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Commonwealth Choice Massachusetts Health Care Training Forum January 2011

What we'll cover . Understand changes to non-group eligibility.Know the updated

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Commonwealth Choice Massachusetts Health Care Training Forum January 2011

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    1. Commonwealth Choice Massachusetts Health Care Training Forum January 2011

    2. What we’ll cover Understand changes to non-group eligibility. Know the updated “special conditions” that allow individuals to purchase during closed enrollment periods. Understand the “renewal” process for new and existing health insurance subscribers. 2

    3. A few terms Non-group: Individual or family health insurance plans bought by individuals, on their own. Group: Health insurance through an employer. MCC: Minimum Creditable Coverage. The benefits you need to avoid penalties under the MA individual mandate. Creditable Coverage: The federal term for =18 months of coverage for medical claims. 3

    4. New law on non-group Chapter 288 of the Acts of 2010 changed… Eligibility: Who can apply for commercial health insurance plan, as of October 1, 2010, and Enrollment: When they can apply for a commercial health insurance plan, as of December 1, 2010 4

    5. Eligibility for non-group purchase – the “who” 5 Old Works for an employer with 50 or fewer employees (YAP only); OR Employer has more than 50 employees… …but contributes 33% or less toward the cost of employee health insurance New Employer size is not a consideration All: Employer plan is not MCC or the actuarial equivalent of MCC 18-26 year-olds only: Employer contributes 33% or less toward the cost of employee health insurance Hand out new policies Hand out new policies

    6. Open Enrollment – the “when” Two opportunities to buy health insurance in 2011: January 1 – February 15 Coverage effective February 1 or March 1 July 1 – August 15 Coverage effective August 1 or September 1 One opportunity to buy health insurance in 2012 and beyond: July 1 – August 15 Coverage effective August 1 or September 1 6

    7. Important Open Enrollment Dates 12/1/10 – 12/31/10 Closed 1/1/11 – 2/15/11 Open 2/16/11 – 6/30/11 Closed 7/1/11 – 8/15/11 Open 8/16/11 – 6/30/12 Closed 7/1/12 – 8/15/12 Open 8/16/12 – 6/30/13 Closed Closed: Customers who meet special conditions may buy a plan. Others must wait for the next open enrollment. Open: Customers, including current subscribers, can buy a plan. 7

    8. It’s Open Enrollment time! 8

    9. Special conditions to buy anytime Some people may meet special conditions to buy health insurance regardless of open enrollment. Had prior creditable coverage that was in effect for an aggregate of 18+ months without a break of more than 63 days; and Do not currently have access to ESI that meets MCC standards, Medicare, or MassHealth; and Did not lose coverage due to fraud or non-payment of premium; BUT… 9

    10. Special conditions: loss of group coverage …they must apply within 63 days of losing qualifying health coverage from an employer or the government “group,” such as: Employer-sponsored health insurance coverage COBRA or mini-COBRA benefits Government-subsidized health benefits such as MassHealth, Commonwealth Care, TRICARE, etc. What if prior coverage was non-group coverage? 10

    11. Must apply within 63 days of losing non-group coverage due to: Loss of dependent status Limited to divorce, legal separation, termination of domestic partnership, death of a spouse or dependent, aging out of a parent’s health plan The carrier closing their plan Moving outside of their plan’s service area Loss of qualified student health insurance coverage “Aging out” of a Young Adult Plan 11 Special conditions: loss of non-group coverage

    12. Special Conditions to buy anytime: What is qualifying coverage? The prior non-group or group coverage must be “creditable coverage,” under the FEDERAL (HIPAA) definition. Must have health insurance coverage for an aggregate of 18 months, without a break in coverage of more than 63 days. 12

    13. Anniversary Dates: New CommChoice Subscribers People allowed to enroll during closed enrollment will get a short plan year. They must “renew” during the next open enrollment. People who enroll during the Jan/Feb 2011 open enrollment period may: Renew during the July/Aug open enrollment (recommended) or Keep their 12-month anniversary, which will fall outside of the 2012 open enrollment. 13

    14. Anniversary Dates: CommChoice Subscribers who came in before the changes 14 Those with anniversary dates between Jan 1, 2011 and July 1, 2011 may: Change carriers and plans at the time of their renewal Renew into Commonwealth Choice from a separate carrier Renew for a 12-month contract, or Renew for a short contract and then renew again during the July/Aug open enrollment period

    15. Those with an anniversary date between Sept 1, 2011 and July 1, 2012 may: Enroll in an new plan during the July/August open enrollment, or Renew their existing coverage during the July/August 2011 open enrollment period, or Wait until their 12-month anniversary and become “locked in” to their plan until the next open enrollment period. 15 Anniversary Dates: CommChoice Subscribers (cont.)

    16. Commonwealth Care Bridge Update 16

    17. QUESTIONS? See you at the roundtables! 17

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