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Reporting Life Change Events (LCE). Objectives. This Presentation will Provide an overview of the types of changes that can be reported and when Provide an overview of the LCE reporting process Familiarize you with the Report Life Change Events (LCEs) Form

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Presentation Transcript
objectives
Objectives

This Presentation will

  • Provide an overview of the types of changes that can be reported and when
  • Provide an overview of the LCE reporting process
  • Familiarize you with the Report Life Change Events (LCEs) Form
  • Direct you to the right sections of the Form, depending on the LCE being reported
  • Provide instructions on filling out the Report LCE from
expectations
Expectations
  • The change reporting process is completely manual at this time. Changes will not be made in real time.
  • Many changes will also need to be reported in PEAK.
  • We will post a slide deck from PEAK on reporting changes in PEAK, and under which circumstances a new PEAK application is needed.
  • We will work with PEAK to get a live webinar scheduled on reporting changes.
  • We will do our best to answer questions about the process as it is right now and we can set up a separate opportunity for comments about the process and how it is working.
definitions
Definitions

Coverage Effective Date Rules follow the 1-15th of the month; 16th-end of the month logic.

Qualified Life Change Event is a change that allows new and current customers to enroll in or update health care coverage outside of an open enrollment period.

Cancellations may be made if the consumer has not yet paid to effectuate enrollment.  During the open enrollment window, selection of a new plan is permissible after a cancellation.

  • if cancellation is wanted before plan effective date, consumer can make the change using the PDF Change Form or by calling the Service Center
  • if cancellation is wanted after plan effective date, consumer can make the change using the PDF Change Form or by calling the Service Center

Terminations occur after the consumer has made a payment to the issuer to effectuate coverage. 

initial enrollment timelines in open enrollment
Initial Enrollment Timelines (in open enrollment)

Individual Marketplace:

  • For a plan submission between the 1-15th of any month, coverage must be ensured the first day of the following month.
  • For a plan submission between the 16th and last day of the month, coverage must be ensured the first day of the second following month.

*In order for the effective date to remain and go into effect, the payment for the Individual must have been successfully processed.

SHOPMarketplace:

  • Small employers and employees will be required to provide information to the Marketplace by the 15th of the month.
  • Initial enrollment information provided to the Marketplace by the 15th would trigger effective coverage for the 1st of the next month.
  • 834s for employees will only be sent once full payment has been received from the employer.

*In order for the effective date to remain and go into effect for the group, the employer must pay in full by the 15th of the month before coverage.

post enrollment changes in open enrollment
Post Enrollment Changes (in open enrollment)

Individual Marketplace:

  • During the open enrollment period, customers may cancel/terminate coverage and will be allowed to enroll in new coverage subject to Coverage Effective Date Cut Off rules (a gap in coverage may occur)
  • During an open enrollment period, a customer with a Qualified Life Change Event may update coverage that is not subject to the Coverage Effective Date Cut off.
    • Births or Adoptions, the effective date of coverage is the date of birth.
    • All other Qualified Life Change Events are effective the first of the month following the reported Qualified Life Change Event.
      • Example: Customer reports to C4HCO that they need to add their new spouse (Qualified Life Change Event = Marriage) on February 23. The coverage effective date for this change is March 1 because the change is classified as a Qualified Life Change Event.
post enrollment changes in open enrollment1
Post Enrollment Changes (in open enrollment)

SHOP Marketplace:

  • During an open enrollment period, customers are able to enroll in coverage at any time.
  • During an open enrollment period, a customer with a Qualified Life Change Event may update coverage or select new coverage.
    • Births or Adoptions, the effective date of coverage is the date of birth.
    • All other Qualified Life Change Events are effective the first of the month following the reported Qualified Life Change Event.
  • During the open enrollment period, customers may cancel/terminate effective coverage and will be allowed to enroll in new coverage prior to the close of the enrollment period.
what changes are accepted during open enrollment oe
What Changes are Accepted During Open Enrollment (OE)?
  • Adding/removing dependents
  • Loss of other coverage under Medicaid/CHP+
  • Permanent change in residence
  • Income change
  • Erroneous enrollment
  • Customer wants a new plan
  • Received a hardship/affordability exemption and wants a CYA plan
  • Data entry error (entered wrong SSN or birth date)
  • Adding/removing dental
  • Customer forgot to run plan selection by spouse
  • Provider isn’t in the plan like they thought
post enrollment changes outside oe
Post Enrollment Changes (outside OE)

Individual Marketplace:

  • Newcustomers (who are not American Indian or Alaska Native) are not allowed to enroll in new Medical coverage without a Special Enrollment Period.
  • New and current customers (who are not American Indian or Alaska Native) may only initiate Special Enrollment Periods to enroll in new coverage or change existing coverage due to a Qualified Life Change Event.
  • When a customer is allowed to shop as a result of a life change they have a 60-day shopping window from the date of the life change event.
  • Customers may voluntarily terminate existing coverage, but are not allowed to enroll in new Medical coverage
  • Customers can enroll in Dental coverage at any time during the year.

Effective date is always the first of the following month

post enrollment changes outside oe1
Post Enrollment Changes (outside OE)

Small Business Marketplace:

  • New employee hires can enroll in SHOP coverage at any time
  • Employers can set effective dates for eligible new employee hires as early as the 1st day of month following the date of hire and as late as 90 days from the date of hire.
  • Current, enrolled employees must submit a Qualified Life Change Events for the SHOP to open a Special Enrollment Period.
  • When an employee is allowed to shop as a result of a life change they have a 30-day shopping window from the date of the life change event.
  • Employees can enroll in Dental coverage at anytime during the year.

Effective date is always the first of the following month for current employees

changes are accepted outside of open enrollment qualified life changes
Changes are Accepted OUTSIDE of open enrollment (Qualified Life Changes)

Allows current enrollees to Shop for a new plan:

  • Marriage or civil union
  • Birth or adoption
  • Change of AI/AN status
  • Change of residence (if moving out of a service area)
  • Gain or loss of eligibility for the tax credit or cost sharing reduction
  • Loss of eligibility for the hardship exemption making you ineligible for your CYA (catastrophic) plan
  • Misconduct on the part of a non-Marketplace entity that led to an incorrect or inappropriate enrollment
  • A customer is inadvertently or inappropriately enrolled or not enrolled in a health plan as a result of error, misrepresentation, or inaction by the Marketplace or one of its instrumentalities
  • A customer demonstrates that their health plan has substantially violated a provision of its contract.
changes accepted outside open enrollment
Changes Accepted OUTSIDE open enrollment
  • Allows current customers to Update current plan (meaning they can’t select a new plan):
  • Removal of dependent due to divorce/annulment/separation
  • Removal of dependent due to child age out (dependent turns 26)
  • Removal of dependent due to death
  • Allows new customers to Shop for a health plan:
  • Loss of minimum essential coverage (MEC)
  • Employer-sponsored coverage becomes unaffordable
  • Gain of Citizenship or Immigration status
  • Change in incarceration status
  • Loss of eligibility for the exemption to purchase health insurance coverage
  • A customer demonstrates that their health plan has substantially violated a provision of its contract.
  • Change of residence
to summarize
To Summarize….
  • Enrolled customers can submit any type of change to enrollment during the open enrollment period
  • Effective dates for changes during open enrollment depend on whether the change is a Qualified Life Change Event.
    • If it isn’t, then the effective date will follow the 15/16th logic
    • If the change is a qualified life change event, the change will be effective the 1st day of the following month
  • C4HCO will only accept Qualified Life Change Events outside of the open enrollment period in the Individual and SHOP marketplaces. All reported Qualified Life Change Events will be effective the first day of the following month .
i may have a change what next
I may have a change… What Next?
  • Fill out the Report Life Change Events Form
  • Submit Form to the Marketplace
  • The Marketplace Processes the Form

Resulting in

No new plan OR Shopping for a New Plan

**Generally, customers will need to report changes through PEAK if the change affects household composition, income, immigration/lawful presence status. Job aid forthcoming.

what is the report lces form
What is the Report LCEs Form?

The Report Life Change Events Form is a paper application designed to capture two types of Information:

  • Requests to update/modify specific pieces of information that were incorrectly entered in the system
  • Complex Requests involving LCEs, modifications to enrollments based on updated Medicaid Eligibility, etc.
who may use the report lce form
Who May Use the Report LCE Form?
  • Current Marketplace Customers who have Financial Assistance
  • Current Marketplace Customers without Financial Assistance but whose LCE may allow them to get Financial Assistance
  • New applicants whose LCEs allow them to enter the Marketplace to access health insurance
who may fill out report lce form
Who May Fill Out Report LCE Form?

Current Customers

Those who are not yet Customers

OR

Someone Working on Customer’s Behalf:

  • An Authorized Representative
  • Certified Application Counselors
  • Health Coverage Guides
  • Agents
  • Brokers
what is the kind of lce reported
What is the Kind of LCE Reported?

Gain other MEC

Loss of MEC

Pregnancy

Income

Dependents

Marital Status

Other LCEs

Incarceration

Change in Residence/Mailing Address

Lawful Presence

General Account / Application Changes / Corrections

marital status changes
Marital Status Changes

New Marital Status