broker platform · what is enhanced direct enrollment? ede is a new cms technology. healthsherpa...

Broker Platform

Training Topics

1. EDE Overview

2. Platform Overview

3. Broker Quoting

4. Broker Renewal

5. EDE Application

6. Post Enrollment Tools

7. Client Self Enrollment

8. Client Dashboard

Enhanced Direct Enrollment

What is Enhanced Direct Enrollment?

EDE is a new CMS technology. HealthSherpa was the first to implement EDE and is one of the only enrollment platforms that has this new technology.

Enhanced Direct Enrollment allows HealthSherpa to fully integrate with HealthCare.gov so you can do applications entirely on HealthSherpa without being redirected to HealthCare.gov.

ACA Technology Comparison

Capability Double Redirect Enhanced Direct Enrollment (EDE)

Quoting

Plan Selection

Enrollment HC.GOV

Eligibility HC.GOV

Payment HC.GOV

Document Management HC.GOV

Effectuation Carrier

Three Phases of EDE

All EDE implementations are not created equally:

Entities have the option to implement one of 3 phases of EDE in 2019 OEP:

% of Cases Covered

~60%

HH Circumstances Covered

Simple Cases only

PHASE I PHASE II PHASE III

% of Cases Covered

~95%


Phase I + Students, Naturalized & Non US Citizens, Pregnant applicants, step children, grandchildren, foster care

% of Cases Covered

100%


Phase I + Phase II + Rare tax circumstances: Not filing, married, but not filing jointly, child not on tax return, dependents over 25

Live Today 2020 OEP

Additional Post Enrollment Functionality

New EDE Features:

● Make First Payment

● Upload Documents

● Prefilled renewals

● Report changes

● Search & Add Clients

More visibility with EDE Reporting:

● Get Binder Payment Status

● Get Document & Verification Status

How to make a previous HealthSherpa application an EDE application:

Some applications may not have EDE functionality yet.

To enable EDE features, simply click on the client's name, and if EDE is not enabled, you will see an option to 'Enable EDE'.

Platform Overview

Get EDE Approved

Turn on EDE to:

● Complete applications on HealthSherpa directly

● Quickly effectuate plans with document upload / payment button

● View document and payment status without having to go to Healthcare.gov

Help Center

Access the Agent Help Center from this button

Help Center

● Getting Started Guide

● Helpful articles on FAQs

Start Application

Start a renewal or a new application from this button

Add Clients

Quickly add Marketplace clients to HealthSherpa

Clients Tab

Displays all clients who have submitted applications

Additional features

● Quote● Renew● Filter ● Bulk email

Clients Tab→ Client Details

Client details gives you the plan details and follow ups of each client

Additional features

● Effectuation to-do list● Quick action buttons ● Members on policy● Coverage details

Clients Tab→ Client Details

Client details gives you the plan details and follow ups of each client

Additional features

● Client notes● Application history

Leads Tab

Displays all leads that have begun quoting, shopping or applying, but have not yet submitted an application

Additional features

● Filters● Actions: Resume● Dynamic search

Leads Tab→ Lead Details

Displays additional details relating to the lead

Additional features

● Resume● Eligibility● Contact information● Chosen plan● Notes

Marketing Tab

Marketing tab contains a unique broker link to send to clients

Additional features

● Clients can self enroll● Filters into leads tab● Retains broker NPN

Broker Quoting

Broker Quoting

Quickly quote and search for plans

Broker Quoting

Quickly quote and search for plans

Additional features

● Add dependents● Update income● Eligibility determination● Save lead

Broker Quoting

Quickly quote and search for Marketplace plans or Stand-alone Dental Plans*

Additional features

Filters● Premium● Deductible● Prescription● Provider● Metal level● Network

* Stand-alone dental plans require that an applicant also have a Marketplace health plan

Broker Quoting→ Compare plans

Compare plans side by side

Additional features

● Compare plans● Email to client

Broker Quoting→ Send to client

Begin quote and email to client

Additional features

● Add custom message● Includes resume link

Broker Quoting→ Add to Cart

Select the health plan your client would like to enroll in and click “Add to cart”


From here you can jump into the health application by clicking “Start Application”

You can also help you client find a Stand-Alone Dental plan by clicking “Shop Dental”

Broker Quoting→ Dental

You can also click over to the Dental tab from the Plan Results page, to see the plans available to your client

Additional Features

● Filter by monthly premium, network or company


Once your client selects a dental plan, you can click “Add to cart” to view both the health and Stand-Alone Dental plan

Clicking “Start Application” drops you into the application process

Broker Renewal

Broker Renewal

Quickly quote and search applications on the Marketplace

Application

Marketplace Application

With Enhanced Direct Enrollment the application is completed on HealthSherpa

Additional Information● Renewals are prefilled

*Note: Application steps vary by household

Post Enrollment Tools

With HealthSherpa document

management, upload your client’s

documents and view statuses.

Document Upload and Status

● Identify required documents

● Upload documents

● Get the status

● Alerts and updates

With HealthSherpa payment

integration, you can make your

client’s binder payment

Binder payment

● Make binder payment

● Get the status

Change Plan, Report Life Changes

Easily update

applications

1095-A forms & Eligibility Notices

Easily download client documents

● 1095-A Tax Form

● Eligibility Document

Making a previous application an EDE application

Click “Enable EDE” on previous applications to have access to EDE features

Client Self Enrollment


Quote using zip code and email

Additional detail

Email is optional, when used, it creates a lead record on your agent dashboard


Spouse & dependents


Income

Additional detail

There is an income calculator tool available for self enrolling clients


Income Calculator

Calculate income

● Annual● Monthly● Weekly● Per Project


CSR


SEP Verification (if applicable)


Plan Selection

Additional filters

● Premiums● Deductibles● Providers● Prescription● Network types● Metal tiers


Plan details page

Additional Information

A client can click into a specific plan to see additional information regarding the plan


Save Progress

Additional Information

When a client saves progress, they can pick up where they left off later.

This also creates a lead in the broker dashboard


Choose plan

EDE Application experience is the same for brokers and consumers.

Note if client is self enrolling using your enrollment site, there is an ID proofing step

Client Dashboard

To-Do List

● Intuitive to-do list identifies

follow ups for your clients

● Clients can submit their own

documents and payments

directly from HealthSherpa

Documents

● Identify documents needed

● Upload documents

● Get status / Approval

Plan Details

● Current year’s plan

● History of Marketplace apps

● Coverage Details

Payment

● Make Payments

● Get Payment Status

HealthSherpa Broker Support

HealthSherpa Broker Support

In the event of feature questions or technical issues, HealthSherpa’s broker support is available

PHONE

EMAIL

CHAT

(888) 684-1373

[email protected]

Chat from dashboard

Open 8am-4pm PST during SEP

& Extended hours during OEP and surrounding the deadline day

Appendix

Cases that will require a redirect to Healthcare.gov

● American Indian and Alaskan Natives● Applicants with no home address, living

separately or living at home address that is in a different state than where they are applying for coverage

● Applicants who are not planning to file a tax return or married applicants who are not filing a joint tax return

● Applicants responsible for a child 18 or younger who lives with them but is not included on tax return

Don't worry, we will identify these for you and redirect you to Healthcare.gov when necessary. Once you complete the application on Healthcare.gov, you will be redirected back to HealthSherpa to finalize the plan. These clients will appear in your Clients section of your dashboard.

● Applicants who are offered coverage through their job, someone else’s job, or COBRA

● Applicants with dependent children who are over 25 or who are married

● Applicants with dependent children living with a parent not on their tax return applying for coverage

● Applications where dependents that are applying are not being claimed on taxes.

● CRM for your ACA clients● Easy Quoting● EDE- Enhanced Direct Enrollment● Complete applications on HealthSherpa ● Upload required documents● Make binder payments● Print 1095A forms● Prefilled renewal● Search and Add Clients● Client Dashboard

Benefits