bar or typing in the amount. Once the applicant is satisfied with the amount, he or she selects Use This Amount. Applicants can now apply for new health insurance coverage. Click Select a Health Insurance Plan to begin the process. Applicants will now see a variety of plans. They can then compare as many as they wish and select a plan that fits their health needs and budget. Choose coverage that fits bcidaho.com 13
If the applicant has a child under age 19, then the child must have dental coverage. If the client or child has coverage through a separate policy, they will need to provide proof of this coverage (the insurer and policy number meet this requirement). Select Continue. This confirms the applicant s plan choice and who is covered under the new plan. The applicant must agree that he or she will lose the premium tax credit if found eligible for other minimum essential coverage. Applicants also agree to contact the exchange in case of eligibility for other coverage or possibly lose their QHP. Final slide. The applicant has completed all steps of the health plan application. The next step is to pay for the plan. The applicant needs to click Pay For Health Plan to proceed. 14 Affordable Care Act Toolkit from BLUE CROSS OF IDAHO Brokers
Brokers Additional Resources You know full implementation of the ACA will change the health insurance industry, and impact your clients differently. Each person that walks through your door will look for you to guide them through the cumbersome enrollment process, and to pick coverage that fits their family s health needs and budget. That s why Blue Cross of Idaho developed GetCoveredIdaho.com, a free resource for Idaho and brokers, to help Idahoans get straightforward answers about ACA impacts and prepare for yourhealthidaho.org. More importantly, GetCoveredIdaho.com offers a simple tool to estimate if your clients will pay a lower monthly premium for health insurance. In fact, it s likely many of your clients may qualify for some level of financial help with their monthly insurance premium. We also offer free digital buttons for your website, sample social media posts, and a sample newsletter article about the changes in health insurance. You may order hard copies or download any of these resources at getcoveredidaho.com/partner-materialpage.php. When ordering, scroll toward the bottom of the page, and choose the materials you wanted sent to your office. Orders come in packages of 25. We encourage you to tell your clients to check out GetCoveredIdaho.com before their scheduled appointment. GetCoveredIdaho.com also provides free education resources printed and digital materials for your business and your clients. Information includes fact sheets in English and Spanish on: How to find the right health plan How to determine a monthly premium payment The new state exchange Choose coverage that fits bcidaho.com 15
Co-Operative Advertising program Blue Cross of Idaho brokers have the opportunity to participate in our Cooperative Advertising Program to help you get the most from your advertising dollars. Through this program, we will pay pre-approved costs up to $750 per calendar year for up to five brokers in your agency. You can design your own ad, use one of our pre-approved ads or we can help design your ad. Your advertising options include Print ads Newspaper inserts Social media Radio Trade and specialty publications Promotional items After your ad is approved, you ll submit it to the publication, radio station or website. If the ad is printed or used on a website, please be sure to clip or screen shot the ad. When the you receive the invoice for your published ad, you pay the full amount. Next, complete the co-op reimbursement form, sign, date and mail to Blue Cross of Idaho, Attn: Corporate Communications Department, P.O. Box 7408, Boise, ID 83707-1408. Include the paid, itemized invoice, a tear sheet (or screenshot and URL) for each ad, and a copy of the approval email from Blue Cross of Idaho. Medicare Advantage ads have special requirements; please see bcidaho.com/ brokers for more information and for a copy of the reimbursement form. For Co-op program contact Bret Rumbeck at 208-387-6921, or email at brumbeck@bcidaho.com. 16 Affordable Care Act Toolkit from BLUE CROSS OF IDAHO Brokers
Brokers Guidelines for broker advertising You may use the Blue Cross of Idaho name and/or logo to indicate you are offering Blue Cross of Idaho coverage. Brokers may NOT use the Cross without the name or tagline and may not use the Shield. The advertising must reflect that the broker is independent and not apart of Blue Cross of Idaho and must use the language, independent authorized agent of. Blue Cross of Idaho s name and logo must be as big or bigger than the broker s or other listed companies whom the broker represents. When the Blue Cross of Idaho name or logo is used, the ad must also state: Blue Cross of Idaho is an independent licensee of the Blue Cross and Blue Shield Association. Register on our broker portal Have you ever been on the phone with your client and needed quick answers to a question? Or maybe you needed more background on an individual product? Our broker portal has all the answers to your questions and more. Plus, registration provides you access to our weekly broker blasts and breaking news alerts. These emails contain critical information about the Affordable Care Act, commission payments, news articles and much more. Registration is easy! Simply point your browser to bcidaho.com/brokers, and click on Register Now on the left side of your screen. Then, enter your broker number, email address, and select Register Now. That s it! You may not alter the proportions of our logo you may resize it proportionately to fit your space, but you should not squish it either vertically or horizontally to fit your space. keep your business logo visually separate from ours to indicate a clear distinction between you and us. In Yellow Page advertising, the listing must be in the name of the agent, not under Blue Cross of Idaho (i.e. ABC Insurance, listed under A. It may NOT be listed as Blue Cross of Idaho-ABC Insurance). Please obtain final approval from Blue Cross of Idaho before using any ads. Choose coverage that fits bcidaho.com 17
P.o. Box 7408 Boise, ID 83707 800-365-2345 bcidaho.com STREET ADDRESS 3000 East Pine Avenue Meridian, ID 83642-5995 Meridian MAIlING ADDRESS P.o. Box 7408 Boise, ID 83707 208-387-6683 800-365-2345 ClAIMS INQUIRIES (208) 331-7347 (800) 627-1188 Coeur d Alene 1450 Northwest Boulevard, Suite 106 Coeur d Alene, ID 83814 208-666-1495 STREET ADDRESS 1910 Channing Way Idaho falls, ID 83404 Idaho falls MAIlING ADDRESS P.o. Box 2287 Idaho falls, ID 83403 208-522-8813 STREET ADDRESS 1010 17th Street lewiston, ID 83501 STREET ADDRESS 275 South 5th Avenue Suite 150 Pocatello, ID 83201 STREET ADDRESS 1431 North fillmore Street Suite 200 Twin falls, ID 83301 lewiston Pocatello Twin falls MAIlING ADDRESS P.o. Box 1468 lewiston, ID 83501 208-746-0531 MAIlING ADDRESS P.o. Box 2578 Pocatello, ID 83206 208-232-6206 MAIlING ADDRESS P.o. Box 5025 Twin falls, ID 83303-5025 208-733-7258 2014 by Blue Cross of Idaho, an independent licensee of the Blue Cross and Blue Shield Association (Rev. 7/01/14)