Understanding your Certified Enrollment Counselor Role

Understanding your Certified Enrollment Counselor Role Participant Guide

Version 4.0

Covered California Participant Guide Course Name: Understanding Your CEC Role Version 4.0

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TABLE OF CONTENTS

1. STAGE I: CERTIFIED ENROLLMENT COUNSELOR ROLE ............................................................. 1

1.1. Course Objectives .............................................................................................................. 1

2. INTRODUCTION TO THE CERTIFIED ENROLLMENT COUNSELOR ROLE ........................................ 1

2.1. Certified Enrollment Entities and Certified Enrollment Counselors ............................. 1

2.2. What are the Certified Enrollment Entity and Counselors Roles and Responsibilities? ............................................................................................................... 2

2.3. The Navigator Program ..................................................................................................... 3

2.4. Medi-Cal Managed Care Plan Enrollment Assistance (MMCP) ...................................... 3

2.5. How to handle media questions ....................................................................................... 4

3. WHAT MAKES A CERTIFIED ENROLLMENT COUNSELOR SUCCESSFUL? ..................................... 5

3.1. What are the steps to be a successful CEC? .................................................................. 5

3.1. Step 1: Identifying uninsured consumers interested in Covered California or Medi-Cal ........................................................................................................ 5

3.2. Step 2: Set an appointment time to provide enrollment assistance ............... 5

3.3. Step 3: Walk through the enrollment process with the consumer .................. 6

3.4. Step 4: Approach the process with sensitivity and confidentiality .................. 6

3.5. Step 5: Provide information and assistance in ways that are culturally and linguistically appropriate and meet the Standards of the ADA ....................... 7

3.6. Step 6: Comply with all Federal and State Regulations and program requirements .................................................................................................. 8

3.7. Step 7: Follow-up with Annual Renewals ....................................................... 8

4. HOW WILL COVERED CALIFORNIA MONITOR PERFORMANCE AND COMPLIANCE? ...................... 8

4.1. Overview of Performance Monitoring .............................................................................. 8

4.1. CEC ROLE .................................................................................................... 9

4.2. CEE ROLE ..................................................................................................... 9

4.2. Compliance Monitoring ..................................................................................................... 9

4.5. Quality Assurance and Monitoring ............................................................... 10

5. VOTER REGISTRATION ........................................................................................................... 10

6. STAGE II: CERTIFIED ENROLLMENT COUNSELOR ROLE .......................................................... 11

6.1. What are the Next Steps After CECs Complete Training? ........................................... 11

7. HOW TO USE SOCIAL MEDIA TO REACH CONSUMERS ............................................................. 13

7.1. Tips to Maximize Social Media Strategies ..................................................................... 13

7.2. Popular Social Media Tools and Platforms ................................................................... 14

8. WHAT SUPPORT EXISTS FOR CERTIFIED ENROLLMENT COUNSELORS? ................................... 15

Covered California Participant Guide Course Name: Certified Enrollment Counselor Role Version 4.0

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9. ACTIVITY ANSWERS ............................................................................................................... 20

Covered California Participant Guide Course Name: Understanding Your CEC Role Version 4.0

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1. STAGE I: CERTIFIED ENROLLMENT COUNSELOR ROLE

1.1. COURSE OBJECTIVES

Describe the Certified Enrollment Counselor roles and responsibilities

Understand what makes a Certified Enrollment Counselor successful

Understand the types of performance monitoring for the role

Learn about the next steps after completing training

Learn how to use social media to reach consumers

Learn about the resources available to support day-to-day activities

2. INTRODUCTION TO THE CERTIFIED ENROLLMENT COUNSELOR ROLE

2.1. CERTIFIED ENROLLMENT ENTITIES AND CERTIFIED ENROLLMENT COUNSELORS

Here are some definitions that will help you understand the roles and programs we’ll discuss in this course. Certified Enrollment Counselors function within Certified Enrollment Entities which are trusted and known organizations that serve as critical resources for consumers.

Certified Enrollment Entity (CEE)

Enrollment Entities are organizations that are certified to participate in one of the following Enrollment Assistance Programs: Medi-Cal Managed Care Plan, Certified Application Counselors, Plan-Based Enrollers, and the Navigator Program.

The CEE is the organization that provides the resources for consumers. The CEE is responsible for promoting Covered California and Medi-Cal as a trusted resource for health care coverage by establishing an internal system of quality and compliance while adhering to Covered California’s monitoring and evaluation requirements. CEEs have direct access to Covered California’s primary populations.

Certified Enrollment Counselor (CEC)

The CEC is an individual that works for, or volunteers with, a CEE. The Certified Enrollment Counselor program is designed to provide one-on-one assistance to educate consumers about Covered California health plans, Medi-Cal, and provide guidance through the enrollment process. During the early years of Covered California, about 50% of targeted consumers (over 2.5 million) are expected to need personal assistance.


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The chart below depicts an overview of a typical consumer enrollment process in Covered California:

This Program includes Certified Application Entities, also referred to as CAEs, with Certified Application Counselors, known as CACs, to provide face-to-face, in-person, Consumer enrollment Assistance.

2.2. WHAT ARE THE CERTIFIED ENROLLMENT ENTITY AND COUNSELORS ROLES AND

RESPONSIBILITIES?

Entities and Counselors need to

Maintain expertise in eligibility, enrollment, and program specifications

Provide information and services in a fair, accurate and impartial manner. Such information and services shall include assistance with other insurance affordability programs such as Medi-Cal

Facilitate selection of a Covered California Health Plan

Refer enrollees with a grievance, complaint, or question regarding their health plan, coverage, or a determination under such plan or coverage to any applicable office of health insurance Consumer Assistance or health insurance ombudsman established under Section 2793 of the Public Health Service Act, 42 U.S.C. § 300gg-93, or any other appropriate State agency or agencies

Comply with the privacy and security standards established by Covered California

Certified Application Counselors associated Certified Application Entities are registered, trained and certified by Covered California and have cleared Fingerprinting and Criminal Record Check by the California Department of Justice and the FBI to provide in-person counseling to help consumers enroll in Covered California or Medi-Cal.

Certified Enrollment Counselors Provide In-

Person Assistance at this stage


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Certified Application Counselors (CACs)

Associated with CAEs

Registered, trained, and certified by Covered California

Cleared Fingerprinting and Criminal Record Check by the California Department of Justice and Federal Bureau Investigation (FBI)

Responsible for providing one-on-one consumer enrollment assistance

2.3. THE NAVIGATOR PROGRAM

The purpose of the Navigator Grant Program is to engage trusted organizations to conduct outreach, education, enrollment assistance and post enrollment services on behalf of Covered California.

The Navigator Program Activities include:

Informing Covered California eligible consumers of the availability and benefits of obtaining health care coverage

Promoting the value of purchasing health care coverage and motivating consumers to act

Helping consumers shop for and compare plans;

Providing outreach and education about Covered California and its options;

Helping consumers enroll in Covered California Health Plans;

Providing post-enrollment and renewal support;

Providing information in a manner that is culturally and linguistically appropriate to the needs of the population being served.

Ensuring that registration assistance is available in compliance with California Code of Regulations, Title 10, Chapter 12, Article 4 Section 6462.

Providing post enrollment support to ensure successful enrollment and retention; and

The organizations awarded the Navigator Grant are also referred to as the Certified Enrollment Entities and individuals carrying out these activities will be referred to as Certified Enrollment Counselors.

2.4. MEDI-CAL MANAGED CARE PLAN ENROLLMENT ASSISTANCE (MMCP)

Provides consumers with support in enrolling in Medi-Cal and Covered California

A Certified Medi-Cal Managed Care Plan (CMMCP): an entity contracting with the Department of Health Care Services (DHCS) to provide health care services to enrolled Medi-Cal beneficiaries in the regions it serves.

Certified Medi-Cal Managed Care Plan Enrollers (CMMCPE): are employees or contractors of a Medi-Cal Managed Care Plan that provides one-on-one enrollment assistance to consumers in the respective regions they serve.

CMMCPE’s roles are similar to that of the enrollment counselors, CMMCPs and CMMCPEs shall:

Maintain expertise in eligibility, enrollment, and program specifications;


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Provide information and services in a fair, accurate and impartial manner;

Facilitate selection of a Covered California Health Plan during the enrollment application process;

Provide referrals to any applicable office of health insurance Consumer Assistance or health insurance ombudsman, or any other appropriate State agency or agencies, for any enrollee with a grievance, complaint, or question regarding their health plan, coverage, or a determination under such plan or coverage;

Provide voter registration assistance; and

Comply with any applicable federal or state laws and regulations.

More information can be found in the Medi-Cal Managed Care Plan Enrollment Assistance Regulations, Article 12, at this link:

http://hbex.coveredca.com/regulations/PDFs/Medi-Cal%20Managed%20Care%20Approved%2004-27-15.pdf

Enrollment assistance personnel must not:

Have a conflict of interest as defined in the CEC Agreement.

Mail the paper application for the consumer.

Coach or recommend one plan or provider over another.

Provide gifts, including gift cards or cash or provide promotional items that market the services or products of a third party to any consumer as an inducement for enrollment.

Accept any premium payments from the consumer.

Input any premium payment information on behalf of the consumer.

Pay any part of the premium or any other type of consideration to or on behalf of the consumer.

Create multiple applications from the same household solely for the basis of increased compensation.

Invite, influence, or arrange for an individual whose existing coverage through an eligible employer-sponsored plan is affordable and provides minimum value.

Coach the consumer to provide inaccurate information on the application regarding income, residency, immigration status and other eligibility rules.

Solicit any consumer for application or enrollment assistance by going door-to-door or through any other unsolicited means of direct contact unless the Certified Application Counselor has a pre-existing relationship with the consumer.

2.5. HOW TO HANDLE MEDIA QUESTIONS

The media may approach you for information about Covered California or Medi-Cal. In your role as a CEC you should not speak with the media about Covered California or Medi-Cal. Should any news agencies, reporters or journalists contact you, inform them that you do not engage the media and refer them to Covered California’s media line.

Covered California’s Media Line

916.206.7777


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3. WHAT MAKES A CERTIFIED ENROLLMENT COUNSELOR SUCCESSFUL?

3.1. WHAT ARE THE STEPS TO BE A SUCCESSFUL CEC?

There are seven steps that are critical to be a successful CEC. The chart below depicts each step:

Seven Steps to be a Successful CEC

Step 1 Identify the uninsured and potential consumers interested in Covered California or Medi-Cal.

Step 2 Set a time for an appointment to provide enrollment assistance.

Step 3 Walk through the enrollment process with the consumer.

Step 4 Approach the process with sensitivity and confidentiality.

Step 5 Provide information and assistance in culturally and linguistically appropriate methods as required and meet the standards of the Americans with Disabilities Act (ADA)

Step 6 Comply with all Federal and State Regulations.

Step 7 Follow-up with annual renewals.

3.1. STEP 1: IDENTIFYING UNINSURED CONSUMERS INTERESTED IN COVERED

CALIFORNIA OR MEDI-CAL

Most CECs will become aware of uninsured consumers through their CEE’s network and activities. The CEE will help identify primary populations and channel those referrals to the CECs.

CECs will need to determine the level of interest of uninsured consumers and answer general questions about Covered California or Medi-Cal in order to schedule an appointment.

3.2. STEP 2: SET AN APPOINTMENT TIME TO PROVIDE ENROLLMENT ASSISTANCE

To best serve the consumer and facilitate a successful enrollment, the CEC should establish a timeframe for an appointment that will allow for up to 90 minutes. Providing an adequate window of time allows for all questions and concerns to be addressed without the consumer feeling rushed or pressured.

At the time the appointment is scheduled, the CEC should end the communication by:

Confirming the appointment date and time is satisfactory for the consumer

Confirming the consumer knows how to find the location of the appointment

Providing the consumer with the Covered California Enrollment Worksheet

The Covered California Enrollment Worksheet’s intended use is to collect information necessary to facilitate/expedite the online enrollment at the appointment. However, the


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worksheet is not to be retained by the assisting certified enrollment counselor and must be returned to consumer or destroyed after enrollment.

In order for the application process to be completed accurately, remind the consumer to bring documentation for the information provided on the worksheet regarding:

Photo ID

Household members (date of birth, Social Security Number, citizenship/immigration status)

Personal demographic information (disabilities, medical expenses for the last 3 months, pregnancy information, American Indian/Alaska Native status)

Personal tax information (if primary tax filer if filing for the current benefit year, tax filing status if claimed as a dependent)

Personal healthcare information (current insurance and policy numbers, need for long term care/home or community-based services, if consumer has Medicare)

Income information (most recent pay stub, W2 employment income, W9 self-employment income, other income, income deduction types and amounts)

Documents will not be collected or kept by the CEC, but will be helpful for consumers to validate what is submitted during the application process.

All enrollment appointments should occur in a location that provides privacy and security to discuss the sensitive information contained in the application and allows access to a secure computer to use CoveredCA.com

3.3. STEP 3: WALK THROUGH THE ENROLLMENT PROCESS WITH THE CONSUMER

Upon arrival the CEC should greet the consumer in a friendly manner, be polite and courteous to establish a rapport. Be sure to explain to the consumer that the appointment could take as long as 90 minutes.

Approach the process with the “no wrong door” approach and ensure that all consumers receive assistance regardless of whether they:

Qualify for Medi-Cal or Covered California Health Plans

Have special language or cultural needs

Have disabilities or special circumstances

Walk through the online application and assist the consumer with completing all required information accurately to determine program eligibility and eligibility for financial assistance.

Assist the consumer to select the health plan that best meets their needs without guiding the consumer’s choices.

If the application cannot be completed during the appointment, a follow-up appointment is required to complete the application as soon as possible.

3.4. STEP 4: APPROACH THE PROCESS WITH SENSITIVITY AND CONFIDENTIALITY

Information provided during the application process contains sensitive financial and health information. The Privacy and Security course discusses the definition of personally identifiable information (PII), federal tax information (FTI) and protected health information (PHI), the Health Insurance Portability and Accountability Act (HIPAA) and when this confidential information can be used and disclosed. The course also discusses ways to keep


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information secure, how to report privacy and security violations and the rights individuals have regarding their personal information. It is crucial for CECs to follow these rules and regulations regarding sensitive information in the course of their duties. It is also important to understand the regulations and penalties involved for individuals who do not handle confidential data in an appropriate manner.

CECs should always be looking out for information that is considered PII. PII is any information that identifies or describes an individual. Some examples of information that can be PII include:

Full Name

Birthplace

Email Address

Vehicle registration plate number

Credit card numbers

Country, state, zip code or city of residence

Name of school attended or workplace

Social Security Number

Biometric records (including photographs)

National Identification number

Driver’s license number

Age

Grades, salary or job position

Date of birth

Mother’s maiden name

To maintain an atmosphere of confidentiality, the CEC must:

Make sure that enrollment assistance is provided in locations that are private.

Avoid asking personal questions not required as part of the enrollment process.

Not retain any information used by the consumer as part of the enrollment process.

Not mail in a paper application.

3.5. STEP 5: PROVIDE INFORMATION AND ASSISTANCE IN WAYS THAT ARE CULTURALLY

AND LINGUISTICALLY APPROPRIATE AND MEET THE STANDARDS OF THE ADA

When engaging consumers it is very important to do so in ways that are culturally and linguistically appropriate and meet the standards of the Americans with Disabilities Act (ADA).

CECs should develop and maintain general knowledge about the racial, ethnic and cultural groups of consumers including cultural health beliefs and practices, preferred languages, and health literacy.

Covered California requires that CECs provide services in-language including interpretation, at no cost to the consumer when necessary or requested to ensure effective communication. One method to easily achieve this is determining if the consumer has a family member that can be used to translate. Use of a consumer’s family or friends can satisfy the requirement if it is requested by the consumer as their preferred alternative. If a family member does not meet the consumer’s needs, the CEC should arrange for a third party language line through the Covered California Service Center at 800.300.1506.

To the extent possible, provide access to the location of the appointment that allows people with disabilities to come and go as easily as everyone else. Also, ensure communication


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with people with disabilities is effective, including providing materials suitable for those with hearing or visual impairment.

3.6. STEP 6: COMPLY WITH ALL FEDERAL AND STATE REGULATIONS AND PROGRAM

REQUIREMENTS

There are many requirements, regulations and rules critical to your role in Covered California. The Compliance Standards course as well as the Privacy and Security course discuss the requirements and state and federal regulations in greater detail.

CECs must also abide by all requirements as outlined in the Certified Enrollment Counselor’s Agreement. These include:

All requirements related to privacy and security.

Not collecting payment (direct or indirect) for enrollment assistance services.

Not collecting premium payments for health insurance.

Other important requirements include wearing the Covered California identification badge at all times while engaging consumers.

The program at times will require CECs to satisfy training courses including updates, annual retraining and recertification. More information will be released regarding these additional training requirements as it becomes available.

CECs are also required to report any suspicious activity surrounding Covered California operations immediately to a Supervisor, Covered California or the Department of Health Services (DHCS), as appropriate.

3.7. STEP 7: FOLLOW-UP WITH ANNUAL RENEWALS

The role of the CEC continues after a consumer enrolls in Covered California. CECs will answer questions from consumers or refer consumers needing assistance to appropriate resources on an ongoing basis.

To the extent possible, CECs will follow-up with consumers annually for renewal of coverage to promote retention in a Covered California health plan or Medi-Cal. Promoting retention is a valuable role of the CEC to help keep the consumer engaged in coverage.

4. HOW WILL COVERED CALIFORNIA MONITOR PERFORMANCE AND

COMPLIANCE?

4.1. OVERVIEW OF PERFORMANCE MONITORING

It is critical that each consumer’s interaction with a CEC is a positive experience. Protecting consumers from fraud, waste and abuse is critical to building consumer trust, upholding a positive consumer experience and promoting Covered California as a trusted brand. Therefore, Covered California will proactively promote compliance with program standards and address

What is retention?

Retention is the act of retaining continued use in Covered California, Medi-Cal and other qualified health plan services. Also included are follow-ups with annual renewals in Qualified Health Plans and re-determination for Medi-Cal.


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program violations. To maintain a high level of quality and consumer satisfaction, CECs will be closely monitored and evaluated by the affiliated CEE and Covered California.

4.1. CERTIFIED ENROLLMENT COUNSELOR ROLE

At a minimum, CECs are expected to:

Maintain accuracy in application submissions

Renew CEC certification each year, completing all training and other requirements for recertification

Represent the best interests of consumers

Act in an ethical manner and avoid all conflicts of interest

4.2. CERTIFIED ENROLLMENT ENTITY ROLE

CEEs are responsible for promoting Covered California as a trusted resource for affordable health care coverage by:

Establishing an internal system for monitoring program quality and compliance

Adhering to Covered California’s monitoring and evaluation requirements

CEE monitoring of affiliated CECs includes, at a minimum:

A mechanism(s) through which to evaluate the performance of CECs, including:

o Verifying that activities are delivered as planned

o Evaluating the accuracy of education messages and information

o Assessing overall compliance with program standards and guidelines

Identification and reporting of instances of non-compliance of Privacy and Security regulations to Covered California within 30 days and specifying a plan(s) for corrective action

Identification and reporting to Covered California within 30 days any and all concerns related to conflicts of interest, fraud, or violations of program standards

Site visits will also be conducted at which technical assistance and support will be provided to CEEs, as well as gathering feedback.

Should any CEE or affiliated CEC be deemed no longer eligible to represent the program the CEE and/or CEC will be de-registered/de-certified by Covered California.

4.2. COMPLIANCE MONITORING

Compliance monitoring relies on proactive quality assurance, field monitor reports, and consumer complaint sources to identify potential violations of program standards among Covered California CEEs and CECs. Compliance Representatives (CRs) will conduct fact-finding activities to determine the severity of these issues, and respond appropriately to resolve the issue. The results of these activities provide continuous program improvement by resolving noncompliance at an early stage, implementing corrective action plans, and removing violators from Covered California programs. In addition, consumer complaints will be used to identify entities and individuals claiming to be Covered California-certified entities and enrollment counselors, and stop potentially fraudulent or abusive activity that could harm consumers.


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When program violations and/or instances of fraud, waste, and abuse are identified and confirmed through fact-finding activities, CRs will classify the violations as minor, moderate, or major. The potential harm to the consumer is a standard to which violations of program standards will be assessed. Major program violations (those with the highest potential risk to the consumer) will be escalated to Covered California for adjudication and referral to law enforcement. Minor and moderate program violations (those with lower potential risk to the consumer) will be corrected and monitored.

4.5. QUALITY ASSURANCE AND MONITORING

Quality assurance and monitoring to proactively identify violations of program standards among CEEs and CEEs will include:

Data collection and analysis Random site visits Secret shopping Analyzing enrollment trends to detect anomalies Following up on referrals from program support resources

5. VOTER REGISTRATION Under Federal and State law, Covered California must offer consumers voter registration services each time a person seeks service or assistance with:

An application A renewal or reenrollment of their application Change of address

If a consumer seeks help for one of the above reasons Covered California must offer help with voter registration to the same degree as is offered by the representative to complete Covered California’s form, unless assistance is declined.

When providing voter registration services you must be prepared to answer basic questions about how to register to vote and review the application for completeness.

The task guide linked on your screen provides more information on voter registration that you should review on your own.

Remember the following when assisting consumers with voter registration:

You must allow consumers the opportunity to register to vote in private Never lead applicants to believe that their decision whether or not to register to vote will

affect their application for benefits Never influence a consumer’s political party registration Never discourage a consumer from registering to vote. Never make determinations about voter eligibility. Each consumer must determine his or

her eligibility to vote.

When providing in-person assistance for online or paper applications, Enrollment Counselors, Certified Insurance Agents, and CMMCPEs are required to provide voter registration services to consumers

Read aloud or allow applicants to read all the “Important Notices” to ensure they understand their options.


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Applicants can answer “Yes,” “No,” or “Send,” or they can decline to make a selection to the voter registration question.

If the consumer wants to register to vote, and the internet is available, choose “Yes, I will go online” and take the consumer to the link shown here. Select “Yes,” and then choose the registration form in the consumer’s preferred language if it is offered and provide assistance filling out the form, unless assistance is declined.

If the consumer wants to register to vote and internet is not available, choose “Yes, send me a voter registration form” and a card will be mailed to them.

6. STAGE II: CERTIFIED ENROLLMENT COUNSELOR ROLE In this stage you will learn the next steps for CECs after they have completed training. It will describe taking CoveredCA.com system training, completing the certification exam, working with your CEE to start performing work and recertification requirements.

6.1. WHAT ARE THE NEXT STEPS AFTER CECS COMPLETE TRAINING?

Once the training is complete for CECs there are several next steps to become officially certified. These steps in the certification process include:

Steps to Certification

Step 1 Complete the Certified Enrollment Counselor Application Form with the your information, sign, date, and submit the application to the Certified Enrollment Entity

Step 2 Complete the background check process through Live Scan fingerprinting and the California Department of Justice (DOJ) and Federal Bureau of Investigation (FBI)

Step 3 Complete certification training and pass the certification exam with a score of 80% or higher

Step 4 Create your Certified Enrollment Counselor account in CoveredCA.com once you have received your Delegation Code via e-mail

Step 5 Provide your Enrollment Entity with current photo (head-shot) for ID Badge

Step 6 Work with your Enrollment Entity to develop a work plan to start activities

Step 7 Become recertified as required by Covered California

Step 1: Complete the Certified Enrollment Counselor Application Form

You’ll need to fill out and complete the Enrollment Counselor Application and Agreement provided by your Enrollment Entity and provide them with a headshot picture. Your Certified Entity submits this form to Covered California.

Step 2: Complete the background check process through Live Scan


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It is important to start the Background Check process prior to or immediately following CEC Training. Background check clearance by the Department of Justice will take at least 30 days and could take up to 8 weeks to be finalized.

Capital Live Scan 877-288-5519

Mon-Sat, 9am to 5pm

Email: [email protected].

Web Address: www.coveredcalivescan.com

Criminal Disclosure and Request for Live Scan Forms

1. Access: https://ipas.ccgrantsandassisters.org/

2. Log on to the entity account

3. Click on the number under the CECs column

4. Click on CEC

5. Download the pre-populated forms for the CEC. Exception: MMCPEs will provide a form and payment for fingerprinting due at the time services are rendered

Step 3: Pass the Certification computer Based Training

Complete the certification computer-based training and pass the certification exam with a score of 80% or higher.

Complete Training at https://learning.coveredca.com:

Take the computer-based training (CBT) courses through the Covered California Learning Management System

Pass an Exam consisting of 50 questions with a score of 80% or higher within 3 attempts

Step 4: Create your CEC account in CoveredCA.com once you have received your Delegation Code via e-mail

Step four is to create your Certified Enrollment Counselor account on CoveredCA.com once you have received your Delegation Code via e-mail. Check your email for notification from Covered California. The notice will include your certification number, a delegation code and your Enrollment Entity’s legal business name.

You will ONLY receive this e-mail if the following criteria have been met:

Tips for Passing the Certification Exam

Tip #1 – Use the printable training reference materials to research questions and find correct answers.

Tip #2 – Go slow. Take time to read and understand each question completely before answering.


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Your Certified Enrollment Counselor Agreement is uploaded and accurately completed

Your Certified Enrollment Entity’s status is Active

You have passed the training requirements and Certification Exam

Your background check clearance has been received by Covered California

Then, access CoveredCA.com and follow the instructions to log into your Certified Enrollment Counselor account using the information provided in the email.

Step 5: Provide your CEE with current photo (head-shot) for ID Badge Upload a current photograph (headshot) with a plain background.

For example:

Provide the primary contact at your organization with a headshot photo that will be uploaded into your CEC application

Once all CEC requirements have been achieved you will receive your ID Badge

Step 6: Developing a plan to start work

Next, you will need to develop a plan with your Certified Enrollment Entity to start work. Work with your Certified Enrollment Entity supervisor to develop a work plan to help consumers enroll in Covered California Health Plans or Medi-Cal. It’s important that you are consistent with your organization’s objectives and the population served. This includes:

Following up on consumers to schedule appointments Turning appointments into successful enrollments

Step 7: Becoming recertified

Each year CECs must complete the annual recertification training and exam. In addition, throughout the year CECs will be expected to participate in program updates as they become available. Covered California will provide your organization additional details as they become available.

7. HOW TO USE SOCIAL MEDIA TO REACH CONSUMERS Technology has changed the traditional methods by which people communicate information. The pool of people we now have the opportunity to meet and interact with has been greatly expanded to near limitless possibilities. The use of social media can be a very effective tool for reaching consumers to market enrollment assistance services, promote special events, and conduct outreach to those that may require enrollment assistance.

7.1. TIPS TO MAXIMIZE SOCIAL MEDIA STRATEGIES

As with any effort to reach and market certain populations it is not necessarily what you do, but how you do you it, that has the biggest impact. Below are tips and strategies for maximizing your social media presence:


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Social Media Tips

Make Your Social Media Count Treat Twitter, Facebook and Instagram accounts as promotional tools by keeping followers updated on your day-to-day education and enrollment activities.

Embrace Social Media Trends Not all social media is created equal. It is important to try different social media trends, such as pictures, videos, hashtag statements to enhance the ability to impact target populations.

Treat Hashtags Statements with Care Hashtag statements offer a method to connect with and inspire consumers to share your statements with others. Hashtags also provide a reporting tool to track if your statements are being utilized by other users. Be cautious with overusing hashtag statements in a single post, as it may dilute the message.

Proofread and Double Check Writing Before Posting

Carefully review the writing of your message before posting. Errors in grammar, spelling or event details can cause your marketing efforts to backfire.

Leverage Existing Covered California Social Media Resources

Covered California regularly updates its social media accounts with:

Facebook

Twitter

Google+

YouTube

Instagram

Social media is designed for these outlets to leverage information sharing. For example, use a video from Covered California’s YouTube Channel to post on your organizations Facebook page.

Harness the Power of Storytelling Consumer testimonials are a powerful way to connect with other consumers who have a similar story. When sharing a testimonial from a consumer, follow all Privacy and Security guidelines and ensure that consumer consent is confirmed with written authorization prior to releasing the information on your social media accounts.

7.2. POPULAR SOCIAL MEDIA TOOLS AND PLATFORMS

The most common types of social media include:


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Facebook: The world’s largest social network, with more than 1.3 billion people using the site. Users create a personal profile, add other users as friends, and exchange messages, including status updates. Organizations can create pages and Facebook users can “like” pages to receive updates and information.

Twitter: A social networking platform that allows both organizations and individuals to stay connected through the exchange of short status messages (140 character limit). Users “follow” each other and are notified when new messages have been posted.

YouTube: A video hosting and watching website. Create an account to post video content to be shared via web links.

Instagram: A free photo and video sharing app that allows users to apply digital filters, frames and special effects to their photos and then share them on a variety of social media platforms.

LinkedIn: A website where groups of professionals with similar areas of interest can share and participate in conversations related to their fields.

8. WHAT SUPPORT EXISTS FOR CERTIFIED ENROLLMENT COUNSELORS? After training, there are many resources available to CECs both for support in day-to-day activities and for in-depth education on health care reform, Covered California, and government agencies.

Listed below are tables that describe the three different types of resources:

Job Resources

Educational Resources

Contacts

Resources for Certified Enrollment Counselors

Benefit

Training Reference Material Reference guides with information on Covered California, health insurance, and resources for Enrollment Representatives

Job Aids Key information for often-needed details

Shop and Compare Tool Use the Shop and Compare Tool to help consumers review plan options and estimate costs. Find the tool here: http://www.coveredca.com/shopandcompare/#calculator

Frequently Asked Questions (FAQs) FAQs listed on CoveredCA.com address the most common questions and concerns asked by consumers. Reviewing FAQs is helpful to stay up-to-date on program information to address consumer needs. Find FAQs here: http://www.coveredca.com/faqs/


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Benefit

Covered California Service Center

(800) 300-1506

Staffed with representatives who speak in multiple languages

Dedicated resource for consumer questions regarding:

Health plans, eligibility, applications, enrollment, benefits or current coverage

Certified Enrollment Representative Service Center

M-F, 8am-5pm

(855) 324-3147

This number is not to be shared with consumers

Dedicated resource for Certified Enrollment Representative questions regarding:

Eligibility

Status update on paper applications submitted

General CoveredCA.com errors

General information in the Enrollment Assistance Program and processes

Enrollment Entity application process

Delegation codes

CoveredCA.com password resets

Covered California Health Plans Consumer help with accessing and finding doctors or healthcare services, healthcare claims, etc.

Health Consumer Alliance (HCA) The HCA is a partnership between legal aid organizations that provides free local assistance to individuals and families applying for or enrolled in Covered California or Medi-Cal. Refer consumers to HCA for additional help and information.

Go to www.healthconsumer.org for more information by county or call 1-888-804-3536.

Covered California Consumer complaints or issues regarding a Certified Enrollment Counselor or Enrollment Entity.

[email protected]

Or the Certified Enrollment Representative Service Center at 855-324-3147

Learning Management System (LMS) The LMS ongoing database for training needs, found here: https://learning.coveredca.com


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Benefit

In-Person Assistance System (IPAS) Website

https://ipas.ccgrantsandassisters.org/

bi-weekly webinars for community partners and Certified Insurance Agents

Tips of the Week

FAQs, and more

Educational Resource Reference

Federal health care reform www.healthcare.gov

www.healthcare.gov/center/regulations/index.html

The Centers for Medicare and Medicaid Services’ Center for Consumer Information and Insurance Oversight

http://cciio.cms.gov/

California Health Benefit Exchange www.healthexchange.ca.gov

Department of Managed Health Care (DMHC) and its programs

www.dmhc.ca.gov

Office of the Patient Advocate www.opa.ca.gov

Contacts

As a Certified Enrollment Counselor, you will likely be asked questions or have situations for which you need additional support. This quick-reference list provides contact information for many common situations. In addition, the Contacts and Resources Job Aid is a great tool to have at your desk, as it includes all the Covered California contact information you may need.

Certified Enrollment Counselor Activity Support

Who to Contact

Questions about your day-to-day activities Your immediate supervisor at the Certified Enrollment Entity with which you are affiliated

Trouble connecting to or using CoveredCA.com, the Covered California online portal


1.800.300.1506 (or CEC Help Line)

Application questions Covered California Service Center

1.800.300.1506 (or CEC Help Line)

A small-business owner wants help reviewing his health insurance options for his company

Certified Insurance Agent―if they want to look at several health insurance company options. They can be found on www.coveredca.com. CECs are prohibited from referring consumers to a specific agent or set of agents.


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Certified Enrollment Counselor Activity Support

Who to Contact

An individual is having a problem with their insurance benefits or something related to their current coverage


1.800.300.1506

Note: The consumer may be transferred to their health insurance company’s complaint unit or to the appropriate state regulatory entity.

Office supplies or other on-site needs Your Certified Enrollment Entity


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Activity 1

Check your knowledge of the Certified Enrollment Counselor role basics by answering true or false for each statement.

True False

1. Certified Enrollment Counselors can enroll consumers in Covered California health plans.

2. Certified Enrollment Entities have the option of targeting specific markets or populations and turning away others who ask for assistance.

3. The primary goal of the Certified Enrollment Counselor role is to provide in-person assistance to consumers as they sort through health insurance options and make the right choice.

Activity 2

Check your knowledge about the Certified Enrollment Counselor program by circling the correct answer.

Answer

1. Which of the following are requirements to be a Certified Enrollment Counselor?

a. Pass a background check

b. Complete required training courses

c. Sign a code of conduct

d. Be affiliated with a registered Certified Enrollment Entity

e. All of the above

2. Certified Enrollment Counselor services include:

a. Assisting consumers with completing eligibility requirements for all Covered California products and programs

b. Supporting retention efforts including coverage renewals

c. Providing information to the media about Covered California

d. Serving all consumers in a fair, impartial, and respectful manner

e. All but C

f. All of the above


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9. ACTIVITY ANSWERS

Activity 1

1. True

2. False

3. True

Activity 2

1. E

2. E

Understanding your Certified Enrollment Counselor Role

Documents

Transcript of Understanding your Certified Enrollment Counselor Role