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CEE AND CEC WEEKLY WEBINAR ~
JANUARY 9, 2014
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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
CONSUMER PRIVACY
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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
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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
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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
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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
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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.
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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)
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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
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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
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1. https://www.coveredca.com/privacy/
2. Covered California Participant Guide, Privacy and
Security, Version 2.0, pp. 1-12
SOURCES
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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
CEE AGREEMENT AND PAYMENT
UPDATE
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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.
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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.
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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.
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CEE AGREEMENT AND PAYMENT UPDATES
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CEE AGREEMENT AND PAYMENT UPDATES
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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.
ANNOUNCEMENTS AND UPDATES
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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
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IMPORTANT PAYMENT DATES
Refer consumers to the
CoveredCA.com site for
information about paying.
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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.
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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
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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.
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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.
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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.
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IPAS UPDATES
Updated information on the IPAS homepage: https://ipas.ccgrantsandassisters.org/
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WEBINAR INDEX
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WEBINAR INDEX
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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
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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
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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
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QUESTIONS
QUESTIONS?
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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)
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.
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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.
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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
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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.
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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.
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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.
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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