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Process for Financial Assistance at Go-Live. Marketplace Training. 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

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Presentation Transcript
today s topics
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

2

2

objectives of this training
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

3

3

key dates to remember
Key Dates to Remember

Dates to plan by:

  • C4HCO opens 10/1/2013
  • Plans and payment needed by 12/15/2013
  • 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

ongoing training and support
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!

terms and definitions
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
go live functions and release plans
Go-Live Functions and Release Plans
  • Features ready on Oct 1st:
    • Small Business Marketplace
      • Employers can set up accounts and select plans to offer
      • Employees can shop for plans offered by employer
    • Individual Marketplace
      • Browse Plans
      • Quick Eligibility Calculator and browse plans
      • Account Creation
      • Complete application and plan selection with and without financial assistance

2

2

go live functions and release plans1
Go-Live Functions and Release Plans
  • C4HCO will offer extra support through our customer service network for individuals shopping with financial assistance, because:
    • The path for financial assistance is new and for most, uncharted territory
    • With ongoing testing, we want to ensure accuracy and a good customer service experience
    • APTC determinations and amounts can be calculated in the C4HCO service center
  • The full path for financial assistance will be widely deployed early Nov

2

2

early focus
Early Focus
  • Activities to focus on in October
    • Get more familiar with the shopping experience and health plans
    • Help customers set up accounts on the Marketplace
    • Help customers get their questions answered about plans
    • 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!
overview of medical assistance programs
Overview of Medical Assistance Programs
  • Through new laws, the realm of financial assistance programs for medical coverage has expanded

Available from the State of Colorado

Available in the Marketplace

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

4

4

eligibility determinations for various programs

Advance Premium Tax Credits & Cost Sharing Reductions

Medicaid

CHP+

Eligibility Determinations for Various Programs

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

OR

OR

Available from the State of Colorado

Available through C4HCO

Customers can only be eligible for one program

5

5

online experience to apply for medical financial assistance
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:
    • Colorado Works
    • Food Assistance
    • Medical Assistance (connection with C4HCO)
    • Adult Financial
more about peak
More about PEAK
  • PEAK’s system has undergone significant improvements in 2013:
    • Re-launch 9/27
    • Design of web-pages
    • Functionality and usability
    • Ability to process real-time determinations for some MAGI applicants
    • Co-branded with C4HCO to support medical-only applicants that start in the Marketplace

15

6

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

  • 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
  • Choice #2: Actively manage the financial application process by helping customers start the application in PEAK for a Medicaid/CHP+ determination
customer service involvement in aptc csr determination for october
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
eligibility determination steps using financial application
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. Screen shot PEAK eligibility results page and upload to customer account (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

6

6

eligibility determination steps using financial application1
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

financial assistance through the marketplace day 1 through early november
Financial Assistance  Through the Marketplace Day 1 through early November

Create an account in Connect for Health Colorado

Select Plan(s)

Associate Broker/HCG/ Authorized Rep as appropriate

Shop for Plan(s)

Start application and review privacy language

Walk through APTC/CSR determination

Complete Non-Financial Application

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

Contact Customer Service Center for APTC determination

N

LEGEND

Y

= Broker/HCG or Service Rep

Contact Service Center

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

If not MedicaidCHP+ eligible, answer additional questions needed for APTC/CSR

Y

= PEAK system

N

= Service Rep

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

in PEAK

Medicaid eligibility results displayed in PEAK

training for choice 1 and choice 2
Training for Choice #1 and Choice #2
  • If you choose Choice #1. . .
    • You do not need to complete mandatory PEAK training in late Sept/early October
  • If you choose Choice #2. . .
    • You need to be comfortable using PEAK and uploading documents to the customer’s C4HCO account in early October
    • You also need to follow the tips in this training!
step 2 start of financial assistance process in c4hco
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!!!
choice 1 steps
Choice #1 Steps
  • Steps 3-7 are completed at the Customer Service Center
  • You will be informed when a determination is made
c4hco prefers applications are submitted online
C4HCO prefers applications are submitted online
  • The customer has options about method to submit application (online, mail or fax)
    • 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
customers can decide to take the tax credit up front or when filing taxes
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

12

12

key takeaways
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
contact
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)

16

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16

next steps
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:
    • PEAK overview and demo
    • C4HCO live system
  • Watch for announcements about upcoming webinars and open labs