Open Enrollment Period
What are the Open Enrollment Period (OEP) dates for most states, and which two states have an extended deadline?
OEP runs from November 1, 2026, through January 15, 2027 for most states. New Jersey and New York have an extended OEP through January 31, 2027.
What does HIPAA stand for?
Health Insurance Portability and Accountability Act
What major change is happening in Georgia for 2027?
UHC will no longer participate on the Georgia Exchange. Georgia will move to UHC Complete plans available Off Exchange only under GACOMP.
What does IFP stand for?
Individual and Family Plan
What services are delegated to Kelsey-Seybold under the value-based care arrangement?
Claims (medical and pharmacy), referrals, and prior authorizations.
What can individuals do during the Open Enrollment Period?
Individuals can shop for, enroll in, change, or disenroll from an Individual and Family health plan.
True - Minimum Necessary
What should you tell a New York or Massachusetts prospect who wants an Off-Exchange IFP plan?
Do not transfer them to Telesales. Direct them to shop.uhcexchange.com and use Knowledge Central resources to answer their questions.
What was the goal of the Affordable Care Act (ACA) signed into law in 2010?
The goal of the ACA was to help more Americans gain access to health insurance coverage
How can you identify if a member is enrolled in a Kelsey-Seybold plan?
"Kelsey-Seybold" will be included in the member's plan name. Do not rely on the member's Houston-area address to determine enrollment.
If a member clicks "Stop Coverage for 2027," how long will their current coverage remain active?
Their current coverage will remain active through December 31, 2026.
What must be Authenticated when an Authorized Rep is the caller?
What network does UHC Complete use?
The Choice Network.
What are Marketplace Plans called internally by the company?
Marketplace Plans are called Individual and Family Plans (IFP) internally
Name three services that are still handled by UnitedHealthcare and not delegated to Kelsey-Seybold.
What is the purpose of the Annual Plan Changes Letter, and what are some other names it may be called?
The Annual Plan Changes Letter informs members about changes to their health plan for the upcoming year. It may also be called an Annual Notice of Change (ANOC), Renewal Letter, or UM Letter.
How can we HIPAA Authenticate a member when they call In?
First and Last Name
Date of Birth
One of the following: Member ID or DOB
Password if present in the System
Which states require referrals to see a specialist (Gated states)?
Arizona, Florida, Massachusetts, Maryland, New York, and Texas.
Who is eligible for tax credits under an Individual and Family Plan (IFP)?
Members enrolled in an IFP who have an income between 100% and 400% of the federal poverty level are eligible for tax credits that help reduce their monthly premium.
A member calls asking about the status of a prior authorization. Which organization processes most prior authorizations for Kelsey-Seybold plans?
A. UnitedHealthcare
B. Marketplace
C. Kelsey-Seybold Clinics
D. Rally
C. Kelsey-Seybold Clinics
Why is it recommended that members review and update their Marketplace application before the 2027 plan year?
To:
TRUE OR FALSE
Trustees can receive Premium Payment Invoices from other's member's account as long as they are able to HIPPA Authenticate the Account.
TRUE
Under what circumstance would a Kelsey-Seybold member in Texas need a referral to see a specialist?
Only when seeing a specialist outside a Kelsey-Seybold Clinic.
How are the tax credits for eligible Individual and Family Plan (IFP) members applied?
The government pays the tax credits directly to the insurance company, which helps reduce the member's monthly premium.
A member enrolled in a Kelsey-Seybold plan calls about a behavioral health benefit. Who handles this service?
A. Kelsey-Seybold Clinics
B. UnitedHealthcare
C. The provider's office
D. Marketplace
B. UnitedHealthcare