Eligibility
1095- _
Enrollment
Marketplace
Could be this, could be that..
100
What are the three choices you have under the "Eligibility" quick link?
Requirements Insurance Affordability Application
100
What is the timeframe for an address correction on a 1095-A?
I have submitted your mailing address correction request, and you’ll receive a notification within 14 business days. Remember, the deadline for filing your 2016 taxes is April 18, 2017. If you have further questions about your taxes, please visit IRS.gov or consult a tax professional.
100
What is the name of this Script? The open enrollment period for 2017 has ended. If you did not select a new plan during open enrollment, I can help you look into your eligibility for a special enrollment period. If you are not eligible for a special enrollment period, you will have to wait until the next open enrollment period to enroll in Marketplace coverage. The 2018 open enrollment period will begin on November 1, 2017, and run through January 31, 2018.
Enrollment and Coverage Timeline
100
Can a consumer have a dental only through the Marketplace? & What script is this information listed in?
Dental Coverage You can only buy a dental plan through the Marketplace if you also enroll in a health plan. You can get dental coverage as part of your health plan or by enrolling in a separate, stand-alone dental plan. Dental coverage is optional for adults and children, so you don’t need to purchase it in order to avoid paying the fee for not having health coverage.
100
When are we (the marketplace) open?
We are available to help you 24 hours a day, 7 days a week, including some federal holidays. We are closed on Memorial Day, Independence Day, Labor Day, Thanksgiving, and Christmas.
200
What script are these requirements out of? (name and section) To qualify for a tax credit for coverage in 2017, your combined family income must be at or below: •$47,520 for an individual •$64,080 for a family of 2 •$80,640 for a family of 3 •$97,200 for a family of 4 •$113,760 for a family of 5 •$130,320 for a family of 6 •$146,920 for a family of 7 •$163,560 for a family of 8
Advance Payments of the Premium Tax Credit Section 5. What Are the Income Eligibility Requirements?
200
What is the timeframe for a 1095-A reprint? (with no corrections) & what is the script and section called?
The CSR Reprint button does not appear in the consumer’s view and can be accessed only by CSRs. The processing time is 7 business days for simple reprints without corrections. Section 2. Where Can I Get Form 1095-A? of Form 1095-A and Marketplace Tax Questions
200
How Long Does It Take for Coverage to Be Effective?
The date that your coverage starts depends on when you enroll. If you enroll between the first and fifteenth day of the month, your coverage starts the first day of the next month. If you enroll between the sixteenth and the last day of the month, your coverage starts the first day of the month after next. For example, if you enroll on January 16, your coverage starts on March 1.
200
You should always offer to assist the consumer with what?
Whatever issue they are calling about... Mostly an application.
200
Who is a consumer?
For authorization purposes, a “consumer” is anyone on the application over age 18, which includes: •Individuals seeking coverage through the Marketplace, and •The individual filing the application (the application filer), who may or may not be seeking coverage.
300
What is the Script name and section of the script listed below? Cost-sharing reductions are different from tax credits. A cost-sharing reduction is a discount that lowers the amount you have to pay out-of-pocket for deductibles, coinsurance, and copayments, so you pay less when you get care. Tax credits help you pay a lower amount toward your premium. However, like tax credits, cost-sharing reductions are dependent on your income and family size. If your income level and family size change, you must report this to the Marketplace because that could result in a change in your cost-sharing reduction
Cost-Sharing Reduction Section 1. What Are Cost-Sharing Reductions?
300
Why would a consumer receive a form 1095-B?
If you or members of your household had catastrophic coverage through the Marketplace or coverage through public programs like Medicare, Medicaid or CHIP, you may receive a Form 1095-B (Health Coverage) from your insurance carrier, not from the Marketplace. Script: Form 1095-A and Marketplace Tax Questions, Section: 5. What Are Form 1095-B and Form 1095-C, and Why Did I Receive Them?
300
What script do you use if a caller states they had coverage in 2016 & they did not choose or complete an application for 2017. However, they are receiving information from an insurance company for 2017?
Marketplace Plan Re-Enrollment and Automatic Re-Enrollment Section 2. I Thought My Coverage Ended at the End of the Year. Why Was I Re-Enrolled in My Marketplace Plan? If you did not contact the Marketplace during the open enrollment period to actively choose your health coverage for the current year or instruct us not to re-enroll you in health coverage, the Marketplace enrolled you in your health plan from last year. If your plan from last year is no longer available, you may have been enrolled in a similar or alternate health plan. This was done to protect you from a gap in your coverage. If you are eligible for a special enrollment period and would like to change your health coverage for this year, I can assist you with enrolling in another health plan now. If you do not qualify for a special enrollment period, you can select a new health plan during the next open enrollment period. Open enrollment for 2018 begins November 1, 2017, and runs through January 31, 2018.
300
When the consumer calls in with a new plan issue, you should ask them what? & what is the script name?
Plan issues Section: New Plan Issue Have you already tried to contact your plan directly?
300
To enter a valid authorization you must?
You can authorize another individual to access your account information over the phone. This authorization can last for one call, or for up to 365 calendar days. After 365 calendar days, you must contact the Marketplace again to provide a new authorization. Your verbal authorization gives permission for [INSERT NAME HERE] to discuss your information for the amount of time you provide. You can also limit the type of information we release, such as eligibility, application, or enrollment information. How long would you like the authorization to last, and would you like to provide any limitations on the information we release? Mark "none" if no limitations.
400
To be eligible for health coverage through the Marketplace, you must?
To be eligible for health coverage through the Marketplace, you: •Must live in the United States •Must be a U.S. citizen, national, or a lawfully present resident •Can’t be incarcerated
400
Why would a consumer receive a form 1095-C?
If you or members of your household received coverage from a large employer who has more than 50 employees, then you may receive Form 1095-C (Employer-Provided Health Insurance Offer and Coverage) from your insurance company or your employer. It’s important to follow the instructions on these forms so you fill out your federal income tax return correctly. You don’t need to include these forms with your tax return. Instead, save these forms along with your other tax documents. Script: Form 1095-A and Marketplace Tax Questions, Section: 5. What Are Form 1095-B and Form 1095-C, and Why Did I Receive Them?
400
Name 3 of the 7 steps you find in the Enrollment Closing Language script?
Now that you are enrolled in a Marketplace plan, I have a few details to share with you about your coverage and next steps: 1.You can access your application online at HealthCare.gov any time by using your application ID and selecting the Find my application link on the My Applications & Coverage screen. 2.If you have any questions about your coverage, please contact your health insurance company directly. I can help you locate your plan’s contact information. 3.If you had coverage outside of the Marketplace, contact your plan to have your coverage end on the day your new Marketplace plan’s coverage begins. This will help you avoid a gap in coverage and ensure that you don’t have to pay premiums for both plans. 4.It may take up to 2 weeks for your new health insurance company to process your enrollment and send you plan materials with information about how to pay your premium. Usually, you have to pay your premium before your coverage is effective. Don’t worry if your plan name doesn’t appear exactly as the name you saw at HealthCare.gov. Sometimes plans have different names for the different types of coverage they offer. If you do not receive information about your new coverage from your health insurance company, call us back. 5.Contact the Marketplace as soon as possible if you get new coverage and need to end your Marketplace coverage. It can take 14 days or more to terminate your coverage. If you don’t call to set a coverage end date, your coverage could overlap, and you may be billed for 2 plans. 6.You should report life changes to the Marketplace as soon as possible because they could change your tax credit or cost-sharing reduction eligibility. If you do not report a life change, you might have to pay back some of your tax credit when you file your federal income taxes. Life changes include: •Income changes •Births, adoptions, marriage, divorce, and dependents losing dependent status •Offers for job-based coverage, whether accepted or not •Changes in eligibility for Medicare, Medicaid, or the Children’s Health Insurance Program, known as CHIP 7.If you are receiving tax credits, you must file Form 8962 each year when you file your taxes.
400
Per the Cost of Marketplace Insurance script, should you offer to help get the consumer an estimate of prices if the ask?
Yes. You can find a Marketplace plan that fits both your needs and your budget. When you fill out your Marketplace application, you’ll find out if you’re eligible for lower costs on monthly premiums or lower out-of-pocket expenses. You’ll also find out if you’re eligible for free or low-cost coverage through Medicaid or the Children’s Health Insurance Program, known as CHIP. If you’re ready, I can help you fill out an application now or you may fill out your own online. If you just want to get an idea of what the prices may be like in your area, and an estimate of the amount of advance payments of the premium tax credit you may be eligible for, you can use the Window Shopping Tool at HealthCare.gov/see-plans/. I can also help you get a price estimate if you’d like. The health plan premium estimates are based on some basic information and may change. You’ll know exactly how much you’ll pay for a plan after you submit your completed application.
400
What is the script you will use the if the caller states they received a call from the marketplace and they want to know if it is okay to talk to them?
Protecting Consumers' Information Section 7. I’ve Received a Call from Someone Who Claims to Be from the Marketplace. Is It Okay to Talk to Them?
500
What are the five scripts listed under the selection "Insurance Affordability" in the "Eligibility" quick link?
Advance Payments of the Premium Tax Credit Cost-sharing Reduction Form 1095-A and the marketplace Tax questions Reading Form 1095-A Tax filing Assistance
500
Name at least four out the eleven reasons why you would transfer to tier 2 for a Form 1095-A Complex Research Requests? **& what is the one reason you would not transfer to tier 2 even if they fit one of the eleven requirements?
•Issuer name is incorrect. •Policy or individual start date or termination date is incorrect. •Monthly premium or advance payments of the premium tax credit (APTC) amount is incorrect. Do not transfer to a Tier 2 CSR if the amounts are incorrect because:◦The consumer was enrolled in coverage for only part of the month. ◦The premium on the form includes only the part of the premium that covers essential health benefits. ◦The consumer had a stand-alone dental plan or dental coverage for children. ◦The amount for partial-month coverage is incorrect. ◦Coverage ended for nonpayment after a grace period, and the form shows the full premium for the first month of the grace period. •Marketplace-assigned policy number is incorrect. •Individuals are missing on the form or incorrectly listed. •Consumer received a phone call or notice that their previous correction request was denied, and the consumer still believes information on their form is incorrect. •Consumer received a corrected form and believes their form is still incorrect. •Consumer believes they had coverage through the Marketplace but did not receive a Form 1095-A. The consumer does not have a Form 1095-A online and there is no record of the consumer having coverage through the Marketplace. •Consumer received Form 1095-A but did not have coverage through the Marketplace, or thinks they shouldn’t have received a form. •Consumer received a Form 1095-A and has a correction request, but there is no record of the consumer’s enrollment or a copy of their Form 1095-A online. •Consumer had coverage but didn't get a form, and the form isn’t in their account. **Do not transfer the call to a Tier 2 CSR if the issue has already been escalated in the past 30 days.
500
The Reporting a life change script states that a consumer can change the tax credit allocation any time during the year. How?
Tax credit allocation change Note: Report a life change without making any changes to the application. This will enable you to reallocate the advance payments of the premium tax credit. Update application and adjust advance payments of the premium tax credit.
500
Why would someone have a "0" dollar tax credit?
Eligibility Determination – Marketplace Plans Your tax credit eligibility results show a $0 amount. This is because the second-lowest cost silver plan for your area costs less than what you are required to contribute. The law requires that you contribute a certain amount of your income toward your health care coverage. You do not have to enroll in the silver plan, and other options are available, but selecting a plan with another metal level will not change your tax credit eligibility results. I can help you compare plans and enroll now if you’d like.
500
What information do you provide to the consumer if they want to know how to submit their documents? (mail and upload)
If you are having problems uploading your documents or don’t have the option to upload, you can also mail in paper copies. You cannot fax your documents to the Marketplace. If you mail in documents, remember to: •Keep the original versions of your documents and only send copies. You can send documents that say “do not copy” on them. This usually means that you shouldn’t treat the copy as an original document. We just need a copy to verify your information. •Include the bar code page from the initial eligibility notice the Marketplace mailed to you. •If you do not have a bar code, write your legal name and application ID number on each page that you submit so that we can easily match these documents to your application records. You can find your application ID number on the letter you received about your data matching issue. I can also look up your application ID number for you if you can’t find it. Send your documents to: Health Insurance Marketplace Attn: Coverage Processing 465 Industrial Boulevard London, Kentucky, 40750-0001 There is no need to send your documents through FedEx or UPS, or to use United States Postal Service certified mail or send your documents with a confirmation. Once your documents are reviewed and processed, they will be securely shredded and destroyed. You will get a notice explaining if you need to do anything else. uploading •Include the application ID number that is associated with the data matching issue on each page you submit.
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