Process for Financial Assistance at Go-LiveMarketplace Training

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Today’s Topics

• Objectives of this training• Functions and Features at Go-Live• Key Points re: financial assistance process• Overview of medical assistance programs• Steps required to get an eligibility determination• Choices and Tips for applying for financial assistance• Q&A

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Objectives of this Training

• Provide a technology and process refresh for Agents/Brokers and Health Coverage Guides who will support the Marketplace at go-live on October 1st

• Provide training on the most up-to-date system and process steps

• Go deeper about how to expedite and successfully obtain financial assistance for your customers

• Explain how C4HCO’s Service Center will facilitate these financial assistance determinations

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Key Dates to Remember

Dates to plan by:

o C4HCO opens 10/1/2013

o Plans and payment needed by 12/15/2013

o First effective date for coverage 1/1/2014

It is important to get serious about completing an application in November and December to ensure consumers have benefits starting January 2014

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Ongoing training and support

Watch for Open Labs and Webinars to help you come up to speed on our live system before October 1st and throughout the month of October!

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Terms and Definitions

• Advance Premium Tax Credit (APTC): financial assistance with monthly premium costs in the form of a tax credit

• Cost Sharing Reductions (CSR): reductions in out of pocket costs like copayments and deductibles that are automatically included in the health plan for eligible individuals

• CHP+: Child Health Plan Plus program, a state medical program available to pregnant woman and children up to 18 years old

• Financial assistance: includes programs where people are eligible to receive medical care at no or low cost (Medicaid or CHP+) or get help paying for private insurance (APTC and CSR)

• Qualified Health Plan (QHP): plans that include the required essential health benefits that will be sold both inside and outside the Marketplace

• Single Streamlined Application (SSAp): the application for insurance affordability programs

• Marketplace or C4HCO: Connect for Health Colorado• PEAK: Program Eligibility and Application Kit

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Go-Live Functions and Release Plans

• Features ready on Oct 1st:o Small Business Marketplace

• Employers can set up accounts and select plans to offer

• Employees can shop for plans offered by employero Individual Marketplace

• Browse Plans• Quick Eligibility Calculator and browse plans• Account Creation• Complete application and plan selection with and

without financial assistance

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Go-Live Functions and Release Plans

• C4HCO will offer extra support through our customer service network for individuals shopping with financial assistance, because:

o The path for financial assistance is new and for most, uncharted territory

o With ongoing testing, we want to ensure accuracy and a good customer service experience

o APTC determinations and amounts can be calculated in the C4HCO service center

• The full path for financial assistance will be widely deployed early Nov

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Early Focus

• Activities to focus on in October o Get more familiar with the shopping experience and

health planso Help customers set up accounts on the Marketplace o Help customers get their questions answered about

planso Help customers see if they qualify for help paying for

medical coverage using the quick calculator

• It is very important to ”associate” yourself with the account in the system when you are offering assistance!

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Overview of Medical Assistance Programs

• Through new laws, the realm of financial assistance programs for medical coverage has expanded

Former (pre Oct 1st 2013) New Market (starting Oct 1st 2013)

Medicaid

Child Health Insurance Plan (CHP+)

Medicaid CHP+

Advance Premium Tax CreditsCost Sharing Reductions

Starting October 2013 a person can see if they qualify for financial assistance by completing an application • How?

• Online• Phone• Paper

Available from the State of Colorado

Available in the Marketplace

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Eligibility Determinations for Various Programs

When a person submits the financial application, eligibility determinations will be made for the following programs:

Medicaid CHP+

Advance Premium Tax Credits & Cost Sharing

Reductions

Available from the State of Colorado Available through C4HCO

OR OR

Customers can only be eligible for one program

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Eligibility Determination and Enrollment

If Medicaid/CHP+ Eligible If Denied Medicaid/CHP+, check APTC/CSR eligibility

Enrolled in Medicaid/CHP+ programRange = under 133% FPL Medicaid up to 250% FPL CHP+

Consumer will receive benefit information and be enrolled*

*Some people eligible for CHP+ are required to pay initial premium to complete enrollment

Return to Connect for Health Colorado to determine eligibility for APTC/CSR, shop and buy insurance

Determine APTC credits: Range = 133% - 400% FPL

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Online experience to apply for medical financial assistance

• C4HCO will be using the state’s online portal called PEAK to get a determination for Medicaid/CHP+ as the first step in the application process

• PEAK is a website that allows people to apply and access all public assistance programs in Colorado, including:

o Colorado Workso Food Assistance o Medical Assistance (connection with C4HCO)o Adult Financial

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More about PEAK

• PEAK’s system has undergone significant improvements in 2013:

o Re-launch 9/27o Design of web-pageso Functionality and usability o Ability to process real-time determinations for some

MAGI applicantso Co-branded with C4HCO to support medical-only

applicants that start in the Marketplace

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You choose how involved you want to be in the first step in the financial assistance path

Agents/Brokers and Health Coverage Guides have some choices to make about how active they want to be in the financial assistance application process in October

o Choice #1: When someone wants to complete the financial assistance application you can decide to connect the applicant to our Customer Service Center to walk them through all the steps

o Choice #2: Actively manage the financial application process by helping customers start the application in PEAK for a Medicaid/CHP+ determination

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Customer Service Involvement in APTC/CSR determination (for October)

• C4HCO’s Customer Service Center will then help customers fill out a short form to gather additional information for APTC/CSR determinations and upload this information to the customer’s account

• The Customer Service Center will then use the application information from PEAK and the additional APTC/CSR questions gathered to make the initial APTC/CSR determination and support the customer to finalize plan selection (through early November)

• You will be informed when the determination is complete

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Eligibility determination steps using financial application

Step 1. Create Account in C4HCO and associate

Step 2. Start Financial Assistance Application (Choice #1)

Step 3. Start PEAK medical-only application to complete the Medicaid /CHP+ determination (Choice #2)

Step 4. Download PDF of PEAK application and save (Choice #2)

Step 5. If a customer is ineligible for Medicaid/CHP+ additional questions will be asked to determine eligibility for APTC /CSR. Fill out short questionnaire with APTC/CSR specific questions. This will be completed by Customer Service Center representative

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Eligibility determination steps using financial application

Step 6. C4HCO Customer Service Center representative will upload PDF of PEAK application and APTC/CSR short questionnaire to customer’s C4HCO account

Step 7. C4HCO Customer Service Center will complete steps to determine APTC/CSR eligibility and send notice of preliminary determination

Step 8. Customer Service Center will assist the customer to shop and select health plan

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Financial Assistance Through the Marketplace Day 1 through early November

Create an account in Connect for Health Colorado

Associate Broker/HCG/ Authorized Rep as appropriate

Start application and review privacy language

Want to see if you qualify for financial help for your medical coverage?

Have you already been denied for Medicaid/CHP+ since October 2013?

Complete Non-Financial

Application

Contact Service Center

Start first step in application – check for Medicaid/CHP+ eligibility

in PEAK

Medicaid eligibility results displayed in PEAK

Contact Customer Service Center for APTC determination

Walk through APTC/CSR determination

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= Broker/HCG or Service Rep

= PEAK system

= Service Rep

LEGEND

Select Plan(s)

If not MedicaidCHP+ eligible, answer additional questions needed for

APTC/CSR

Shop for Plan(s)

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Step 1: Account creation in C4HCO and associate

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Step 1: Account creation in C4HCO and associate

• Associate screen shot

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Shop and preview health plans

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Training for Choice #1 and Choice #2

• If you choose Choice #1. . .o You do not need to complete mandatory PEAK

training in late Sept/early October

• If you choose Choice #2. . .o You need to be comfortable using PEAK and

uploading documents to the customer’s C4HCO account in early October

o You also need to follow the tips in this training!

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Step 2: Start financial assistance application in C4HCO

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Step 2: Start of financial assistance process in C4HCO

• From this “Continue” button, the customer will be sent to the PEAK website and instructed to create an account in order to apply for Medicaid or CHP+.

• Choice #1—Call Customer Service Center at this point in the process!!!

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PEAK Application steps

Submit

Review application information

Other bills

Housing bills (answer if disabled)

Other income

Job income

Liquid and other assets (answer if disabled)

People applying for coverage

Identify who is offering application assistance

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Choice #1 Steps

• Steps 3-7 are completed at the Customer Service Center

• You will be informed when a determination is made

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C4HCO prefers applications are submitted online

• The customer has options about method to submit application (online, mail or fax)

o PREFERRED METHOD—SUBMIT ONLINE• Increases likelihood of getting real-time

determination for Medicaid/CHP+ and quick APTC determination

• If you use other method, mail or fax it right away. Applications process faster when received same-day

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Customers can decide to take the tax credit up front or when filing taxes

• Some customers who can qualify for the tax credit might be ok receiving their tax credits at the year end, instead of up front and pay the full premium throughout the year.

• This option is beneficial for customer with unstable income or customer who does not want to report income changes during plan year

• If so, they can use the non-financial application. • The plan needs to purchased through C4HCO to

receive the tax credit at the end of the year

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Key Takeaways!

• Create accounts, browse and select plans starting October 1st• Associate yourself with customer in account• Answer customer’s questions about available financial

assistance and use the quick eligibility calculator• If customer wants to go through financial application,

preferred method is to submit online • You have a choice how active you want to be in the financial

application process in October• The Individual non-financial application path functionality is

ready for everyone to use online• Eligibility determinations for all programs can be made with

support in October

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Contact

• Website: www.ConnectforHealthCO.com

• Questions: Info@ConnectforHealthCO.com

• Service Center- 1-855-PLANS-4-YOU (855-752-6749)

• Social Media:

@C4HCO (consumers) @COHBE (stakeholders)

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Next Steps

• Choice #2—PEAK training will commence through webinar last week of September

• Open labs will also be available to cover the following throughout October:

o PEAK overview and demoo C4HCO live system

• Watch for announcements about upcoming webinars and open labs