CEE - Microsofthbexmail.blob.core.windows.net/eap/1 9 14 Covered California CEE-CEC... · CEE...

43

Transcript of CEE - Microsofthbexmail.blob.core.windows.net/eap/1 9 14 Covered California CEE-CEC... · CEE...

Page 1: CEE - Microsofthbexmail.blob.core.windows.net/eap/1 9 14 Covered California CEE-CEC... · CEE AGREEMENT AND PAYMENT UPDATES Reminder CEE Payment Terms: Exhibit B, Section C and D
Page 2: CEE - Microsofthbexmail.blob.core.windows.net/eap/1 9 14 Covered California CEE-CEC... · CEE AGREEMENT AND PAYMENT UPDATES Reminder CEE Payment Terms: Exhibit B, Section C and D

CEE AND CEC WEEKLY WEBINAR ~

JANUARY 9, 2014

Page 3: CEE - Microsofthbexmail.blob.core.windows.net/eap/1 9 14 Covered California CEE-CEC... · CEE AGREEMENT AND PAYMENT UPDATES Reminder CEE Payment Terms: Exhibit B, Section C and D

3

AGENDA

• Webinar Topic: Consumer Privacy

• CEE Agreement and Payment Updates

• Announcements and Updates

o Important Payment Dates

o Opt Out of Medi-Cal

o Paper Applications

o Update on Covered California System Issues

o IPAS Updates

o Resources

• Upcoming Webinars

• Questions

Page 4: CEE - Microsofthbexmail.blob.core.windows.net/eap/1 9 14 Covered California CEE-CEC... · CEE AGREEMENT AND PAYMENT UPDATES Reminder CEE Payment Terms: Exhibit B, Section C and D

CONSUMER PRIVACY

4

Page 5: CEE - Microsofthbexmail.blob.core.windows.net/eap/1 9 14 Covered California CEE-CEC... · CEE AGREEMENT AND PAYMENT UPDATES Reminder CEE Payment Terms: Exhibit B, Section C and D

5

Notice of Privacy Practices

Covered California’s (CC) Notice of Privacy Practices informs

consumers of their rights and how CC uses and shares their

information.

Covered California is required by law to:

• Maintain the privacy of consumers’ personal information

• Give consumers notice of CC’s legal duties and privacy practices

• Notify consumers following a breach of unsecured protected

health information.

COVERED CALIFORNIA PRIVACY REQUIREMENTS

Page 6: CEE - Microsofthbexmail.blob.core.windows.net/eap/1 9 14 Covered California CEE-CEC... · CEE AGREEMENT AND PAYMENT UPDATES Reminder CEE Payment Terms: Exhibit B, Section C and D

6

Information Covered California May Collect

When a consumer visits the coveredca.com website, talks to a representative, or sends CC an application, the personal information CC collects may include, but is not limited to:

• Name

• Address

• Email address

• Telephone number

• Social Security Number

• Demographic information

• Health information

• Financial information

INFORMATION COVERED CALIFORNIA MAY

COLLECT

Page 7: CEE - Microsofthbexmail.blob.core.windows.net/eap/1 9 14 Covered California CEE-CEC... · CEE AGREEMENT AND PAYMENT UPDATES Reminder CEE Payment Terms: Exhibit B, Section C and D

7

What Is Personally Identifiable Information (PII)

PII is any information that identifies or describes an particular

individual. Following are examples of PII:

Full name Date of birth

Birthplace Social Security Number

Email Address National Identification

number

Vehicle registration plate

number Driver’s license number

Credit card numbers Age

Country, state, zip code, or

city of residence Mother’s maiden name

Name of schools attended

or workplace Biometric records

Grades, salary, or job title

PERSONALLY IDENTIFIABLE INFORMATION

Page 8: CEE - Microsofthbexmail.blob.core.windows.net/eap/1 9 14 Covered California CEE-CEC... · CEE AGREEMENT AND PAYMENT UPDATES Reminder CEE Payment Terms: Exhibit B, Section C and D

8

Federal Regulations Requiring Covered California to Safeguard PII

• Federal regulations require CC to safeguard the PII it collects, maintains,

and uses in order to prevent unauthorized access to this information.

• CC must also protect the integrity of this information to prevent it from being

altered or destroyed by unauthorized users.

State Regulations Requiring Covered California to Safeguard PII

• California law regulates the collection and use of personal information by

state government agencies, as specified in the Information Practices Act

of 1977 (IPA).

PII FEDERAL REGULATIONS

Page 9: CEE - Microsofthbexmail.blob.core.windows.net/eap/1 9 14 Covered California CEE-CEC... · CEE AGREEMENT AND PAYMENT UPDATES Reminder CEE Payment Terms: Exhibit B, Section C and D

9

Important Things to Remember

• Do not discuss private personal, financial or medical matters

in an open/non private area

• Do not collect documents with PII and leave them unattended

• Do not email PII

• Do not email screen shots with PII present

• Do not leave a computer screen unattended with PII present

• Do not discuss consumer application information with others

• After assisting consumer, destroy all scans, cell phone

photos or copies of documents containing PII.

Page 10: CEE - Microsofthbexmail.blob.core.windows.net/eap/1 9 14 Covered California CEE-CEC... · CEE AGREEMENT AND PAYMENT UPDATES Reminder CEE Payment Terms: Exhibit B, Section C and D

10

What Is Protected Health Information

• Includes documentation in any medium: written, oral, or electronic (e.g.,

paper, CDs/DVDs, flash drives, smart phones, and laptops).

• Consists of the following past, present, or future information about the

physical and mental health of an individual:

o Condition of the individual

o Provision of health care to the individual

o Payment for health care by the individual

PROTECTED HEALTH INFORMATION (PHI)

Page 11: CEE - Microsofthbexmail.blob.core.windows.net/eap/1 9 14 Covered California CEE-CEC... · CEE AGREEMENT AND PAYMENT UPDATES Reminder CEE Payment Terms: Exhibit B, Section C and D

11

Tips for Securely Uploading Documents for Covered California

Important:

For your security, CC cannot accept documents for upload via e-mail. Also,

do not upload individual documents in multiple files.

• If a document is too large to upload, try one of the following options:

o Rescan the document at a lower resolution (recommended

resolution: 200 dpi).

o Use free compression software, which can be downloaded online.

(This can reduce the size of the document by 30 to 50%.)

o If you have Adobe Acrobat Pro (not Adobe Reader), you can

decrease the size of the document by:

1. Opening the file in Acrobat Pro.

2. Going to File->Save As Others->Reduce Size PDF.

DOCUMENT UPLOADING TIPS

Page 12: CEE - Microsofthbexmail.blob.core.windows.net/eap/1 9 14 Covered California CEE-CEC... · CEE AGREEMENT AND PAYMENT UPDATES Reminder CEE Payment Terms: Exhibit B, Section C and D

12

If Your Upload Is Timing Out

If your upload is timing out before completion, check the following:

• Your Internet connection may be too slow. Slower connection

speeds coupled with large file sizes frequently result in a

timeout.

• Be sure you are using Google Chrome or Mozilla Firefox as

your browser.

• Only attempt one file upload at a time.

• The file size of the document must be less than 40MB.

DOCUMENT UPLOADING TIPS

Page 13: CEE - Microsofthbexmail.blob.core.windows.net/eap/1 9 14 Covered California CEE-CEC... · CEE AGREEMENT AND PAYMENT UPDATES Reminder CEE Payment Terms: Exhibit B, Section C and D

13

1. https://www.coveredca.com/privacy/

2. Covered California Participant Guide, Privacy and

Security, Version 2.0, pp. 1-12

SOURCES

Page 14: CEE - Microsofthbexmail.blob.core.windows.net/eap/1 9 14 Covered California CEE-CEC... · CEE AGREEMENT AND PAYMENT UPDATES Reminder CEE Payment Terms: Exhibit B, Section C and D

14

Do NOT email sensitive personal information

Email is not a secure form of communication

• Do not email CEC, Consumer, or other PII to Covered

California, the Help Desk, or any other organization

• PII on screenshots for trouble tickets should be removed

• Open the screenshot in a document or editing

software, delete the PII, and save the new document

• Print a copy, black out the PII, scan it back to your

computer

• All change request and other forms should be faxed to

(559) 436-5293

REMINDER

Page 15: CEE - Microsofthbexmail.blob.core.windows.net/eap/1 9 14 Covered California CEE-CEC... · CEE AGREEMENT AND PAYMENT UPDATES Reminder CEE Payment Terms: Exhibit B, Section C and D

CEE AGREEMENT AND PAYMENT

UPDATE

Page 16: CEE - Microsofthbexmail.blob.core.windows.net/eap/1 9 14 Covered California CEE-CEC... · CEE AGREEMENT AND PAYMENT UPDATES Reminder CEE Payment Terms: Exhibit B, Section C and D

16

CEE AGREEMENT AND PAYMENT UPDATES

CEE Agreement Status• Executed Agreements have not been mailed but will be

soon.

CEE Agreement Amendments• All CEE Agreements will be amended to reflect the

following changes:

• No application assistance payment for Medi-Cal

renewals.

• No application assistance payment for individuals who

were enrolled in Medi-Cal in the prior 12 months.

• Application assistance payments for Medi-Cal

enrollments will be issued when Covered California

receives payment from DHCS.

Page 17: CEE - Microsofthbexmail.blob.core.windows.net/eap/1 9 14 Covered California CEE-CEC... · CEE AGREEMENT AND PAYMENT UPDATES Reminder CEE Payment Terms: Exhibit B, Section C and D

17

CEE AGREEMENT AND PAYMENT UPDATES

Reminder CEE Payment Terms:

Exhibit B, Section C and D of CEE AgreementC. DHCS Budget Contingency Clause

1. If funding for any fiscal year is reduced or deleted by the California Department of Health Care Services for purposes of this program, the State shall have the option to either cancel this Agreement with no liability occurring to the State, or offer an agreement amendment to the Contractor to reflect the reduced amount.

Page 18: CEE - Microsofthbexmail.blob.core.windows.net/eap/1 9 14 Covered California CEE-CEC... · CEE AGREEMENT AND PAYMENT UPDATES Reminder CEE Payment Terms: Exhibit B, Section C and D

18

CEE AGREEMENT AND PAYMENT UPDATES

D. State Budget Act Contingency Clause

1. It is mutually agreed that if the Budget Act of the current year and/or any subsequent years covered under this Agreement does not appropriate sufficient funds for the program, this Agreement shall be of no further force and effect. In this event, the Exchange shall have no liability to pay any funds whatsoever to

Contractor or to furnish any other considerations under this Agreement and Contractor shall not be obligated to perform any provisions of this Agreement.

Page 19: CEE - Microsofthbexmail.blob.core.windows.net/eap/1 9 14 Covered California CEE-CEC... · CEE AGREEMENT AND PAYMENT UPDATES Reminder CEE Payment Terms: Exhibit B, Section C and D

19

CEE AGREEMENT AND PAYMENT UPDATES

Page 20: CEE - Microsofthbexmail.blob.core.windows.net/eap/1 9 14 Covered California CEE-CEC... · CEE AGREEMENT AND PAYMENT UPDATES Reminder CEE Payment Terms: Exhibit B, Section C and D

20

CEE AGREEMENT AND PAYMENT UPDATES

Page 21: CEE - Microsofthbexmail.blob.core.windows.net/eap/1 9 14 Covered California CEE-CEC... · CEE AGREEMENT AND PAYMENT UPDATES Reminder CEE Payment Terms: Exhibit B, Section C and D

21

CEE AGREEMENT AND PAYMENT UPDATES

Application assistance payments for

coverage effectuated in Covered California

Plans (QHP) will be paid in mid-February.

Application assistance payments for

Medi-Cal enrollments will be paid at a later

date when Covered California receives

payment from DHCS.

Page 22: CEE - Microsofthbexmail.blob.core.windows.net/eap/1 9 14 Covered California CEE-CEC... · CEE AGREEMENT AND PAYMENT UPDATES Reminder CEE Payment Terms: Exhibit B, Section C and D

ANNOUNCEMENTS AND UPDATES

Page 23: CEE - Microsofthbexmail.blob.core.windows.net/eap/1 9 14 Covered California CEE-CEC... · CEE AGREEMENT AND PAYMENT UPDATES Reminder CEE Payment Terms: Exhibit B, Section C and D

23

IMPORTANT PAYMENT DATES

Consumers now have until January 15, 2014 to make their first month’s

premium payment.

• Consumers may use the services covered by their health plan

starting January 1st

Page 24: CEE - Microsofthbexmail.blob.core.windows.net/eap/1 9 14 Covered California CEE-CEC... · CEE AGREEMENT AND PAYMENT UPDATES Reminder CEE Payment Terms: Exhibit B, Section C and D

24

IMPORTANT PAYMENT DATES

Refer consumers to the

CoveredCA.com site for

information about paying.

Page 25: CEE - Microsofthbexmail.blob.core.windows.net/eap/1 9 14 Covered California CEE-CEC... · CEE AGREEMENT AND PAYMENT UPDATES Reminder CEE Payment Terms: Exhibit B, Section C and D

25

OPT OUT OF MEDI-CAL

Consumers have the option to opt out of Medi-Cal and select a plan. On the Apply For Benefits screen select “NO”NOTE: The consumer will not be eligible for premium assistance.

Page 26: CEE - Microsofthbexmail.blob.core.windows.net/eap/1 9 14 Covered California CEE-CEC... · CEE AGREEMENT AND PAYMENT UPDATES Reminder CEE Payment Terms: Exhibit B, Section C and D

26

PAPER APPLICATION

DO NOT SUBMIT PAPER APPLICATIONS

• CECs may use paper applications to start an

application for a consumer

• CECs should enter all paper applications on the

CoveredCA.com site

• Follow-up with the consumer to obtain any

information needed to complete the application

Page 27: CEE - Microsofthbexmail.blob.core.windows.net/eap/1 9 14 Covered California CEE-CEC... · CEE AGREEMENT AND PAYMENT UPDATES Reminder CEE Payment Terms: Exhibit B, Section C and D

27

UPDATE ON COVEREDCA.COM SYSTEM ISSUES

Access Codes

• There is a known issue with consumer access codes not being generated.

• CoveredCA.com is working on a fix.

• Consumers have to call the Service Center at (800) 300-1506 to receive their access codes.

CEC Dashboard

• There is a known issue with applicants not showing in the CEC dashboard.

• CoveredCA.com is working on a fix.

• CECs can expect delays of up to a day for their applications to appear on their dashboards.

Page 28: CEE - Microsofthbexmail.blob.core.windows.net/eap/1 9 14 Covered California CEE-CEC... · CEE AGREEMENT AND PAYMENT UPDATES Reminder CEE Payment Terms: Exhibit B, Section C and D

28

COVEREDCA.COM TIPS

Eligibility Calculator

• The eligibility calculator in the application is functioning.

• If the consumers are married, they have to mark “Married-Filing Jointly” to be evaluated for APTC

• APTC is a premium tax credit. If they are not filing taxes they are not eligible for the tax credit.

Shop and Compare Calculator Differences

• There are two Shop and Compare calculators and there may be differences between the results

• It is only an estimate for informational purposes.

Income

• Reminder: Have the consumer project their income for 2014.

Page 29: CEE - Microsofthbexmail.blob.core.windows.net/eap/1 9 14 Covered California CEE-CEC... · CEE AGREEMENT AND PAYMENT UPDATES Reminder CEE Payment Terms: Exhibit B, Section C and D

29

UPDATE ON COVEREDCA.COM SYSTEM ISSUES

Medi-Cal

• Do not exclude household members on Medi-Cal

• If the parents want Medi-Cal and the children already have it everyone needs to be included in the application.

• Children should not be excluded from the application. Medi-Cal will know that the children already receive Medi-Cal.

• The system will provide a notification at the end of the application that the children are not eligible because they already have existing Medi-Cal.

Medicare

• If the consumer is on Medicare they are not eligible to apply on CoveredCA.com.

• If they are Medi-Cal eligible they need to go to the county office.

Page 30: CEE - Microsofthbexmail.blob.core.windows.net/eap/1 9 14 Covered California CEE-CEC... · CEE AGREEMENT AND PAYMENT UPDATES Reminder CEE Payment Terms: Exhibit B, Section C and D

30

IPAS UPDATES

Updated information on the IPAS homepage: https://ipas.ccgrantsandassisters.org/

Page 31: CEE - Microsofthbexmail.blob.core.windows.net/eap/1 9 14 Covered California CEE-CEC... · CEE AGREEMENT AND PAYMENT UPDATES Reminder CEE Payment Terms: Exhibit B, Section C and D

31

WEBINAR INDEX

Page 32: CEE - Microsofthbexmail.blob.core.windows.net/eap/1 9 14 Covered California CEE-CEC... · CEE AGREEMENT AND PAYMENT UPDATES Reminder CEE Payment Terms: Exhibit B, Section C and D

32

WEBINAR INDEX

Page 33: CEE - Microsofthbexmail.blob.core.windows.net/eap/1 9 14 Covered California CEE-CEC... · CEE AGREEMENT AND PAYMENT UPDATES Reminder CEE Payment Terms: Exhibit B, Section C and D

33

RESOURCES

CEE Resource Purpose for Contact

Your Entity’s assigned Enrollment Assistance Specialist

Call: 888-402-0737 to find your EAS contact information

All Certified Enrollment Entities have been assigned an Enrollment

Assistance Specialist (EAS) who are well equipped to answer questions

and provide help

Enrollment Assistance Help Desk

Call: 888-402-0737

E-mail: [email protected]

General questions about the Enrollment Assistance program and

process

Enrollment Entity application process questions

Delegation Codes questions

Certified Enrollment Entity application and resource

website:

https://ipas.ccgrantsandassisters.org/

Find resources such as recorded informational webinars, checklists and

worksheets

Application Change Request Form

Check that status of applications submitted

Consumer Help Desk

Phone: 800-300-1506

(Staffed with Service Center Staff who speak multiple

languages)

To access tools online to assist the consumer:

www.coveredca.com

Consumer or CEC general questions about health plan applications,

enrollment, benefits or current coverage

Online CoveredCa.com use the Shop and Compare Tool to help

consumers review plan options or download FAQs to answer questions

Page 34: CEE - Microsofthbexmail.blob.core.windows.net/eap/1 9 14 Covered California CEE-CEC... · CEE AGREEMENT AND PAYMENT UPDATES Reminder CEE Payment Terms: Exhibit B, Section C and D

34

RESOURCES

CEC Resource Purpose for Contact

Enrollment Assistance Help Desk

Call: 888-402-0737

E-mail: [email protected]

General questions about the Enrollment Assistance program and

process

Enrollment Entity application process questions

Delegation Codes questions

Learning Management System (LMS) and Training Help Desk

Call: 559-573-3580

E-mail: [email protected]

Link: https://learning.coveredca.com/

Login assistance

Help with Instructor-Led Training/Self-Guided Training Registration

Questions on the (2) Computer-Based Training

Assistance with the Certification Exam

Live Scan – Covered California’s Fingerprinting Provider

Criminal Disclosure Form:

http://www.healthexchange.ca.gov/Documents/CECdisclosure.pdf

To find locations for fingerprinting

Schedule appointments

Check the status of your background check clearance

Download Live Scan request form

Consumer Help Desk

Phone: 800-300-1506 (Staffed with Service Center Staff who speak

multiple languages)

To access tools online to assist the consumer:

www.coveredca.com

Consumer or CEC general questions about health plan

applications, enrollment, benefits or current coverage

Online CoveredCa.com use the Shop and Compare Tool to help

consumers review plan options or download FAQs to answer

questions

Page 35: CEE - Microsofthbexmail.blob.core.windows.net/eap/1 9 14 Covered California CEE-CEC... · CEE AGREEMENT AND PAYMENT UPDATES Reminder CEE Payment Terms: Exhibit B, Section C and D

35

UPCOMING WEBINARS

• All Webinars are scheduled for Thursdays 10:00-11:30 am

o January 16, 2014

o January 23, 2014

o January 30, 2014

Page 36: CEE - Microsofthbexmail.blob.core.windows.net/eap/1 9 14 Covered California CEE-CEC... · CEE AGREEMENT AND PAYMENT UPDATES Reminder CEE Payment Terms: Exhibit B, Section C and D

36

QUESTIONS

QUESTIONS?

Page 37: CEE - Microsofthbexmail.blob.core.windows.net/eap/1 9 14 Covered California CEE-CEC... · CEE AGREEMENT AND PAYMENT UPDATES Reminder CEE Payment Terms: Exhibit B, Section C and D

37

QUESTIONS

Application

I have been working with consumers who set up accounts,

selecting me as their CEC and then completing the application.

Who should be signing the application with the PIN number?

The CEC should sign the application and enter their PIN.

One of my applicants' data does not appear in my account. During

the application process the system did not provide a code for the

consumer to access her account. I have application and case

numbers of the individual but have no access to the account.

The consumer must contact 800-300-1506 to secure their access

code.

What telephone number do we call, as CECs, when we need

assistance or have an error code/message on an application?

For general application assistance please call the CEE/CEC Help

Desk at 888-402-0737. If you encounter an error code or

message in an application, please email the CEE/CEC Help Desk

to have a Trouble Ticket submitted. The email should contain a

screen shot (with all PII redacted) and include an application

number (if applicable)

[email protected]

When we use the “add a new individual”, the client no longer

shows on our active list.

Why are some of my consumers missing from my dashboard?

This was due to a system issue. A data fix is being run periodically

until the issue is resolved. Please expect delays with individuals

appearing on your dashboards until the issue is resolved.

Individuals should show up within 1-2 business days.

What is the best web browser or way to enroll people online? Google Chrome.

Why can’t I get through to the help desk using the chat feature? The chat is not intended for CECs.

Page 38: CEE - Microsofthbexmail.blob.core.windows.net/eap/1 9 14 Covered California CEE-CEC... · CEE AGREEMENT AND PAYMENT UPDATES Reminder CEE Payment Terms: Exhibit B, Section C and D

38

QUESTIONS

Medi-Cal

What is the timeline for the Medi-Cal application

process? For people that are Medi-Cal eligible,

what’s the average wait time before they are

contacted by Medi-Cal? When Medi-Cal contact

clients about their coverage?

Typically the county will contact the consumer within

45 days of application. If the consumer has not

been contacted, please refer them to their local DSS

County office.

How do I enroll someone for Medi-Cal when they

have Medicare using CoveredCA.com?

Persons with Medicare are not eligible to enroll in

Medi-Cal through CalHEERS. They must go to the

County to apply.

Will there always be a county eligibility worker

portion of the process (outside of the

CoveredCA.com system).

There will be a county eligibility worker portion of the

process.

Why does Covered CA tell those eligible for Medi-

Cal they must sign up for a plan, but have a link

that doesn't show any plans they can sign up for?

The functionality to allow them to sign up for a plan

has not been available to date. This functionality is

coming in April.

Page 39: CEE - Microsofthbexmail.blob.core.windows.net/eap/1 9 14 Covered California CEE-CEC... · CEE AGREEMENT AND PAYMENT UPDATES Reminder CEE Payment Terms: Exhibit B, Section C and D

39

QUESTIONS

Medi-Cal

If one person in the household qualifies for

Medi-Cal, don't all the rest of the family

members qualify? Why is it that some members

are qualified for Medi-Cal and others are not?

How does this work?

Not all members qualify at the same level of

income. Some family members, for example will

only be eligible for Medi-Cal up to 138% of the

Federal Poverty Level (FPL) whereas pregnant

women and children are eligible up to 266%.

Because Medi-Cal eligibility depends on other

factors in addition to income, eligibility is specific

to the circumstances of each individual.

For consumers who previously have been

enrolled in Medi-Cal but have been dropped for

one reason or another and told they need to fill

out new paperwork, can they apply (re-apply)

through the Covered California website?

Yes, consumers may enroll in Medi-Cal through

CoveredCA.com.

For consumers who are enrolled in County

Medical Services Program (CMSP) in

Sacramento County:

• Will they be moved into Medi-Cal?

• If so, will the process be automated or do

consumers need to enroll?

The County Medical Services Program (CMSP)

is a Medi-Cal Program. For more information

about CMSP, please visit their website at:

http://www.cmspcounties.org/ or the Department

of Health Care Services at

http://www.dhcs.ca.gov

Page 40: CEE - Microsofthbexmail.blob.core.windows.net/eap/1 9 14 Covered California CEE-CEC... · CEE AGREEMENT AND PAYMENT UPDATES Reminder CEE Payment Terms: Exhibit B, Section C and D

40

QUESTIONS

Eligibility

Do individuals who are on

unemployment, but own a house, car or

have a 401K account qualify for Medi-

Cal?

Individuals with incomes up to 138% of the Federal

Poverty Level qualify for Medi-Cal without regard to

existing assets.

Can a student who is working and is

claimed as a dependent of their parents

enroll?

A student claimed as a tax dependent can enroll under

his/her parents’ plan up to the age of 26.

If a client’s income is between 300% and

400% and they are eligible for tax credits,

are they not eligible for Advance

Payment of the tax credits? The eligibility

outcome says that they are eligible but

that $0 is available for tax year 2014.

Premium assistance is calculated based on the second

lowest silver plan in the zip code. In cases where a

consumer’s fair share is greater than the premium rate

they would be charged, they will not receive APTC

because their premium is already considered

affordable. This occurs most in regions with low

premiums. In these cases “fair share” of 9.5% can max

out well under the 400% income level.

For example: An individual making $37,000 in

Sacramento County has a Fair Share of $292. The

second lowest silver plan on which the APTC is based is

$270 for a 26 year old which means it’s below the

consumers fair share amount and they will not receive

premium assistance.

Page 41: CEE - Microsofthbexmail.blob.core.windows.net/eap/1 9 14 Covered California CEE-CEC... · CEE AGREEMENT AND PAYMENT UPDATES Reminder CEE Payment Terms: Exhibit B, Section C and D

41

QUESTIONS

Eligibility

Eligibility of Mixed Families: Where one

parent/spouse is AI/AN and the other is not

AI/AN, does the system allow so that they can

have one application together? We have

families that will purchase the insurance or

Catastrophic coverage for the non AI/AN

spouse and no coverage for the AI/AN spouse

as they await the fix. We have other families

that are choosing to wait hoping that the fix will

occur before the 03/31/14 deadline. Do we

have a projected date for the fix?

We need to review this particular case in order to give a

specific answer. However, you should not file multiple

applications for one tax household. All members of a tax

household should be included on one app despite

applying for different programs. The eligibility system will

determine the correct eligibility for the program they are

eligible for. The latest update to CoveredCA.com includes

the ability to select multiple plans for each individual of the

household.

What are the eligibility options if you are 65 or

older? (For example, recently, had a client that

is 65 without Medicare, AI/AN, has Veterans

benefits, makes $31,221/yr. He wanted to

know if he would qualify for Medi-Cal or any

other Medi-Cal program. The eligibility

outcome gave him an option of a AI/AN Bronze

plan for $40.37 premium payment with $508.00

advance payment of tax credits with no

copy/ded, can he chose this option?)

In this example, the individual may be eligible for non-

MAGI Medi-Cal (traditional Medi-Cal) as evaluated by the

county. He may be eligible for APTC and CSR. However,

he can choose one or the other, not both. A consumer

may also choose to opt out of Medi-Cal, but choosing this

option would opt the consumer out of ATPC and CSR if

they were determined to be eligible for those programs.

Page 42: CEE - Microsofthbexmail.blob.core.windows.net/eap/1 9 14 Covered California CEE-CEC... · CEE AGREEMENT AND PAYMENT UPDATES Reminder CEE Payment Terms: Exhibit B, Section C and D

42

QUESTIONS

Immigration

What can we do about clients who do not have an expiration

date printed on their green card? Nor do they have a card

number, only an A#.

For green cards that have no expiration date or number,

please use “12/31/9999” as the expiration date and

“AAA0000000000” for the number. The following link is

helpful when assisting consumers in entering their

Immigration Document information on the application:

https://e-verify.uscis.gov/esp/help/EvHelpPermResCardNumber.htm

Do foreign students need to enroll in insurance here if they

have insurance from their native country?

It isn't insurance bought here or through their school, it is

separate foreign health insurance. Will they be penalized?

IRS in its final rules on exemption from the Individual

Mandate (specifically provides, in the middle column of page

53651, that coverage or a plan provided by a foreign

insurance issuer to foreign nationals lawfully present in the

United States for an extended period of time that is not

offered within a state in the United States is neither an eligible

employer-sponsored plan nor a plan in the individual market.

Therefore, those foreign nationals lawfully present in the

United States are subject to the Individual Mandate and the

imposed tax penalty if they do not maintain minimum

essential coverage in the state in which they reside.

What can we do about clients who lost their naturalization

certificate and therefore do not know their number?

The client should contact the issuing agency for a new

certificate.

Page 43: CEE - Microsofthbexmail.blob.core.windows.net/eap/1 9 14 Covered California CEE-CEC... · CEE AGREEMENT AND PAYMENT UPDATES Reminder CEE Payment Terms: Exhibit B, Section C and D

43

QUESTIONS

Other

What can be done if the county refuses to write a

non-incarceration letter? Marin County refused to

provide a letter for an applicant. I submitted a

letter from an alternative organization to prove

that the person was not in custody.

If the applicant does not have discharge papers

because they have never been to jail or prison

they should call the Service Center and attest to

never having been in jail. This is verification is

fully attestable.

CoveredCA

Why does Covered CA give a client the choice to

be contacted by e-mail and instead sends them

notices to their secure inbox on the CoveredCA

site? Some receive mailed notices even when

they requested e-mail.

The only messages that will ever go to the

Secure Inbox are the same notices that are

mailed out. For now, they receive the notice by

mail and they may also get copies sent to their

inbox.

Plan Options

How long should a consumer expect to wait to

hear from their health plan send information

regarding their first month’s premium payment?

Some companies do not offer online payment

methods.

If a consumer has not heard from their health

plan they may contact the health plan directly.

Payment information is available on the Covered

California website:

https://www.coveredca.com/getting-covered/how-

to-pay.html